biopsy terms
Subject: Re: Need some explaination of biopsy terms Topic Area: Hepatitis CPosted by Janet on July 23, 1999 at 10:33:24Could you please explain a couple of terms on my last liver biopsy? I'll include most of it in case the context is needed. The term I need explained is 'intra-acinar degeneration' . Sections of the needle biopsy of the liver reveals diffuse chronic hepatitis which includes extensive interface hepatitis (piecemeal necrosis). In addition, there is portal inflammation and intra-acinar degeneration of parenchymal cells. There is periportal and bridging fibrosis. Thank you
Posted by HFHSM.D.-D.M. on July 25, 1999 at 17:10:12
I appreciate your questions. Interpretations of liver biopsys can be complicated even for me but I will try to address your questions. Typically inflammation in the liver from hepatitis C begins in the portal tracts which are parts of the liver where the plumbing runs. If the inflammatory cells start to spread out of the portal tracts into the liver cells themselves we call this piecemeal necrosis are interface hepatitis. Intra-acinar degeneration typically means that some of the liver cells (hepatocytes) away from the portal tracts are visibly damaged and in the process of dying. Neither of these findings imply the hepatitis C infection is severe in and of themselves. What we look for the most is significant or advancing fibrosis. You both mention bridging fibrosis and I will try to make some comments about this. Fibrosis is scar tissue that forms as a result of persistent inflammation in the liver. If you cut your skin, you form scar tissue which is good. However, if you inflame the liver, you can develop scar tissue or fibrosis which can be bad. If the fibrosis advances, it can start to destroy the liver. Typically fibrosis starts around the portal tract and the mildest form of fibrosis is periportal. As the fibrosis extends, it typically extends kind of like spokes from the center of a wheel. The spokes are called fibrous septae. When the fibrous spokes from one wheel meet with the fibrous spokes form another wheel, they form a bridge and we call that bridging fibrosis. This is often called stage 3 by the Knodell classification of grading liver biopsies. If the fibrosis advances beyond this, we call it cirrhosis or stage 4. Cirrhosis is the most advanced form of fibrosis and indicates there is substantial damage to the liver. However, a liver can still potentially function well with cirrhosis for many years. Patients with hepatitis C can especially do well for many years with cirrhosis. In fact, many of these patients are appropriate candidates for treatment. Bobby asks if she can wait until the pegylated interferons are available. This is a fair question but a complicated one. Pegylated interferon appears promising but it is still in clinical trials. It can be very difficult to predict when experimental drugs will be available. I anticipate that pegylated interferon will be available in a year but I cant assume this. Plus when it is first available, I am not sure it will be available with or without ribavirin. Finally, decisions about whether a patient can wait or not depend upon a thorough assessment of the patient including the opportunity to evaluate a patient in person. I would suggest that you sit down with your physician and address this issue. If you need the name of someone in your area with a lot of experience with hepatitis C or who does clinical trials with drugs such as pegylated interferon, let me know where you live and I can try to help. Good luck to both of you. I hope this information is helpful to you. I would invite you to post any additional concerns or questions to us at MedHelp. The direct number to our Liver Clinic at Henry Ford is (313) 916-8865. At Henry Ford, we have an active group of liver specialists with an interest in the research and treatment of hepatitis C. This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
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