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Gastroenterology (Expert Forum)
Liver Biopsy Results
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Liver Biopsy Results
by dartmouth03, Jul 14, 2004 12:00AM
Hi Dr. Kevin - i've posted 2 questions for you in the past 2 months or so about my situation, if you recall. I finally went ahead w/ the liver biopsy last week. As noted previously, i have had fluctuating ALT since September w/ my highest ALT being 132 in April, and going to as low as 41. The ALT is usually staying around the 60-100 range. All other enzymes normal. Gammaglobulins and rest of serum electrophoresis was normal. All labs normal except for ASMA was 1:40 in December and 1:80 in June. Went ahead w/ biopsy last week b/c doctors could not figure out cause for fluctuating ALT. Here is the Liver Biopsy report. I was wondering if you could comment on it please.
Received in formalin are 3 soft tissue cores, in aggregate 5.8 x 0.1 x 0.1cm. Sections:A=in total. H&E - two, trichrome - two.
MICROSCOPIC: Multiple pieces of hepatic parenchyma are examined at eight levels. In most areas, the liver appears completely normal. However, there are rare foci of a portal chronic inflammatory infiltrate which includes lymphocytes, histiocytes, and occasional eosinophils w/focal periportal extension of hepatocytes. A rare focus of lobular inflammation is also present. No significant fibrosis is identified on trichrome stain.
COMMENTS: The biopsy shows a rare focus of portal and in some cases periportal inflammation w/out significant fibrosis. The histologic findings are mild and nonspecific.
1)What are your general thoughts on this biopsy?
2)Should i continue to search for a reason for the mild inflammation, even though i've had virtually every test so far?
3)Since the underlying cause of this inflammation is a mystery (and i havent taken restoril or toprol since december), will this mysterious inflammation continue from an unknown cause and is it a silent killer to my liver?
4)why do they say "no significant" fibrosis...does this mean i have some fibrosis or do they just say this on all biopsies??
5)also, i've heard people are diagnosed w/ AIH even though they have no markers on biopsy and bloodtest...w/ a slightly positive ASMA, high ALT, and slight inflammation on biopsy couldnt this be AIH? i'm tired a lot as well.
6) does this mean i have non-A, non-B, non-C hepatitis? is that a big danger since there is no cure or treatment?
7)should i get a second opinion?
8)what happened to the service you guys use to have where you could ask a question and get answers from 3 different specialists?
thank you for all your help. take care.
Received in formalin are 3 soft tissue cores, in aggregate 5.8 x 0.1 x 0.1cm. Sections:A=in total. H&E - two, trichrome - two.
MICROSCOPIC: Multiple pieces of hepatic parenchyma are examined at eight levels. In most areas, the liver appears completely normal. However, there are rare foci of a portal chronic inflammatory infiltrate which includes lymphocytes, histiocytes, and occasional eosinophils w/focal periportal extension of hepatocytes. A rare focus of lobular inflammation is also present. No significant fibrosis is identified on trichrome stain.
COMMENTS: The biopsy shows a rare focus of portal and in some cases periportal inflammation w/out significant fibrosis. The histologic findings are mild and nonspecific.
1)What are your general thoughts on this biopsy?
2)Should i continue to search for a reason for the mild inflammation, even though i've had virtually every test so far?
3)Since the underlying cause of this inflammation is a mystery (and i havent taken restoril or toprol since december), will this mysterious inflammation continue from an unknown cause and is it a silent killer to my liver?
4)why do they say "no significant" fibrosis...does this mean i have some fibrosis or do they just say this on all biopsies??
5)also, i've heard people are diagnosed w/ AIH even though they have no markers on biopsy and bloodtest...w/ a slightly positive ASMA, high ALT, and slight inflammation on biopsy couldnt this be AIH? i'm tired a lot as well.
6) does this mean i have non-A, non-B, non-C hepatitis? is that a big danger since there is no cure or treatment?
7)should i get a second opinion?
8)what happened to the service you guys use to have where you could ask a question and get answers from 3 different specialists?
thank you for all your help. take care.
Doctor's Answer
by Kevin Pho, MD, Jul 16, 2004 12:00AM
, Jul 16, 2004 12:00AM
To answer your questions:
1) The liver biopsy is non-specific, meaning there is no clear diagnosis that was found. It is good in a way, that if there was something serious, it would have been found - however, no clear diagnosis can be made from the results.
2) Many things can cause mild inflammation. With a liver biopsy not showing a serious disease, a reasonable approach would be to serially monitor the LFTs to ensure the liver enzymes don't continue to rise.
3) Tough to say. Any biopsy can miss disease since it only takes a small sample of the liver. The best approach would be to serially monitor the enzymes to ensure there isn't further harm.
4) It means that you may or may not have fibrosis. If fibrosis is present, it is non-significant. This implies that it should not have an adverse effect on your liver function.
5) Anything's possible - so the scenario you describe may be true. Another opinion with a liver specialist should be considered if this is suspected.
6) There are other forms of hepatitis - mainly hepatitis D and E. If this is suspected, it can be tested by your personal physician.
7) If there continues to be confusion with the diagnosis, a second opinion is always helpful.
8) That question needs to be addressed to the administration at ***@****.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
1) The liver biopsy is non-specific, meaning there is no clear diagnosis that was found. It is good in a way, that if there was something serious, it would have been found - however, no clear diagnosis can be made from the results.
2) Many things can cause mild inflammation. With a liver biopsy not showing a serious disease, a reasonable approach would be to serially monitor the LFTs to ensure the liver enzymes don't continue to rise.
3) Tough to say. Any biopsy can miss disease since it only takes a small sample of the liver. The best approach would be to serially monitor the enzymes to ensure there isn't further harm.
4) It means that you may or may not have fibrosis. If fibrosis is present, it is non-significant. This implies that it should not have an adverse effect on your liver function.
5) Anything's possible - so the scenario you describe may be true. Another opinion with a liver specialist should be considered if this is suspected.
6) There are other forms of hepatitis - mainly hepatitis D and E. If this is suspected, it can be tested by your personal physician.
7) If there continues to be confusion with the diagnosis, a second opinion is always helpful.
8) That question needs to be addressed to the administration at ***@****.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
