Liver Biopsy Results

[dartmouth03]

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.

[Kevin Pho, MD]

This seems to be a repeat of the question below.

Thanks,
Kevin, M.D.

[dartmouth03]

forgot to add the diagnosis by the pathologist...

Diagnosis: Liver, Needle Core Biopsy: Focal Mild Portal and Periportal Hepatitis.