Liver Biopsy Results

I am GT 3a.  I just got my BX results from 12/07/11 and need help interpreting them.  I can possibly get into a PSI-7977 in combination with BMS-790052 with or without Ribavirin.  The screening starts sometime in February.  VL in September was 466,000.

FINAL DIAGNOSIS
-Chronic hepatitis with portal inflammation grade 3/4 including interface inflammation
-Lobular inflammation, grade 2/4 (apoptosis).
-Fibrosis portal with incomplete bridging and with periportal sinusoidal fibrosis stage 2/4.
-Thirty percent fatty change

SPECIAL STAINS:
STAIN                                    RESULT
PAS                                        Shows uniform strong cytoplasmic reactivitiy in hepatocytes and highlights some 30% fatty change and expansion and incomplete bridging of triads.

D-PAS                                   All PAS reactivity disappears.
TRICHROME                       Highlights portal expansion by fibrosis, incomplete bridging and periportal filigree sinusoidal fibrosis.  Pericentral sinusoidal fibrosis is not obvious.
RETICULIN                           There is fiber collapse in several periportal areas.
PERL’S IRON                       Negative


Any help offered will be most appreciated!

[jules2551]

Hi Mdudley...if you go to this website it might help you determine your results.  

www.hepititas-central.com

Otherwise I will let the pros chime in here.  Just bumping you up!

Have a great day

Jules

[HectorSF]

The most important thing you should understand is that you liver disease has progressed to stage 3. "-Chronic hepatitis with portal inflammation grade 3/4 including interface inflammation".This means your liver disease has progress a lot but you still having time to undergo treatment to cure yourself of hepatitis C. Your liver disease has advanced so much that is starting to impact your chances of SVR. Luckily the impact is not too great now so you have very good odds of curing the virus with the treatment.

You also appear to have some type of fatty liver disease, which you should ask your doctor about. "-Thirty percent fatty change"

The other details listed in the biopsy report is rather technical and for the doctor to understand with more detail how much your liver is damaged....Without a good understanding of the anatomy of the liver and it functioning the rest is for your doctor not you as the patient.

The portal inflammation spills over to the neighbouring lobular part of the liver (this means the liver cells are damaged throughout the basic structure of the liver=lobule) (this is called "interface hepatitis") resulting in damage and destruction of periportal hepatocytes. (injuy and death of liver cells around the portal vein). This is describing the the destruction caused by hepatitis C to the liver.

Information about "fatty liver" from Medscape...
"Fatty liver disease can range from fatty liver alone (steatosis) to fatty liver associated with inflammation (steatohepatitis). This condition can occur with the use of alcohol (alcohol-related fatty liver) or in the absence of alcohol (nonalcoholic fatty liver disease [NAFLD]).

Fatty liver disease is now the most common cause for elevated liver function tests in the United States. This is mainly due to the ongoing obesity epidemic in the United States.

Fatty liver can be associated with the use of alcohol. This may occur with as little as 10 oz of alcohol ingested per week. Identical lesions also can be caused by other diseases or toxins.

"If steatohepatitis is present but a history of alcohol use is not, the condition is termed nonalcoholic steatohepatitis (NASH). Fatty change in the liver results from excessive accumulation of lipids within hepatocytes. Simple fatty liver is believed to be benign, but NASH can progress to cirrhosis and can be associated with hepatocellular carcinoma. The main risk factors for simple fatty liver (NAFLD) and NASH are obesity, diabetes, high triglyceride levels, or a high fat diet."

Most importantly, you need to talk to the gastro or hepatologist that ordered your biopsy and have them explain how these results impact your health and what it means in terms of treatment for hepatitis C.

You should avoid all toxins to the liver such as alcohol, certain drugs including some over the counter medicines, certain supplements as they will speed up the progression of you liver disease. Consult with your doctor before taking any med. The more diseased your liver is the less chance of the hep C treatment working. Luckily you caught your hepatitis C and liver damage just in time.

Good luck!
Hector

[willbb]

The staining methods are  technical terms on how they arrive at their diagnosis on the degree of inflammation (grade) and fibrosis(stage) .

If I am  reading this report correctly ,I may have a slightly different  interpretation than my friend Hector about the degree of fibrosis

".Fibrosis portal with incomplete bridging and with periportal sinusoidal fibrosis stage 2/4. "

Although it looks like you have grade 3 inflammation ,you would have only stage 2 fibrosis(moderate) according to the Metavir scale.

Best of luck..
Will

[willbb]

The fibrosis is graded on a 5-point scale from 0 to 4. The activity, which is the amount of inflammation (specifically, the intensity of necro-inflammatory lesions), is graded on a 4-point scale from A0 to A3.
Fibrosis score:
F0 = no fibrosis
F1 = portal fibrosis without septa
F2 = portal fibrosis with few septa
F3 = numerous septa without cirrhosis
F4 = cirrhosis

Activity score:
A0 = no activity
A1 = mild activity
A2 = moderate activity
A3 = severe activity

Activity "  is another term for Grading (inflamation (inflammation))

[curiouslady1]

Margaret, I also responded to your PM.  This is the way I see it.  If I understand correctly:

In view of this trial, your biopsy results are not good the way I read them.  I may be wrong but it looks like you are close to being cirrhotic.  I know that most sites are no longer recruiting for the first version of the trial (the one I am in) and the extension is supposedly intended for GT1 only.  But, to make sure, call the site and ascertain that, in fact, they are still recruiting for your genotype.  

If I were in your shoes and I was accepted into the 7977/BMS trials, I would make sure they I had a very good rescue treatment.  The rescue treatment for the first phase of PSI/BMS trial is SOC added to 7977 and possibly BMS for 6 months longer than the time of the breakthrough (48 weeks for GT1).  This would give you the opportunity to have an excellent triple (or quad) which has had very good results in previous studies.  

There are phase III trials coming up.  Your objective would be to get SOC ADDED to 7977 if you should have a breakthrough.   Otherwise, and also if you relapse, (according to the study docs and others involved in these studies) you CAN turn around and treat with the current triple as the resistance issues do not apply in this case.  In my view, this last would not be the most desirable as then you run into the rash issue.  Please see a recent post by norwegiangal on her experience with 7977+SOC.  It seems a bit more benign.  This appears to be a really good option for someone in your position.  Hope this helps.  Best of luck.

[curiouslady1]

If will is correct and you have more leeway, you still may want to call the sites you have in mind for the trials to see if you are eligible.

I am also in favor of discussing this thoroughly with your doctor to see just how progressed your disease, overall, actually is.  As always, lifestyle choices are important.  I read that many people who actually are SVR go on to develop HCC because they fail to make the lifestyle changes they need to.  

[HectorSF]

DOH...You are right Will.
....where my bottle of Lactulose?.....ugh

Hector

[willbb]

We certaimly all make some boo boo"s ,however given everything I have read of your posts....  your info. and advice has been second to none and I have always appreciated it greatly...
Best..
Will

[Aquisi]

Lol, you guys are the best, I'll be starting lead-in Friday, counting down the days. Thanks

Charlie

[mdudley]

Thank you all for your expedient replies!  I have a call into the Research Recruiter to hopefully get the date for screening.  I have been taking various supplements (milk thistle, NAC, ALA, resveratol, Vitamin C, curcumin, etc.,) and I do believe they have helped because my AST went down from 162 to 59, and my ALT went from 234 to 90 in a two month period.  In 08/11 my AST was 241 and my ALT was 381...so I have had a significant drop and I am reluctant to stop those until absolutely necessary.  My doctor did say I was Grade 2 of 4 on Metavir staging system (but after reading the pathology report I became concerned).  When I asked him if he thought I could wait until the trials start, his response was that I should be aware that the trial could be pulled before it even started (which is supposedly sometimes in March) but he gave me the impression that I had time to wait at least that long.  Because of my past four- year ordeal with an awful skin problem on my hands and past severe depression, I am very leery about the SX of treatment with INF and/or RIBA thus my effort to wait for trials.  I will check out all the info each of you provided and please know that I am extremely grateful for your input.

[willbb]

Waiting until March is insignificant and would make no difference to you adversely .
Good luck on whatever you decide regarding tx..
Will

[curiouslady1]

Good.  I am glad it isn't so severe.  Hopefully I am wrong about the recruitment for the BMS/7977 study and extension.  If so, please post to let us know what new arms are available in those trials since we are being told that the initial study is closed and the extension is for GT1 naives and triple-failures.  Thanks.

[mdudley]

Thank you all!  I will certainly post ANY info I get regarding trials...hopefully, the research recruiter will call me back tomorrow.  Hope you all have a wonderful evening!