biopsy results - 6-10-11

[OC]

Was a non responder in 2003 Peg/Intron w/ribavirin, now doc wants me to try Telaprevir (triple therapy).

Here are my liver biopsy results. My hepatologist thinks I may have more fibrosis than the test shows, so he now wants to do a EGD. I thought the biopsy was the gold standard for diagnosing the liver. Let me know what you think.

Final Diagnosis After Microscopy:

Liver (Core Biopsy):

1) Mild Portal and interface necroinflammatory activity, predominantly lymphocytic with nodular lymphoid aggregates, and rare plasma cells and eosinophils
2) Minimal lobular necroinflammatory activity
3) Fibrous portal expansion with occasional periportal fibrosis, suggestion of rare bridging and early nodular regeneration
4) Less than 1% steatosis
5) Negative for malignancy or Mallory-denk bodies

COMMENT:

Approximately 15 portal tracts occupy this intact specimen. Trichrome, reticulin, and periodic acid-schiff stained sections with and without diastase support the morphologic impression. An iron-stained section appears negative for hemosiderosis. The cumulative findings are consistent with viral hepatitis C, grade 2-3, stage 2-3, according to criteria in Batts KP, Ludwig J. Am J Surg Pathol 1995; 19:1409-1417. Some portal tracts are nearly completely spared of necroinflammatory activity and have minimal fibrosis.


GROSS DESCRIPTION:

The specimen is received in formalin labeled with the patient’s identification and “1.” It consists of three tan-brown core biopsies ranging in size from 1 to 1.9 cm in length and all with an average diameter of 0.1 cm. The specimen is wrapped in filter paper and entirely submitted in cassette 1.

HISTOCHEMICAL STAINS:
Trichrome, reticulin, PAS, PAS plus diastase x1 – supportive
Iron x1 - negative

[OC]

Well, he wants to do another ultrasound...I may pass on the EGD for right now.

[OC]

The doctor wants to check for more cirrhosis.

[HectorSF]

So you stage 2 showing some indications of stage 3. You should try treatment again before your fibrosis is too advanced as extensive fibrosis does lower the chanced of cure. Stage 3 is indicated by bridging fibrosis (vs Stage 2 periportal fibrosis), and numerous septa are observed.

Good luck with the new DAA treatment.

Liver biopsy is the gold standard for assessing and staging of liver damage.
An EGD (Esophagogastroduodenoscopy) is a procedure used by your doctor to view your esophagus, stomach, and small intestine. In the context of liver disease this is usually only performed on patients with portal hypertension (a complication of scaring of the liver) to look for enlarged veins that may burst due to higher then normal pressure. Not sure they this would be performed on you. Ask your doctor.

Hector