Re: Biopsy terminology

Posted By Dianne on March 20, 1999 at 19:38:40:

In Reply to: Re: Biopsy terminology posted by HFHSM.D.-D.M. on March 20, 1999 at 17:01:32:






I will be having another liver biopsy in May and in looking at the results of my last one, I am confused by some of ther terminology.  Since I always like to compare my own labs, I was hoping for some help.  The report notes that there is moderate inflammamatory infilitrate around the portal tracts with areas of piecemeal necfrosis and extension of the inflammatory cells into the surrounding liver tissue.  It then define the inflammatory infiltrate as mostly lymphoid cells and some scattered plasma cells and an occasional polymorphonuclear leukocyte.  I am totally clueless as the the significance or difference of these cell types.  It also says the areas around the portal tracts show increase fibrosis.  Now fibrosis is scarring, but not cirrhosis?  Another part I don't understand is that some of the hepatocytes (another type of cell?) show suggestion of ballooning and reactive change?    Then there is a comment that trichrome and reticulum stains confirm the presence of increased fibrosis in theses ares forming some areas of fibrous sept whithout definite cirrhotic nodules identified.  What is fibrous septa?  If you could help me with these terms, I would really appreciate it.  Then perhaps when I read the next one, I can have a clearer understanding of what changes might be more significant than others.  And of course, as you always note, I will ask my doctor.  I just like to think about things myself as well.  Thanks for any help you can provide.  Dianne




Dear Dianne:
I can certainly appreciate how confusing a biopsy report can be.  I spent many years as a hepatologist (liver specialist) before I felt comfortable knowing what a biopsy means for different liver diseases.  Im not sure its really your job to understand every aspect of a biopsy.  However, I would like to make a few general comments to help you. I do want to say that it is critical to go over the results of a biopsy with a physician who knows you and your condition well.  She/he can put the biopsy results in perspective.   The physician will know your diagnosis and what your prior biopsies have shown.  They can let you know if the biopsy is better or worse.  In addition, a given biopsy can mean different things with different diseases. A given biopsy may show advanced disease for one diagnosis, but might meant something else for another.
Lymphocytes, plasma cells and polymorphonuclear leukocyte are all different kinds of inflammatory cells.  Some are more common with different diseases and suggest different diagnoses.  Lymphoid cells are seen with hepatitis C but can be seen with other conditions as well.  Inflammatory cells typically begin in the portal tracts.  If the infiltrate extends outside the portal tract and causes piecemeal necrosis, this means the inflammatory process is more active than if it just stayed in the portal tract.
Probably one of the most important things is the amount of fibrosis or scarring.  Fibrosis is scar tissue that forms as a result of persistent inflammation.  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.  Trichrome and reticulin stains are dyes used to stain liver biopsies that light up fibrosis or scar tissue.  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.  Cirrhosis is the most advanced form or fibrosis and indicates there is substantial damage to the liver.  However, a liver can still potentially function well with cirrhosis.  However, if the underlying cause of the liver disease is not identified and treated, a cirrhotic liver will usually ultimately fail.  
I hope this information is helpful to you. Good luck with your repeat biopsy.  I would invite you to contact us again with additional concerns or questions.   At Henry Ford, we have an active group of liver specialists.   You can contact us directly at [phone].
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.  





Thank you for the info.  When I had this biopsy done it was after I had started responding to prednisone.  The diagnosis was AIH of unknown etiology.  My GI didn't think the biopsy results were alarming and I still continue to respond to immuran.  From what I understand, cirrhosis can go undetected for quite sometime?  Why is it that liver function tests don't always reflect what is going on?  I'm sorry to have so many questions.  And I have learned to ask more questions about things.  When I had this done, it was after too many tests for too many things and I just took my pills and went home.  Now when the next one is done, I have a better idea of what to ask.  Thanks  Dianne