liver biopsy results

[Denis3nadin3]

Diagnosis LIVER, RIGHT LOBE, NEEDLE BIOPSY - PORTAL FIBROSIS AND MINIMAL CHRONIC INFLAMMATION. (See microscopic description) /jrs

Elizabeth Ruckdeschel, M.D.; Resident Pathologist Electronically Signed By Sanjay Mukhopadhyay, M.D., Attending Pathologist 8/3/2012 17:49:28

The attending pathologist named above attests that he/she has personally reviewed the relevant preparation(s) for the specimen(s) and rendered the final diagnosis.

Gross Description The specimen is received in formalin labeled with the patient's name "Denise Moore" and "liver biopsy". It consists of two soft tan-white tissue cores measuring 1.1 and 1.4 cm in length and averaging 0.1 cm in diameter. Totally submitted in one cassette. ER/sj

Microscopic Description This biopsy shows fragments of liver parenchyma with small amounts of dense fibrosis within the portal tracts. There is a mild lymphocytic infiltrate within the portal tracts but plasma cells are rare. There is no significant decrease in bile ductules. No granulomas are identified. There is minimal interface activity and minimal lobular necroinflammatory activity. The findings, although quite non-specific, argue against autoimmune hepatitis and raise the possibility of of primary sclerosing cholangitis, although the classic onion-skinning seen in that entity is not identified. The presence of portal fibrosis is confirmed by a trichrome stain. A reticulin stain shows no evidence of nodule formation. A PAS stain with diastase pretreatment shows no evidence of alpha-1 antitrypsin globules. An iron stain shows no increase in iron stores. can U plz explain to me what it means? thanks

T

[Denis3nadin3]

I just sent a online request to get referred to a liver doctor so the Doctors office will probably get back to me on Monday.

[Denis3nadin3]

I had a old gast doctor n he told me he couldnt find anything wrong so i asked for second opion so been going to new doctor since April so this new gast is the second one i seen also i had chronic dihrea since oct aswel i lost 51 pounds. So i will call thanks

[HectorSF]

"So when i go on the 30th should i asked to be seen by a liver doctor?"
I wouldn't even wait 3 weeks personally. He's had 11 months to figure it out!
And he tells you "nothing to worry about"???

You need a knowledgeable and experienced doctor (a hepatologist-a specialist in liver disease) who actually cares about your health. You need a referral to a liver treatment program NOW. Not in 3 weeks. If you do have Primary Sclerosing Cholangitis(PSC) he can't treat you anyway, so why see him? No gastro can treat PSC.
Do you have a primary care doctor? Maybe she/he can give you a referral?
It depends on which center you are trying to get into. There are different requirements. You may be able to set up an appointment yourself too. See Mt. Sinai info below.

They will be able to determine the cause of your liver disease and what treatment you may need. Your doctor hasn't even diagnosed you in almost a year?!  He can't figure out what is causing abdomen pain?
"nothing to worry about"
NO ONE should be in pain from liver disease or from any disease and not have a diagnosis since Oct 2011!!! Pain is a sign that something is very WRONG!!! Pain in the abdomen can be very serious.
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For example...here is the Mt. Sinai Liver Disease Center
"Among the specific liver diseases we treat and manage at the Recanati/Miller Transplantation Institute at Mount Sinai are early and end-stage:

* Cholestatic disease (including primary biliary cirrhosis and primary sclerosing cholangitis)

If you would like more information or to schedule an appointment, please call: 212-241-8035.

http://www.mountsinai.org/patient-care/service-areas/organ-transplants/programs-and-services/adult-liver-diseases-and-transplantation
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Let us know what happens.
Hector

[Denis3nadin3]

So when i go on the 30th should i asked to be seen by a liver doctor? Now this been going in since oct 2011 cause i am tired of this and the pain!

[Denis3nadin3]

Now i talked to gast doctor today and he said nothing to worry about but i see him on the 30th now do i have something to worry about? And my side where the liver is at hurts real bad when i lay on it bend,laugh and cough.. will it get worse if it doesnt get taken care of?

[HectorSF]

What I know about PSC I know from a friend who had a transplant almost 9 years ago for PSC. As he says, he is "cruising right along" ever since his transplant. I do know he says that patients with PSC, their MELD scores never go very high. His MELD was 19 when he got transplanted. BUT he says he was very ill at that time so MELD doesn't correspond to how ill patients with PSC feel.

To learn more about PSC you may want to read
http://www.medicinenet.com/primary_sclerosing_cholangitis/article.htm

"How common is primary sclerosing cholangitis?

Primary sclerosing cholangitis is a rare disease with an estimated prevalence in the United States of 6 per 100,000 people. It is more common in men then in women; approximately 70% of primary sclerosing cholangitis patients are men. The mean age at diagnosis of primary sclerosing cholangitis is around 40 years of age."

The pathologist seemed to think you might had PSC even though you did not have some of the main features commonly seen during biopsy. "the classic onion-skinning seen in that entity is not identified".
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"The presence of portal fibrosis is confirmed by a trichrome stain."

Utility of Trichrome Stain: In summary, a trichrome stain is used to assess fibrosis, which gives important information about stage and progression of disease. The stain is used to make treatment decisions; utilized to assess the effect of therapy, medications in clinical trials and is needed for all liver
biopsy specimens.
(Meaning you have stage 1 portal fibrosis).
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"A reticulin stain shows no evidence of nodule formation."

In summary, a reticulin stain is useful for demonstrating liver architecture;
hepatocyte necrosis and hepatocyte regeneration.
(Meaning no cirrhosis.)
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"A PAS stain with diastase pretreatment shows no evidence of alpha-1 antitrypsin globules."

Utility of PAS Stain: In summary, the PAS stain is useful for demonstrating alpha-1 antitrypsin globules in hepatocytes; storage cells in Gaucher’s and Niemann-Pick disease, and abnormalities of the bile duct basement membrane in biliary diseases.
(Meaning you don't have alpha-1 antitrypsin globules).
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"An iron stain shows no increase in iron stores. "

In summary, the iron stain is useful for demonstrating excess iron
deposition in the liver providing information about the degree of
iron deposition and clue to the underlying causes leading to the  
iron deposition.
(You don't have an iron storage liver disease).

So in summary your liver disease is "quite non-specific" but "raise the possibility of of primary sclerosing cholangitis". It doesn't seem like they have a definitive diagnosis and further testing needs to be done.
PSC is a rare disease. IF that is what you have. Most gastros may see only one case in their careers. So this is a disease that really needs the care of experts with lots of experience with liver disease. This can be found at a transplant center.
A transplant center has the resources and expertise to diagnose the cause of your liver disease when a gastro does not. At transplant centers they have teams of doctor that collaborate together sharing their specialty with other members of the team. For example. I have liver cancer. My hepatologist as great as she is is not an expert in cancer. So at my transplant center they have a "tumor board".  My hepatologist meets with oncologists and Interventional Radiologists to diagnose my cancer and to decide what treatment is best for my cancer. My hepatologist still directs all my care but she has input from other experts in fields that are not her specialty. That is one great advantage that being seen at a transplant center provides that no gastro no matter how good can provide.

Good luck to you!
Hector

[mikesimon]

There are no drug/medications that will cure for Primary Sclerosing Cholangitis(PSC). If that is, in fact, your diagnosis then you should definitely be managed by a liver transplant center. If your disease progresses to a point where your liver is not functioning adequately then a liver transplant would be your only option. I myself had a liver transplant for Hepatitis C in June 2000 and around the same time at my transplant center a woman also received a transplant and her underlying disease was PSC. We became friends and she and I are still alive and well and it's been 12 years since our surgeries. I remember very well how scary the idea of a liver transplant is but it really is a viable option if the disease progresses to that point. If you do have PSC or any serious liver disease then it's wise to be associated with a transplant center sooner rather than later. You really want a hepatologist managing your care and while, early in the disease, a gastroenterologist may be capable I'd be more comfortable if you were being seen by a hepatologist experienced in transplant medicine. As stated in Hector's post ulcerative colitis(UC) is often seen in patients with PSC and my friend also had UC.

I wish you the best of luck.

Be well,
Mike

[Denis3nadin3]

So u saying i would need a liver transplant? No i am seeing a gast doctor i finnaly got a answer been sick since oct 2011

[HectorSF]

I'll give you an overview instead of a line by line translation.

You have very little inflammation and liver fibrosis. "Portal fibrosis" is equal to stage 1 liver disease. Portal fibrosis is when excess connective tissue forms within the portal tracts, which consequently become densely staining and expanded, but there is no extension into the adjacent parenchyma (Liver cells).

"The findings, although quite non-specific, argue against autoimmune hepatitis and raise the possibility of of primary sclerosing cholangitis, although the classic onion-skinning seen in that entity is not identified."
So it does appear the you do NOT have autoimmune hepatitis.
The pathologist appears to be trying to determine the cause of your liver disease. It could be "primary sclerosing cholangitis" a biliary disease. "although the classic onion-skinning seen in that entity is not identified."
It appears that further testing must be done to determine the cause of your liver/biliary disease.

Primary sclerosing cholangitis (PSC) is a chronic liver disease caused by progressive inflammation and scarring of the bile ducts of the liver. The inflammation impedes the flow of bile to the gut, which can ultimately lead to liver cirrhosis, liver failure and liver cancer. The underlying cause of the inflammation is believed to be autoimmunity; and more than 80% of those with PSC have ulcerative colitis.

"How is the diagnosis of primary sclerosing cholangitis made?

The diagnosis of primary sclerosing cholangitis is suspected from the symptoms (such as fatigue, itching, and jaundice) and abnormal laboratory tests (such as abnormally elevated blood levels of alkaline phosphatase and other liver enzymes); and is confirmed by demonstration of abnormally thickened bile ducts using special radiological tests. It is also important to exclude other diseases that can mimic primary sclerosing cholangitis. These diseases include primary biliary cirrhosis (PBC), gallstones in the bile ducts, bile duct cancers and strictures.

Blood tests

The blood level of alkaline phosphates is usually elevated in primary sclerosing cholangitis. The blood levels of other liver enzymes (AST and ALT) may also be mildly elevated. Except in those patients with the autoimmune form of primary sclerosing cholangitis, the bilirubin usually is normal but gradually increases as the disease progress. Antimitochondrial antibody (AMA), which is elevated in patients with PBC, is usually normal in patients with primary sclerosing cholangitis.

Radiologic tests

Endoscopic retrograde cholangio-pancreatography (ERCP) and magnetic resonance cholangio-pancreatography (MRCP) are commonly performed to visualize the intrahepatic and extrahepatic ducts. These ducts are typically normal in appearance in patients with PBC, but in primary sclerosing cholangitis patients, these ducts have a beaded appearance (multiple narrowings along the ducts with areas of widening in between).

MRCP is noninvasive and safe. ERCP is more invasive and carries a 5%-6% chance of causing an attack of acute pancreatitis. However, ERCP has the advantage of obtaining cell samples (a process called brush cytology) from the bile ducts. Brush cytology is not very accurate, but sometimes can help to diagnose cholangiocarcinoma. Also, during ERCP, doctor can also insert balloons and stents across major areas of narrowing (dominant strictures) to relieve obstruction and treat infection.

Colonoscopy

Patients with primary sclerosing cholangitis have a high likelihood of also having ulcerative colitis, and, as mentioned previously, patients with primary sclerosing cholangitis and ulcerative colitis have higher risks of developing colon cancer. Thus, colonoscopy is important to both diagnose ulcerative colitis and for early detection of cancer or precancerous conditions."

I hope you are seeing a hepatologist at a liver transplant center who has the resources to determine the cause of your illness.

Good luck!
Hector