BX. translation

Question

MY biopsy doesn't say any thing about stage or grade, etc. The G.I. i had then assumed I was untreatable. It says 














9in short

1.Cirrhosis w/ mild inflammatory activity.
2.




 
1. Cirrhosis w/ mild inflamitory activity.  2. Histologic changes compatible w/ chronic hepatitis.    Codes   ICD-9 88307, 88313x4
The usual lobular archtecture is effected.Central veins are difficcult to identify and are sometimes distorted They are arranged in thickened cords and shapes and many have have multiple nuclei.Bile ducts are relatively spared but some are lined by reactive epithehelium No granulomatous inflamation, bile inflamation stasis, excessive iron, or dense plasma cell infiltrates are detected?????????





                           TYVM    Joni















0

cindyazure · Answer

Thank you for the info about liver damage reversal.  That was just what I wanted to hear.  Just another thing to try and keep positive about.

jonihs · Answer

I guess what i really want to know is i become SVR, stict to my liver friendly diet and jus live  a good healyhy life -stlye,even if the cirrhosis doen't imprve, is ther any wat to make an educated guess about how long I have?   Joni

Revenire · Answer

Yep, I realized that but thank you for pointing it out. Peginterferon is peginterferon but not all peginterferons are the same now are they? Pegasys has the same antifibrotic effect that PEG-Intron does though.

I was talking to my doctor today and he was telling me of several patients who WERE cirrhotic that have reversed the cirrhosis with maintenance peginterferon.

And, for those who mentioned how long a scar takes to heal on the outside of your body: I ran that by my doctor today and he explained the healing done INSIDE the body, in the liver, is quite a different animal. That is why we see reversal of fibrosis in some patients.

Anyway, onward to SVR!

Happy Holidays to you friend.

Scott

cindyazure · Answer

well is it true then that cirrosis is considered dead tissue while fibrosis is considered live scar tissue?

BobK · Answer

I think willing is on the mark about the controversy surrounding Poynard's paper.  I also agree that the comments provide a good example of why a person needs to read the entire articles if possible to prevent any illusions that might arise out of reading abstracts only.  Abstracts are the advertising to get you interested enough to search out and read the article. 

Reports of improvements in cirrhosis have always fascinated me especially given the permanent nature of scar tissue.  One only has to look at the scars you have on your own body to understand how longlasting scar tissue is and what the likelyhood of improvement actually might be.

The antifibrotic action of interferons is quite well known and I hope you do see the improvement you are looking for!  I was able to regress three stages with a 100 week treatment regime of peg-intron and riba. 

thanks for the references and links...always appreciated!!

regards,
BobK

simpleman · Answer

I don't know if it makes any difference but I noticed all the studies were about interferon alpha 2b(Peg-Intron) and you are taking interferon alpha 2a(Pegasys). You guys know far, far more than me, I just thought I would mention it.

cindyazure · Answer

never mind question above.  I think i got the answer at Bx score.  Thanx dh Bill.

Revenire · Answer

Yeah, a lot to wade through.

There are other papers, abstracts, studies that DO show a reversal in a certain % of patients. 

Personally, I am going to take a half dose of Pegasys for some time after my 'regular' treatment ends this next week -- at week 50. I am 'betting' on some improvement in the fibrosis.

Take care,

Scott

cindyazure · Answer

wow thank you for going thru the trouble of answering me.  that's alot of reading for my foggy brain so I'll have to take my time with it.  In what I managed to absorb so far is the answer is basically, "Who knows?"  Maybe you'll heal, maybe not.  In that maybe I'll opt for the bx for the answer.  In the meantime I'll take whatever healing, energy level, lowered vl or anything else I can get.  Thanx again.

Revenire · Answer

Many patients do show an improvement, with treatment, per biopsy post-treatment, even at the cirrhosis stage. Can it be reversed? An open question for medical science. See the article posted below:

---------------------------------------------

Reversal of cirrhosis: evidence-based medicine? 
In the May issue 2002 of Gastroenterology, Poynard et al.1 report on the impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic viral hepatitis C. Our main issues are the following: 

The term

Revenire · Answer

http://www.medscape.com/viewarticle/435958 - MedScape

http://www.medscape.com/viewarticle/434537 - MedScape

http://www.amedeo.com/medicine/cir/GASTENTE.HTM - Gastroenterology

http://www.natap.org/2002/Oct/103002_2.htm - Natap - Can Cirrhotics Achieve a Histologic Response?

http://www.hepwatch.com/June2002.htm - Hepatology Watch

http://www.infectiousdiseasenews.com/logon/logon.asp - Infectious Disease News

http://www.hepcassoc.org/news/article36.html - Hepatitis C Association

All of the above have references to the Poynard et al work. Some of the sites you need to register for.

I hope this is what you're looking for. 

Below I've quoted from the study.

It is exciting to see this histologic response in patients. I am hoping for it myself.

Take care,

Scott


--------------------


The Impact of Pegylated Interferon Alfa-2b and Ribavirin on Liver Fibrosis

Gastroenterology 2002 May;122(5):1303-1313 

Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C.

Poynard T, McHutchison J, Manns M, Trepo C, Lindsay K, Goodman Z, Ling MH, Albrecht J
Service d'Hepato-Gastroenterologie, Groupe Hospitalier Pitie-Salpetriere, Universite Paris VI, Paris, France; Scripps Clinic and Research Foundation, Division of Gastroenterology/Hepatology, La Jolla, California; Division of Gastroenterology and Hepatology, Medical School of Hannover, Hannover, Germany; Service d'Hepato-Gastroenterologie, Hotel Dieu, Lyon, France; Division of Gastrointestinal and Liver Disease, University of Southern California, Los Angeles, California; Department of Hepatic and Gastrointestinal Pathology, Armed Forces Institute of Pathology, Washington, DC; and Schering-Plough Research Institute, Kenilworth, New Jersey. 

Background & Aims: Liver fibrosis is an important prognostic factor in patients with hepatitis C. The effect of pegylated (PEG) interferon alone or its combination with ribavirin on fibrosis has not been established. 

METHODS: We pooled individual data from 3010 naive patients with pretreatment and posttreatment biopsies from 4 randomized trials. Ten different regimens combining standard interferon, PEG interferon, and ribavirin were compared. The impact of each regimen was estimated by the percentage of patients with at least 1 grade improvement in the necrosis and inflammation (METAVIR score), the percentage of patients with at least 1 stage worsening in fibrosis METAVIR score, and by the fibrosis progression rate per year. 

RESULTS: Necrosis and inflammation improvement ranged from 39% (interferon 24 weeks) to 73% (optimized PEG 1.5 and ribavirin; P < 0.001). Fibrosis worsening ranges from 23% (interferon 24 weeks) to 8% (optimized PEG 1.5 and ribavirin; P < 0.001). All regimens significantly reduced the fibrosis progression rates in comparison to rates before treatment. The reversal of cirrhosis was observed in 75 patients (49%) of 153 patients with baseline cirrhosis. Six factors were independently associated with the absence of significant fibrosis after treatment: baseline fibrosis stage (odds ratio [OR] = 0.12; P < 0.0001), sustained viral response (OR = 0.36; P < 0.0001), age < 40 years (OR = 0.51; P < 0.001), body mass index < 27 kg/m(2) (OR = 0.65; P < 0.001), no or minimal baseline activity (OR = 0.70; P = 0.02), and viral load < 3.5 millions copies per milliliter (OR = 0.79; P = 0.03). 

CONCLUSIONS: PEG-interferon and ribavirin combination significantly reduces the rate of fibrosis progression in patients with hepatitis C.

willing · Answer

the Poynard tx-fibrosis paper was pretty controversial as evidenced by the number of published comments. I believe the comment Scott cites is the 3rd in the PubMed citation of the paper. Personally, I thought the comment was a good caution but doesn't really detract from Poynard's findings : fibrosis may be only one component of cirrhosis but in practice it seems to be the most significant one. Quantifying liver disease seems to be a very inexact "science" - from the representativeness of the biopsy sample, to the pathologist's subjective judgment, to the relative weighing of the characteristics observed in the tissue. Interestingly, Poynard's group is also probably the most active in searching for reliable blood-marker based indices of disease progression. These may soon end up giving us a more meaningful disease index than today's 'stage'. On the same subject here's an editoriall that appeared in the same issue as the Poynard paper.

OkieJim · Answer

I have beginning stages of cirrosis and did #15 last Friday nite. There is no cure or regeneration of the cirrosis. Once the scrarring takes place it is done. I'm not a doctor but my BX was 3/4 and I'm on TX. I would get a second opionion.

cindyazure · Answer

i have level 2 swelling and fibrosys.  I heard that the liver regenerates.  Is it worth getting another Bx after this Tx is over?

Tallblonde · Answer

I just want you to know that you're in my thoughts and prayers today.  Hang in there, Joni.

Susan

BobK · Answer

Do you have a reference or source for the comments you posted which referred to the Poynard, et al paper?

thanks,
BobK

ps not a big deal I just wanted to know the original source of publication for the comments.

Revenire · Answer

It was from the Janis or something site. I will dig it up tomorrow.

GI.PA · Answer

Patient who have cirrhosis usually lack a lot of inflammation (the liver cells are too scarred) so an inflammation stage is not given.  Cirrhosis is considered the final grade of fibrosis (sometime termed grade 4 or 5).  When the findings are consistant with cirrhosis throughout, it is simply term cirrhosis on biopsy.

GI.PA

MajNeni · Answer

Sorry for doing this, Joni, but it's easier to read.
Question Posted By: jonihs on Monday, December 15, 2003

MY biopsy doesn't say any thing about stage or grade, etc. The G.I. I had then assumed I was untreatable. It says

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