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377521 tn?1203476772

Biopsy - what does it mean?

Ok, I received a call last night from my family MD who said that my biopsy looked good and he didn't think any treatment would be required. the results are being sent to the heptologist for review and recommendation, but it sounds good.  I stopped by today and picked up a copy of the results, but I don't understand the lingo. Cna anyone help interpet this:

The is exactly what it says:

CLINICAL DATA/DIAGNOSIS:  56/M with known hepatitis C.

DIAGNOSIS
Liver, ultrasound guided needle core biopsy x 3
  *  Chronic hepatitis                                                                             070.54/307,313x2
      -  Etiology:  Viral hepatitis C by history
      -  Activity grade:  Gade 1/4, with minimal portal lymphocytic inflamation, minimal interface hepatitis and minimal lobular activity.
      -  Stage:  Stage 0-I/IV, with focal fibrous portal expansion
  *  Minimal macrovesicular steatosis.
  *  Absence of hepatitis siderosis, granulomata, dysplasia and neoplasia.

GROSS DESCRIPTION
Speciman labled "Blodgett, liver biopsies x 3"  received in 10% formalin fixative consists of three brown cores of tissue measuring from 1.5 up to 1.7 cm in greatest dimensions which are totally submitted in cassette 08-S:1327

MICROSCOPIC DESCRIPTION
Examined slides labled Blodgett 08-S:1327, levels on two sides, and iron and trichrome stains with positive controls.  Sections show needle biopsies of liver showing at least 15 portal tracts or portions of portal tracts availble for evaluation.  Trichrome stain shows many normal sized portal tracts with only a few showing fibrous portal expansion.  Portal tracts show focal infiltrates of lymphocytes and show only minimal interface hepatitis.  Lobules show just a minimal increase in mononuclear chronic inflammatory cells including rare nests of lymphocytes, possibly indicative of hepatocyte dropout.  Apoptotic bodies are not clearly seen.  Macrovesicular steatosis affects approximately 5-10% of hepatocytes.  Prussian blue stain shows minimal trace positive staining for iron, probably representing presence of siderophages.


OK, that's it.  What does it all mean.  Most of it sounds good, but thare are a couple things don't.

Thanks

YF
17 Responses
131817 tn?1209532911
It looks to me like you are a stage 0-1, which means little liver damage!  Great!  So you can choose to tx or wait and see!  I don't understand all of it, but it does sound good.
Avatar universal
It's a great biopsy result - report! You should be very relieved. Mike
377521 tn?1203476772
Do you know what it all means?
377521 tn?1203476772
Doesn't appear to be too many that know more about these results than I do.

I should hear next week from the hepatologist.  I hope and expect to hear the same as the MD
Avatar universal
From what I understand the stages go from 0-4.  Stage 4 is cirrhosis.  Stage 0 is no damage.  I did find a website once that explained this, but I cannot remember.  You might be able to find it.  Your biopsy says way more than mine.  I was diagnosed and recommended for treatment.  I had the biopsy and the dr said my liver did not look too bad.  I've been to three drs (2 GI's) and no one has actually looked at the slides.  My biopsy report says "mild increase in portal fibrous tissue".  That's it.  Now I'm trying to get more info as far as the staging.  
Avatar universal
Hello!
This is a good biopsy! you are grade 1, stage 0 (or less than 1)...It means..grade= inflammation ..Inflammation shows how much the hepatitis is stressing your liver...Stage= scarring/ damage...in stage 1&2, you have fibrosis which is reversible damage..In 3&4, it becomes cirrhosis/ irreversible scarring..as the damage worsens, the scarring replaces the healthy tissues of your liver...eventually it can become this hard prune that doesn't work very well...Portal fibrous tissue =the portal system is the network of blood vessels that exchange the blood in your liver for cleaning and detoxifying...When these get scarred, your blood starts to back up and the body has to increase the vessel pressure (kind of like pressing oil through a dirty filter)..When the blood back-up starts (known as portal hypertension) the blood's "water" backs up into your legs and belly creating a swollen appearance...
The "macrovesicular steatosis is the amount of fat cells in your liver...When your liver reaches a certain percentage of fat cells, you develop a condition known as "fatty liver"     ...I'm not sure of what the cutoff is, but I think it's at least 20% or higher..This can be controlled sometimes with weight loss, but even skinny people can get it...It is another condition that "plugs up" your liver...By the way, what is your genotype?  If it is 3a, they are prone to fatty liver more than the other types...
Also, know this...Most people die with hepatitis C, not of it...and only 20% progress on to cirrhosis and needing a liver transplant...and only 2% of those get liver cancer...You have time...lots of it...This is a slow moving disease and it takes decades to get bad damage...
...
377521 tn?1203476772
Thanks for the adice.  Right now I a drunk an probably should'n't be resonding,  I guess I felt tht irf the virus I have has only caused the damage I have.. what the hell is anothe few years.  Probably worng and I will re think it tomorrow,
Avatar universal
Hello again...
Just so you know...There are things that speed up the liver damage...Alcohol use is one of them..Tylenol use too...Maybe a good excuse to start anew? Best wishes...
92903 tn?1309908311
After carefull review - my take on it all is that your name is Yellowfin Blodgett. I've been known to be wrong though, so you may want to check your driver's license.

Medicmommy: As the diagnosed hepc population ages, that 20% number seems to be revising upwardly. Off hand, I believe the odds of HCC diagnosis for cirrhotics is about 5% annually. Where did you get that 2% number?
Avatar universal
Hmmm..you may be right...I'm going to go back and check my source's #s...I use Hep central quite a bit for info, but I dig up quite a bit on my own too...it may have been from the CDC...
Avatar universal
Maybe a dose of reality for you is required here.  We have people on here who have come out at the stage and grade you are and five years later are the same.  We have others here who have found themselves so far along after five years that a liver transplant was required because the damage had leaped that fast.  If you want to play such Russian Roulette with your life and drink like that...start checking out the transplant centers around your area.  You have no idea when you caught this,and how fast it will progress once it hits a certain stage.  

I'm Stage 1, Grade 1 like you.  I've had it for 23+ years going by my risk factors but who really knows.  Mine was found by accident and not by symptoms.  And yet in the past four months I notice that I tire more easily and that the throbbing pains in my abdomen are more frequent and more noticeable.  I notice changes in my urine that were never there before that indicate my body isn't working quite the same way as before.  All in the last four months.  And I have cut my alcohol consumption to practically nil.  When I DO indulge, my abdomen yells at me.

You have no idea how fast your alcohol consumption will move things along once you hit a certain point and you will have no idea that you've hit that point.  The safest thing for you to do ... is start cutting alcohol out completely.  
233616 tn?1312790796
seems to me you started out with a high VL...19 mil if I recall.

that said stage and grade can change rapidly once the virus eats up healthy cells faster than they can normally relicate...and so you get fibrosis instead...

if you are going to wait for better txs t come out, I'd lay off all booze,pot,etc Rx's and go to a liver friendly diet with preservative supplements and a yearly scan/biopsy to make sure the prgression doesn't get away from you.

It's easier to get treatment, and survive it well if your liver is still working well than it is when the thing is already compromised and working at half normal outputs.

I guess the old "you'll did of something else adage doesn't hold water with me. that something else is often a ruptured portal vein or esopheageal bleed....either way, you are dead and the hep c, while not THE THING that got yah...was indeed the direct cause of the condition that did cause the demise.

Some folks with low grades treat because they see some benefit to ridding themselves of the virus now, not in five years, when it can affect manyother areas, including glands, brains etc. Many treat because they have seen their energy and stamina shink to nada...after all...most times we walk around with billions of viral cells, that happens.
(yes it is billions when you include all the blod volume). they treat because quality of life is suffering even before the liver begins to explode.
so there is still much to consider.
maryB
Avatar universal
MeryyBe is right...I've only had the Hep since 2003, was a very light drinker, ate fairly healthy...Since last July, I even had my gallbladder out because it was going bad and stressing my liver...I have also been taking liver supporting supplements...I too have notice ans increase in fatigue, brain fog, and the swelling in my legs started a year ago, despite my biopsy being 1/1...I don't want to even consider going the route of cirrhosis or cancer...I have had friends and patients die of both, and it is a horrible way to go...I am starting conventional tx on Monday...
Avatar universal
Ruptured portal vein? That must be a rare event, isn't it? I have never heard of anyone having a ruptured portal vein as a result of cirrhosis and I have seen a whole lot of cirrhosis related portal hypertension, esophageal bleeds (I had 2 myself) ascites, splenomegaly (had that too) and a few cases of encephalopathy - but not one ruptured portal vein. We learn something new everyday here. Mike
233616 tn?1312790796
jup, even from me you may occasionally learn....

http://bjr.birjournals.org/cgi/reprint/78/927/265.pdf

I also remember from somewhere in the plaque ridden recesses of my now cheese gratered brain that stones forming in the liver could also cause inordinate pressure and big vein blow outs,
it's not like the gall bladder is the only place gall stones can form...the liver is a big target

but cysts are a number one cause of this....though it is rare.  
I've got lot's of cystic stuff going on
so it a good thing to watch for in the liver as well....
especially if you are like me and have them already (egg sized) on my ovaries and kidney....so any who...it can happen.
Always tell your tech you have cysts... if you do...the radiologist will pay more attention to whereever they are scanning and be watching for new ones.
Not often but sometimes a cyst can be life threatening...as when it's on your portal vein.

The one on my kidney really has me nervous as it's the size of an egg but they won't remove it...they say chances are it won't blow....it's like driving around with a bubble in my tire tread....not real comforting to hear rare...when you walk around every day with it.

LOL....it nice to know something you don't once in year mike...

mb
Avatar universal
  I have had hepatitis c for approx 35 years. Had lab work and liver biopsy done very recently. Showed liver fibrosis with mimimal portal fibrosis between 1 and 2. But yet Dr. advised me to start treatment. I am confused, I know any fibrosis in the portal area is not good. But treatment.



Avatar universal
You have posted at the end of a very old thread. You would be better to go to the "green post a question " at the top and start your own thread as you will get a better response .

Do you know what geno type you are..as this also is important when making the desicion on when to treat and with what meds.

The success rates for treatment of all geno types now is approx. 75%   ..so I would imagine your doctor is advising with a mild to moderate amount of fibrosis ...it would be best to treat before that progresses to significant fibrosis(cirrhosis).Also it has been shown that  with milder fibrosis the outcome of treatment is somewhat improved.

Good luck..and welcome to the group..
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