Biopsy Report

[friole]

I received my report on Thursday and it has taken days to absorb it.  There is no grade or stage on it, and I was extremely upset and confused about it.  I have called the pathologist with no success but will try to get him to grade and stage it next week.

Diagnosis  "Chronic hepatitis with mild to moderate chronic triaditis, no parenchymal injury, no piecemeal necrosis and mild fibrosis"

Microscopic Description "Trichrome stain shows light collagen expansion of triads with no significant bridging and no parenchymal fibrosis.  Limiting plates are intact.  Bile ductules are within normal limits.  A few triads show lymphoid aggregates.  Central veins are present and parenchyma appears in normal architecture with no significant hepatocellular dropout.  No significant cholesatsis or steatosis is seen.  Iron stain shows slight iron deposition within hepatocytes.  No malignancy is seen."

I have poured over every word of this and have pulled it part to find the meaning of each phrase using the information on the Janis7 site.  My personal conclusion is = Grade ( amount of inflamation) 1, State (amount of fibrosis) 1.

Any comments would be most appreciated.  I am 57 yof, infected 35 years ago, VL 1.52IU/mL, don't know geno yet (D*** doctor got the results last Tuesday and never called me or returned my call).

ps the only phrases I am still confused about are "lymphoid aggregates" and "triaditis" (altho I think that is inflammation of the portal triads or something like that)

[willing]

lymphocytes are cells that play a key role in the immune response. They're made in bone marrow and thymus and then are distributed around the body. I believe the point of that slide is that they can occur normally in places like the intestine, where they monitor food-associated intruders, or abnormally, in infected tissue. I don't know whether they would ever show up in a healthy liver, but they definitely show up in an infected one ,as shown in the two slides (49 and 50) of infected triads. Those two slides, also show the effect of infection on the "normal architecture" of a triad : the plugged bile duct in 50 and the fibrosis or buildup of collagen in 49. None of these slides is HCV-specific, but they may help give some idea of what the pathologist was trying to put into words. The lymphoid aggregate slide is from a med-student training site at U. of Kansas. The nice part of that site it that it also includes the answers! (click on "answer"). You can get to the whole series by clicking on "home". Their slide <a href="http://www.pathguy.com/histo/051.htm">51</a> includes both lymphocytes and collagen fibers, though it doesn't specify what tissue these are from (given massive the amount of collagen it's likely not due to infection). As far as I know, no one's going to be able to tell you with any reliability how much time is involved in going from "light collagen expansion" to "bridging fibrosis". Consensus seems to stop at "not very quickly"...ie you've got a good shot at dying of something else first. If you're going to base your tx decision on this, it might be worth shopping your slides around to another pathologist for a 2nd opinion. I think a lot of the skill involves not only picking out characteristics but determining how far out of whack a particular liver architecture is, and studies have confirmed that senior pathologists have a better sense of the lay of the land than junior ones.

[friole]

I thank you all for your comments. Hopefully I will be able to get confirmation on the stage and grade next week.  I had been trying to decide whether to treat and I had told myself if it is 1 or 0 I would wait and if 2 would treat.  When I got the report with no numbers that shot my system totally. But as Willing said, they really did me a favor.  I don't think I would have spent so much time trying to figure it out if the pathologist had just staged it.  As for why it is only this stage with the infection being there for 35 years I must think genetics must play stronly into it.

Willing - I am most interested in everything you said. I looked at all the pictures and was not exactly sure of what to look for in them.   I am curious about what you said about the possibility of stage 2 of inflamation.    I was particulary wondering about the part that said "slight collagen expansion of triads."  The collagen is the stuff that forms the scar tissue and it just kind of strings out from the triad )I think).  Once it starts spreading out its little tentacles that is what is called "bridging" - I guess when it bridges from one triad to another (?)This bridging is then termed intermediate stage of fibrosis.  I am wondering if once the collagen starts forming, it might go quite quickly into bridging.

Also I looked at the pictures you linked of the lyphoid aggregates and was wondering -- are those supposed to be in the liver at all?

One more question.  Everyone posts the PCR and SVR results, and (at least in the 1 1/2 months since I have been reading posts) I have never seen anyone post a SVR biopsy report.  Aren't they done after you clear?  Wouldn't it be important?

If anyone with grade 1 or 2 would like to share the wording of their bx reports, I would really like to read them to see the diff between 1 and 2.
friole

[dendel]

That does sound like a stage 1. That's good news. I am a 2 with
little Fibrosis.  Which isn't that bad either.  I am on Peg and
Cop for two months now. Not that bad.

[chellski]

i have got any idea what all that means...i needed my doc to say grade 2 stage 2....geno type 1  (no a or b)..etc...
good luck to you - it seems from everyone else that its not that bad - good for you....what i wouldn't do w/o this site
<3 michelle

[jmjm530]

Sounds like grade 1, stage 1, which is excellent news considering how long you've had the virus. Some people -- more women than men -- seem to coexist a better with the virus than others.

What does concern me a little is the lack of info and support from your current medical team. Not surprising these days, but something to consider.

I'd make sure you get all the information you want, including a staged biopsy report and genotype prior to any treatment decision.

And if you do decide to treat -- given your stage you really have a choice -- make sure you are very comfortable with this particular group of doctors. If not, take your time and find a medical team you are comfortable with. Preferably a heptologist that treats large groups of hepatitis c patients.

Given your stage, there's no rush to make any decisions -- either about treatment or medical team. What you want to do is take the time and make the right decision.

Let us know how things play out. In spite of the lack of communiation with your doctors, I  really think you should be happy with the news so far.

[willing]

I believe your interpreation is right : a <a href="http://www.hepnet.com/liver/glossary.html">portal triad</a>, consisting of an artery, vein and biliary duct, is part of the basic structural unit (lobule ) of the liver. Triaditis would be an inflammation in this area. Enough damage and the triad becomes non-functional <a href="http://courses.umassmed.edu/genpath/InflamBowel/050.html"> (example)</a>. A "lymphoid aggregate" or concentration of lymphoid cells is further evidence of inflammation in this area: eg see <a href="http://courses.umassmed.edu/genpath/InflamBowel/049.html">an infected triad</a>, and <a href="http://www.vh.org/adult/provider/pathology/LiverPathology/08FigureLegends/Figure29.html">another example</a>, also <a href="http://www.pathguy.com/histo/046.htm">recognizing a cluster of lymphocytes</a>.
Your assessment sounds right to me : though maybe inflammation might be at level 2. Some Dr is bound to put numbers on these words eventually, but the understanding you've gotten from poring over the report is much more valuable.

The pathologist's report is really where the rubber hits the road with this disease - everything else is hearsay. Ideally one should learn to make sense of one's slides as well, and thus check the written assessment,but there's a reason pathologists get to earn the big bucks...

[cougareyes]

I agree your interpretation of grade 1, stage 1 sounds right. On the big scale thats good news so take it easy. Take Care

[Tony-z]

The report of your BX shows us one reason why we have to be our own advocates.

<font size="5" color="Green">Congratulations</font><Br> on good news. From what you posted I would agree. Stage 1 Fibrosis with grade 1 inflamation...What we don't know is are you beginning stage 1 or advanced stage 1. I would recommend talking to your Hepatologist. You can always have another Pathologist read your tissue sample.


                     God Bless


                        TonyZ