Liver Biopsy

[frijole]

HOLY CR@P WHO STOLE MY LIVER?

Well, those weren’t the exact words I issued when I picked up my  biopsy report today, -- I think I actually said more calmly, “This is not what I was expecting”-- but it sure was what I was thinking.

A little history ---
First biopsy – I have had Hep C minimally for 34 years, but probably for 40 years.  2005 biopsy showed Grade 1, Stage 1-2 (early periportal fibrosis, no piecemeal necrosis)   I treated for 56 weeks in ’05-’06.  I responded well but still had 40 IU/mL viral load at 12 weeks and was clear by a sensitive test at 20 weeks.  Relapsed

Second biopsy – 2007 – after relapse – showed grade 1, stage 1-2

Third biopsy last Friday --   Grade 3-4, Stage 3-4  , plus Moderate to severe steatosis (never had that before) and  “moderate to severe inflammatory infiltrate with portal tracts with significant piecemeal necrosis and lobular inflammation.  Bridging fibrosis.  “… findings are consistent with a chronic viral hepatitis with cirrhosis.”

There it was – the “c” word – cirrhosis.   I never saw this coming.

I have been on this board quite awhile and am very familiar with the fact that liver progress is non-linear.  It does not progress at the same rate – it may deteriorate at a fast rate,  all of the sudden.  But, when it happens to you…… it is another story.  So, folks, let’s not rely on those old biopsies.  Remember, we feel good until we don’t…

So, there is no question about it.  I will be treating soon.  I  consult with the hepatologist on August 5, get the meds ordered and should be on my way soon.  I spoke with the PA in Dallas and they have not received the report yet.  They need to give orders to have the slides sent to Dallas for the pathologist there to read. All this needs to get done before my appointment.  I am writing the doctor a letter so he can get the meds ordered now instead of waiting.

So to all my crazy and not so crazy friends here, I will be joining you soon and surwly will need your support.

frijole - bean

[jsf52]

Hi, Sorry to hear about the biopsy report.  I recently went from Stage 2 to Stage 3 and know the scariness of having this dragon progress.  Good luck with treatment.  We will be there with you.

jsf52

[nygirl7]

Oh K I dont know what to say........you have been one of the most supportive and helpful people I have known here and I for once dont know what to say.

Except this time you WILL get down to UND and stay there (bless us with our 40s LOL) I have no doubt, I will think it to be and therefore it is.

I'm so sorry about this news.........so damn sorry my good friend.

[fullmoon1]

Sorry to hear the bad news!  We will be here for you....

[willing]

wow... OK, first look on the bright side. Much better to get this news now than say a year ago when it would not have been clear what to do. Now it's obvious. Never mind the risk of the 2am  Klondike bars, full steam ahead.

Then the quibbling: "bridging fibrosis" is not cirrhosis. The latter is almost universally accompanied by other markers : platelets, INR, portal vein and spleen diameter, etc. etc. Worth checking all indicators. And more quibbling : whenever these quick jumps in stage, good or bad, come up following up with a FS seems wise. More noise but much less local sampling bias (does the report mention sample length  and how many portal tracts were visible?). Nevertheless, all details. Good luck picking your PI on the 5th,

[willbb]

Hi...certainly not the biopsy report you must have been hoping for, however not at all too late to have a succesful outcome given the new meds. Good luck with treating with whatever you and your doctor choose,we will be rooting for you.

Will

[Kathy73]

You have whatever support I can give you.

All my best to you,
Kathy

[coeric]

sorry about your recent report.

platelets were my first casualty of cirrhosis.  i am now around 100,000.  you did not mention nodule formation which i believe is used to diagnosis cirrhosis.  my recent report states"architectural distortion with compete and incomplete nodule formation." did the the pathologist state how many portal areas were evaluated?  i've read it takes at least 10 to assign a stage. i will be interested in how the pathologist in Dallas interprets the slide.

blessings,
eric

[orphanedhawk]

I'm so sorry to hear this.
May you soon be hep C free.
My only advice is to drink lots of coffee and try to keep your sense of humor.

Good luck,
OH

[susan400]

I'm sorry to hear about your biopsy report.  I don't know if you remembered but 2 of my 5 biopsies showed bridging fibrosis.  Then, on the one that I had last June, it showed no bridging fibrosis and that actually it looked like I'd had some improvement.  Mind, I still haven't cleared the Hep.  But, I had the two 5 weeks clinical trial treatments, one year apart, between biopsy #4 which showed bridging and biopsy #5, which showed no bridging.  Recently, I had a fibroscan which went along with the biopsy #5, more so than one with bridging.  So, I think that any time we do treatments that it helps the liver.  Try to keep up with your normal positive attitude that I hear in your posts and I think you'll do great!   Susan400

[flcyclist]

From one crazy to another, so sorry to hear about the progression, but hope this round with triple trt with be successful.  

Keep us informed.  Wishing you all the best.  

[charm27]

We are all here to support you...Youve been a great a great addition to the forum.

Wish you well and I know you will terminate the dragon!!

Charm

[Bill1954]

Ah gosh, Kathy—

I haven’t been checking in often in here lately, and almost overlooked this. So sorry to hear about the new developments; as Willing said, at least your path is clearly defined now.

I’ll drop you a quick note and check in further. Good luck, old friend-

--Bill

[coeric]

Dear One  - here is a brief article with a diagram that helped me understand my report.

http://www.aaimedicine.org/journal-of-insurance-medicine/jim/2001/033-01-0109.pdf

eric

[his3707]

With the new meds, You[ll make it this time!  Also in time to reverse some damage!  We'll be here for you!  You can count on it!    

[researchmonkey326]

It is hard to know what to say but I am sorry for your news.  Knowledge is power though so now it is time to move forward.
Debra

[SusieS2010]

The good news is that you are a relapser with a more than excellent chance to clear forever with the new drugs. I think cases like yours really show how significant the sampling errors are on  biopsies. Let us know how your appointment goes.

[ejoli]

          Oh I am sorry to hear about your biopsy. I'm glad that you know now.  Definitely going to do tx now. I'm happy that you can get the new drugs.  You'll make it!   -Libby  

[HectorSF]

Frijole, I am very sorry to hear about the results of your biopsy.

One thing I don't understand personally is "Bridging fibrosis.  “… findings are consistent with a chronic viral hepatitis with cirrhosis.”. Bridging fibrosis from my limited I thought was Metavir Stage 3. I didn't see any mention of distorted architecture and scarring in the report. As coeric also pointed out.

Low platelet count is usually the first indication of cirrhosis. Usually, about one-third of the body's platelets are held in the spleen. When the spleen swells (splenomegaly) due to the back up of blood flow through the scared liver, the spleen will hold on to too many platelets. This means that not enough platelets will circulate in the blood. "thrombocytopenia"

If your liver is now stage 4 it is still early and you are compensated to you still have time on your side. You can remain compensated for many years. The damage to your liver should be able to reversed if you can clear the virus. So it is great that you have the new DAAs available to you. They will give you the best odds there have ever been to cure your chronic hep C. Have you had the IL28B test? You may want to think about it, because it will give you insight into your odds. Of course it is a very personal decision as not every one wants to know.

But you are taking the correct action. Treatment ASAP.
I'm pulling for you. With all your knowledge you should be an ideal patient as far as compliance and caring for your liver. So all that is a big plus too.

Hang in there. You are on track and doing the best thing possible.

Cheers my friend!
Hector

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Medscape
The Liver Biopsy in Chronic Hepatitis C: Fibrosis and Fibrotic Progression
http://www.medscape.com/viewarticle/501268_4

"...The next major transition occurs with the development of fibrosis that bridges between vascular structures. There is general agreement that portal-portal bridging fibrosis precedes portal-central bridging, although instances of the latter can be seen early in the process. Gradually, more and more bridges form, accompanied by distortion of architecture due to hepatocellular regeneration and contraction of fibrotic scars.
When these changes diffusely involve the biopsy, it is classified as cirrhosis. It should be noted that these staging systems were developed for chronic viral and autoimmune hepatitis; although they can be used for chronic cholestatic liver diseases such as primary biliary cirrhosis, they are inadequate for staging steatohepatitis, given that none of them account for the zone 3 perisinusoidal fibrosis that is usually the earliest evidence of scarring."

"the extent of fibrosis clearly has an impact on moderating the rate of response to interferon-based therapies in chronic hepatitis C. This is evident not only in the fact that the response rates are lower in patients who have established cirrhosis as compared with those with precirrhotic fibrosis, but also that the response rates are lower in those with severe fibrosis (bridging or worse) as compared with those with mild fibrosis."
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[Mary4now]

So sorry to hear about the results with your liver, but as noted you still have time and the new drugs will hopefully increase your odds for clearing.
I wish you the best of luck and medicine and good luck.
Mary

[James10500]

Sorry to hear this, best of luck with tx this time. New drugs equal new success !

[fretboard]

Whoa, that sux big time, sorry to hear about your bad news.  I have a feeling things are gonna go well for you and you will SVR this time.  Heck with the new drugs, your knowledge and friends here on this forum.  I think you're gonna do well.  good luck and God Bless!

[elpasolady]

Sorry for your news, but you have the best attitude to go forward.  We are all in this togerther.  All for one, and one for all, ( as the saying goes)
You will beat this this time!!!!
Blessings to you!
~Debbie~

[lapis]

Thanks for sharing your story.  As you said, it's a reminder to us all that liver disease progression is non-linear and things can change just as they did for you.  It is good that you have a plan and you're ready to move forward.  I'll be just another forum member, cheering for you!
Lapis

[Gracie_Lue]

Man I totaly know what that feals like. I too was not expecting the results I got form my biopsy. I am stage 3. So sorry to hear your bad news I wish you luck on your tx. I will be praying for you!