Help interpreting biopsy results requested

[mikeymike2]

Could any of you good people help me to interpret my bio results (basically I would like to know how bad the damage is) The results read:

"Good sample of liver parenchyma. Normal architectural relationships preserved. Periportal inflammation with piecemeal necrosis.  No evidence of involvement of biliary epitheluim nor of ductopaenia.  Minimal lobular inflammation.

Some evidence of fibrous portal expansion but not of bridging fibrosis or established cirrhosis.
Very mild degree of steatosis but no evidence of accummulation of any form of abnormal pigment

Knodell score:
Periportal/bridging necrosis - 1 (mild piecemeal necrosis)
Intralobular necrosis - 0
Portal inflammation - 3 (inflammatory cells in 1/3-2/3 of tracts)
Total necro-inflammatory score - 4
Fibrosis stage - (fibrous portal expansion)"


My viral load is 287,031
ALT is 124

Genotype 1b (drat)

Probably had the infection about 20 years. I'm male 46.

One problem I have in interpreting the results is that I don't know, for example, what Intralobular necosis means - seems good that the score is zero - but portal inflammation is 3 - is this high? Which is worse - Intralobular necosis or portal inflammation??

What on earth does it all mean!!

Thanks all

[lizzee]

HI MAGNUM,
HOW HAVE YOU BEEN??
I NEED TO ASK YOU A QUESTION BUT WOULD IT BE OK IF I E MAILED YOU OR YOU ME?
MY ADDRESS IS: ***@****..
THANKU MAGNUM..
BE WELL..
LIZE

[mikeymike2]

thanks to everybody for their comments - it's been a great help

[Steve']

Thanks so much for your info I'm not sure if I'm in good or bad shape considering the Bx would we class it as a good or bad result, I realise to some it would be either way..... I laughed when you said, keeps your mind off the itching, I'm in the same boat haha ...<b>Thanks Again</b></font>
<br><hr><P><marquee direction="right"><Font face="Brush Script MT"size=+3<b>Steve</b></font></marquee><br>

[willing]

you're welcome - hopefully GIPA will have a chance to comment but to me the results seem pretty good. If you look at the following treatment <a href="http://hepatology2.aasldjournals.org/scripts/om.dll/serve?action=image&location=/extractor/images/jhep/36/5b/f0360s65003.jpg">recommendations</a>, the cutoff for recommending tx is >= A2F2 (grade 2, stage 2) on the Metavir scale. The Scheuer and Metavir scales both use a 0-4 range for measuring the stage of fibrosis so, if you were a 1,  you'd be close to the bottom of the "should treat" category. As a 3 your chances are so good you should be treating anyway and your fibrosis stage tells you even if this round doesn't work you've got time.

[Galen]

Welcome back Magnum.  I found more info on the vaccine you reference.

http://medschool.slu.edu/vaccine/index.phtml?page=hepc&cat=current

Hepatitis C Vaccine Study

The Center for Vaccine Development and Liver Center at Saint Louis University are currently conducting a research study with an investigational hepatitis C vaccine.

Background on hepatitis C:

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). The main way of getting HCV is by contact with the blood of an infected person. HCV is serious for some people, but not for others. Most people who get the virus carry it for the rest of their life. Some people eventually develop serious liver cirrhosis or scarring and liver cancer. The Center for Disease Control estimates that 35,000 to 180,000 new cases of hepatitis C occur in the United States each year. Cirrhosis due to hepatitis C infection is the leading cause of liver transplants in the United States.

Purpose of this study:

Currently there is no licensed vaccine to protect against hepatitis C. This research study will look at the safety and protective response of three strengths of an investigational hepatitis C vaccine.

Frequently Asked Questions:

Who qualifies?

You may be eligible to participate if you are a healthy adult between the ages of 18 and 45 years. You must not have cancer, HIV infection, hepatitis or other conditions that weaken your immune system. If you are female, you cannot participate if you are pregnant or breastfeeding.
What does the study involve?

12 visits over approximately 16 months. The first visit you will have a screening evaluation to see if you are eligible to enter the study. If enrolled, you will receive a shot of vaccine or placebo (inactive substance) four times during the study, and you will have blood tests done at every visit.
Will I acquire hepatitis C from the test vaccine?

NO!  The test vaccine is not infectious.
Will I be paid for participating?

Yes!  You

[Magnum]

New vaccine for hepatitis C

Reported by Susan Aldridge, PhD, medical journalist

Doctors are testing, for the first time, an investigational vaccine that may be able to protect people from hepatitis C.
With an estimated 170 million people around the world already infected, hepatitis C - a blood-borne infection of the liver - is probably responsible for around 10,000 deaths a year in the US. It is also responsible for around half of all the liver transplants carried out each year.

A vaccine against hepatitis C may prevent many infections and deaths. Doctors at St Louis University School of Medicine are now testing such an investigational vaccine. Initially they will look at the safety and effectiveness of three different dose strengths of the vaccine. Should they succeed in the trial, it will be a major step forward in the control of this major public health problem.


Source
St Louis University School of Medicine 17th November 2003

[willing]

Steve': sorry, I got that back-asswards. Portal inflammation is at grade 3 and your lobular activity is only at grade 1. Same issue, moderate inflammation - but different place.

Susan - you're welcome - maybe I'll grow up and become a reference librarian some day. For now it just helps keeps my mind off the itching!

[willing]

Steve - is it possible you mistyped "portal-portal septor(grade 2)" instead of "portal-portal septa(stage 2)"? The Scheuer scale is yet  <em>another</em> scoring scheme:

1. Grade
A. Portal inflammation and interface hepatitis
0 Absent or minimal
1 Portal inflammation only
2 Mild or localized interface hepatitis
3 Moderate or more extensive interface hepatitis
4 Severe and widespread interface hepatitis
B. Lobular activity
0 None
1 Inflammatory cells but no hepatocellular damage
2 Focal necrosis or apoptosis
3 Severe hepatocellular damage
4 Damage includes bridging confluent necrosis
2. Stage
0 No fibrosis
1 Fibrosis confined to portal tracts
2 Periportal or portal?portal septa but intact vascular relationships
3 Fibrosis with distorted structure but no obvious cirrhosis
4 Probable or definite cirrhosis
(<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11441339&dopt=Abstract">from</a>
). Unlike Knodell's it uses 5 rather than 4 stages of fibrosis. You were at a 2. The inflammation was mild (portal inflammation=1) but there were extensive dead/distorted cells (lobular activity=3)

[Tallblonde]

Thanks for the great link on fibrosis.  I bookmarked that one.  I really appreciate the terrific job you do on keeping us so well-informed on this disease.  I've really learned a lot from you.  

Susan

[Steve']

Hi I typed all this out once a few weeks ago & something happened it was lost or maybe brain fog got me haha I'm on week #16 of Tx Peg Interferon + Ribavirin I'm 45 yers old in Sydney, Australia & geno 3a ... lets try again ..  My biobsy I've never understood it way to technical ... please help me understand it GI.PA I apprerciate your help immensly, you do a great job here in your free time I've followed this site for a while & seen the good you've done Thanks Again :) ... Here's my Bx
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The core biopsies of liver show normal hepatic architechture. The portal tracts are expanded by fibrosis with portal-portal septor (grade 2). They also contain a chronic inflammatory infiltrate with lymphoid aggregate formation & moderate interface hepatitis (grade 3). The lobules show pachy inflamation with no eosinophil body formation (grade 1). Moderate macrovesicular steatosis is noted & the orcein & iron stains are non contributory. No pas possitive diastase globules are identified & there is no evidence of mallory's hyaline or ground glass cells. There is no evidence of bile pigment retention. The features are in keeping with chronic hepatitis c with mild to moderate activity. Scheuers score 3+1+2=6</font>
<br><hr><P><marquee direction="right"><Font face="Brush Script MT"size=+3<b>Steve</b></font></marquee><br>

[willing]

botched the first <a href="http://tpis.upmc.edu/tpis/schema/HAI.html">link</a>

[willing]

this is  a <a href=http://tpis.upmc.edu/tpis/schema/HAI.html">summary</a> of the Knodell HAI the scoring system used for your biopsy. The first three indices (1,0,3 in your case)describe inflammation in the liver - basically the  extent and pattern of inflamed or dead (necrotic) cells in the tissue  The last number describes the extent and pattern of scar-tissue(extra-cellular matrix, ECM). This is the one you care about since excessive scar tissue leads to liver dysfunction and eventually failure. Interestingly they didn't assign a number but "fibrous portal expansion" (scar tissue starting to radiate out  from the portal vein area but not yet interconnected) corresponds to  a score of 1. Per standard "who to treat" algorithm (<a href="http://hepatology2.aasldjournals.org/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=fullfree&id=ajhep03600s3#head4">see</a> ) you are on the cusp between having tx be a recommended or purely elective decision, but leaning toward the former. Your relatively low VL improves your chances of success if you do treat. Good news overall! Here's a good <a href="http://hepatology2.aasldjournals.org/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=fullfree&id=ajhep0360s47">review</a> on fibrosis progression.

[GI.PA]

Heres the basic things to take away from the biopsy (keep in mind there are so many ways to look at and score biopsies).

Key one:   Periportal Inflammation  (this is inflammation around the liver cells).  This is almost always seen in any type of "hepatitis", generically this is liver inflammation.  Piecemeal necrosis:  This is just more inflammation and even a few cells that are deteriorating.  This too is expected in Hep C.

Key two:  Most important:  There is some mild fibrosis (early scarring) but no "bridging fibrosis" which is more extensive scarring..early steps to cirrhosis.

Considering you have had this for 20 years, this is a very favorable biopsy finding, suggesting a slow-moving disease process.

Hope this helps.

GI.PA