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    What does my biopsy report indicate?

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Posted on Mon, 17 Jul 2017 in Digestion and Bowels
Question: Jus received my biopsy results ..help me understand results
Age: 56 Gender: Female
Results
Order: Pathology Exam Name Date Value Units Range Source Pathology Exam 6/20/2017 see details Sharp Rees-Stealy Medical Group Notes: *****Anatomic Pathology Report*****
Accession Collected Received Pathologist Number Date/Time Date/Time 02-SP-17- 06/20/2017 06/20/2017 Behling MD, 0000 00:00 PDT 18:05 PDT XXXXXXX
Diagnosis Liver, biopsy:
CHANGES CONSISTENT WITH PRIMARY BILIARY CHOLANGITIS
MILD FIBROSIS.
*************************************************************
ACTIVITY (GRADE*)
FOCAL LOBULAR NECROSIS:
1 - AT LEAST ONE NECROINFLAMMATORY FOCUS PER LOBULE.
PORTAL INFLAMMATION:
Name Date Value Units Range Source
2 - MONONUCLEAR AGGREGATES IN ALL PORTAL TRACTS.
INTERFACE ACTIVITY:
1 - FOCAL ALTERATION OF THE PERIPORTAL PLATE IN SOME PORTAL TRACTS.
BRIDGING NECROSIS:
0 - ABSENT.
STAGE*
1 - PORTAL FIBROSIS WITHOUT SEPTA (PORTAL FIBROUS EXPANSION).
OTHER FINDINGS:
STEATOSIS - 20. IRON - NEGATIVE. PAS-D - NEGATIVE. # OF PORTAL TRACTS - 18.
COMMENT PAS-D, trichrome, reticulin, and iron stains support the interpretation.
REFERENCE *Grade and Stage are based on the METAVIR Scoring System: Bedossa, P. and Pynard T. et al, An Algorithm for the Grading of Activity in Chronic Hepatitis C HEPATOLOGY 1996;24:289-293.
*****Anatomic Pathology Report*****
Accession Collected Received Pathologist Number Date/Time Date/Time 02-SP-17- 06/20/2017 06/20/2017 Behling MD, 0000 00:00 PDT 18:05 PDT XXXXXXX
88307, 88313 x4
Name Date Value Units Range Source XXXXXXX Behling, MD CB/mjw 06/23/2017 (Electronic Signature) Performed at Sharp Memorial Hospital, 7901 Frost Street, San XXXXXXX CA 92123
Clinical History R94.5 - Elevated LFTs; serology suggestive of primary biliary cholangitis
Specimen Liver
Gross Description The specimen is received in formalin labeled with the patient's name and identification, designated on the accompanying requisition as "liver." It consists of a single XXXXXXX core measuring 2.3 cm in length x 0.1 cm in diameter. The specimen is entirely submitted in cassette 1A for CTBX and LIVSS protocols. RTS/ll/sae
Microscopic Description Microscopic examination was performed, and 6 slides were reviewed t got my biopsy results

doctor
Answered by Dr. Ramesh Kumar 7 hours later
Brief Answer:
Please go through explaination.

Detailed Answer:
Hello,
Thanks for choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concerns.

As per your query answers are-
1)CHANGES CONSISTENT WITH PRIMARY BILIARY CHOLANGITIS

MILD FIBROSIS.

-Primary biliary cholangitis, is considered an autoimmune disease,It is a disease in which the bile ducts in your liver are slowly destroyed. Immune system of body fails to differenciate between external and internal cells hence starts destroying own cells.

When bile ducts are damaged, as in primary biliary cirrhosis, harmful substances can build up in your liver and sometimes lead to irreversible scarring of liver tissue called fiborsis.
So mild fibrosis is due to primary biliary cholangitis. When ever there is damage to a particular part of body the cell,cells in that part starts to die and dead cells are fibrosed(scarred).



1) FOCAL LOBULAR NECROSIS: Apoptosis(cell death) is mediated by proteolytic enzymes called caspases, which trigger cell death(liver is made of million of small units termed as cells). Caspases exist in all cells as inactive precursors producing a proteolytic caspase cascade leading to necrosis(the death of most or all of the cells in an organ or tissue due to disease, injury, or failure of the blood supply).

2) - MONONUCLEAR AGGREGATES IN ALL PORTAL TRACTS. INTERFACE ACTIVITY:
1 - FOCAL ALTERATION OF THE PERIPORTAL PLATE IN SOME PORTAL TRACTS.
BRIDGING NECROSIS:
0 - ABSENT.
STAGE* 1 - PORTAL FIBROSIS WITHOUT SEPTA (PORTAL FIBROUS EXPANSION).

In lay mans version all these things are mediacal explaination for the same thing.
Hepatobilliary system consists of Liver,Gallbladder and Portal vein.Portal vein brings blood to liver as already explained that as cell starts to die the small blood pipes supplying liver also dies leading to necrosis and fibrosis.

Take home message-As immunity of your body is acting against your hepatobilliary system it is destroying cells.These destroyed cells due to lack of blood supply converts into fibers.

Though not asked yet-

PBC is a progressive disease that can be controlled but not cured.

Damage to the bile ducts and liver leads to an increase in enzymes produced by your liver. The high level of enzymes can be detected by certain routine blood tests. A diagnosis of PBC can usually be confirmed by checking your blood for anti-mitochondrial antibodies (AMAs).Hence to keep a check on condition liver functions should be repeated every six month.

Ursodiol treatment late in the course of the disease can still slow the progression of liver damage. Ursodiol treatment improves the outcome of primary biliary cirrhosis, it does not cure the disease.

P.s -There are various types of necrosis(pathologically).However that classification does not have any effect on prognosis of your problem.
Hope i was helpful.
Please feel free to follow up.


Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ramesh Kumar 33 minutes later
Hi Dr XXXXXXX

Will you say from the results of biopsy submitted that the stage of my disease as 1. There is also a #2 in regards to portal inflammation. Does the 2 refer to a stage?
Also steatosis 20...is that a percentage? a high measure?

Thanks

xxx XXXXXXX
doctor
Answered by Dr. Ramesh Kumar 14 minutes later
Brief Answer:
Follow up.

Detailed Answer:
Hello again,
All feature are suggestive of stage one fibrosis.

No that does not mean stage 2.
I am sorry but steatosis 20(i don't think such classification is mentioned in any of the standard books).So i can't make individual comment on that.

Overall you need not to worry you are just in initial stages and it takes about 20-30 years for this disease to progress to serious stages.
So i don't feel there is any need to worry.

Just keep repeating LFT every six months.

Thanks.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2426 Questions

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