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Pathology report of liver .... pls for interpretation ?

I just had a biopsy on 21 May 2012 and the results are :
                               pathology report
Gross:
    one of core of yellow soft tissue, 20mm in length. totally submitted.

Microscopic:
     Microscopic examination revealed one core of liver tissue showing preserved architecture. there is mild ballooning and moderate steatosis of hepatocytes.

There is :
      - portal inflammation :mild to moderate (2)
      - piecemeal necrosis : mild (1)
- focal lytic necrosis  : 2-4 foci / 10 X objective (2)
-confluent necrosis : No
fibrosis : there is moderate expansion of all portal area with septa
No evidence of dysplastic change or malignancy

Dianosis :

liver, core biopsy, chronic hepatits, viral c, modified ISHAK HAI 5/18, stage 2/6, metavir A 2/3, stage 1/4.

thank you.


what is my liver current status based on the biopsy report. and what these numbers mean?
Best Answer
446474 tn?1446347682
"what are these no. mean?"

The liver biopsy is an important diagnostic tool because it is considered the most precise procedure we have today for evaluating the health of the liver by measuring the degree of liver inflammation and staging of fibrosis for
predicting disease progression and treatment outcome.  

The liver biopsy involves taking a very small specimen of liver tissue.  The specimen is usually sent to a pathologist for evaluation.  It is very important that this procedure and all lab tests are interpreted by a medical provider.  
With this in mind, the information below is provided to help people understand the Grading and Staging of a biopsy

Grading and Staging

There are a variety of ways to interpret a liver biopsy.  
The most common scoring methods include Metavir and  histologic activity index (HAI) also called the Knodell.  It is important to remember that the length of the liver specimen and the knowledge of the professional reading the biopsy can influence the interpretation of the report.

Metavir

The Metavir scoring system was specially designed for patients with hepatitis C.  The scoring consists of using a grading and a staging system.  The grade gives an indication of the activity or amount of inflammation and the stage represents the amount of fibrosis or scarring.  

The grade is assigned a number based on the degree of
inflammation, which is usually scored from 0-4 with 0 being
no activity and 3 or 4 considered severe activity.  The amount
of inflammation is important because it is considered a
precursor to fibrosis.  

Activity score:
A0 = no activity
A1 = mild activity
A2 = moderate activity
A3 = severe activity

The fibrosis score is also assigned a number from 0-4:
• 0 = no scarring
• 1 = minimal scarring
• 2 = scarring has occurred and extends outside
         the areas in the liver that contains blood vessels
• 3=bridging fibrosis is spreading and
connecting to other areas that contain fibrosis
• 4=cirrhosis or advanced scarring of the liver

Yours is Metavir A 2/3 - meaning A2 = moderate activity
Metavir stage 1/4 - Stage 1, meaning minimal fibrosis.

You are lucky. You have very little liver damage and can wait for new non-interferon treatment to come to market in a few years. The treatments will have less side effects and maybe shorter duration than current treatment.

Hector
10 Responses
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2061362 tn?1353279518
I read some of your other posts, and dude you need to relax a little. I know HCV is a scary thing, we were all scared and to a certain extent, still are. Try to educate yourself a bit more and talk with your Dr. so that you can be more at ease. Freaking out will not help your health. :)

As hrsepwrguy wrote, to treat now or wait is a personal decision that no one can make for you. as others have written, you have minimal liver damage and could certainly wait for newer less harsh drugs. It can take quite a while for much damage to occur, but everyone is different. Many of us had HCV for decades before even being diagnosed. If you do decide to wait to treat your Dr will want to monitor the condition of your liver.

If you do decide to treat just because you want ot remove the virus sooner rather than later, there are some risks to treatment with peg and riba; some people do suffer from permanent side effects, but most people do not. How you respond or the side effects you get are wildly different for everyone. No one can tell you if you will get bad side effects or post treatment problems.

You can check into clinical trials in or near your country. This was just recently posted on the social side of the HCV forum.

http://www.medhelp.org/posts/Hepatitis-Social/-A-New-And-Interesting-Addition-To-The-Hep-C-Clinical-Pipeline-/show/1828183

http://seekingalpha.com/article/929921-a-new-and-interesting-addition-to-the-hep-c-clinical-pipeline

Good luck in your decision, hang around, and keep us posted.
Helpful - 0
Avatar universal
Thanks Mr (hrsepwrguy)
Helpful - 0
1747881 tn?1546175878
"What does this scale mean : modified ISHAK HAI 5/18, stage 2/6 ."

It is basically the same score as the Metavir score just on a different scale, if you want to veiw this scale follow these links (the charts don't copy and paste)

http://www.hepatitis-central.com/hcv/biopsy/modified2.html

http://www.hepatitis-central.com/hcv/biopsy/modified.html

http://www.hepatitis-central.com/hcv/liver/scoring.html

Assessment of Stage of Fibrosis
Liver biopsy remains the gold standard for assessment
of hepatic fibrosis. Several systems for scoring liver fibrosis
have been proposed, each based on visual assessment of
collagen staining of liver biopsy samples. The more frequently
used systems are the histology activity index
(HAI: Knodell score), the Ishak modification of the
HAI score, and the Metavir score.
The HAI system scores necroinflammatory activity
from 0 to 18 assessing periportal necrosis and inflammation
(0 to 10), lobular necrosis and inflammation (0 to 4),
and portal inflammation (0 to 4). Fibrosis in the HAI
system is staged as 0, 1, 3, or 4, with 1 indicating portal
fibrosis only, 3 indicating bridging fibrosis, and 4 cirrhosis.
The discontinuous scale was used initially to allow for
clear separation of mild (1) from extensive (3) fibrosis,
which was believed to have important prognostic
value. The HAI system is simple and has been widely
used, particularly in the large multicenter, registration
trials of interferon and ribavirin combination therapy of
chronic hepatitis C. However, the intra- and interobserver
reproducibility of the HAI is only fair, and the lack
of a score for stages between mild (1) and severe (3)
fibrosis is problematic. In addition, the discontinuous
scale complicates statistical analysis in clinical trials.

Ishak et al. have proposed a modification of the HAI
scoring system, which uses similar scores for necroinflammatory
changes (activity: 0 to 18), but scores fibrosis on a
scale from 0 to 6 with no missed numbers. Scores of 1 and
2 indicate portal fibrosis, 3 and 4 bridging fibrosis, 5
incomplete or early cirrhosis, and 6 established cirrhosis.
The Ishak scale provides better discrimination in assessing
small changes in fibrosis, permitting a better assessment of
progression of disease, and possible effects of therapy. The
intra- and interobserver variability of the Ishak scoring
system has yet to be carefully defined.
The Metavir system scores both necroinflammatory
changes on a 4-point scale of 0 to 3 and fibrosis on a
5-point scale from 0 to 4, no numbers being skipped. The Metavir
system has been carefully validated and
shows good intra- and interobserver reproducibility. This
system is commonly used in Europe.

http://www.hawaii.edu/hivandaids/Fibrosis%20And%20Disease%20Progression%20In%20Hepatitis%20C.pdf

"Do my score start treatment ?"

To treat now or not is a personal decision that should be made by you and a doctor that is knowledgable in treating hep c.
Helpful - 0
Avatar universal
What does this scale mean :
        
         modified ISHAK HAI 5/18, stage 2/6
Helpful - 0
Avatar universal
Thanks Mr ( hrsepwrguy ) ..

You said " Sometimes a score of two or greater suggests that treatment should begin "

what do you mean by this, and Do my score start treatment ?
Helpful - 0
Avatar universal
Thanks mr ( HectorSF ) ..  You reassured me .
But ,,,,,,
What do you think in interferon therapy until the new treatment comes and
Is it harmful?


Helpful - 0
1747881 tn?1546175878
What Is a METAVIR Score?

The METAVIR score helps interpret a liver biopsy. When this biopsy is performed, doctors need a reliable way to quantify what is seen under the microscope. This scoring system assigns two standardized numbers: one to represent the degree of inflammation and the other the degree of fibrosis

What Does My METAVIR Score Mean?
The fibrosis is graded on a 5-point scale from 0 to 4. The activity, which is the amount of inflammation (specifically, the intensity of necro-inflammatory lesions), is graded on a 4-point scale from A0 to A3.
Fibrosis score:
F0 = no fibrosis
F1 = portal fibrosis without septa
F2 = portal fibrosis with few septa
F3 = numerous septa without cirrhosis
F4 = cirrhosis

Activity score:
A0 = no activity
A1 = mild activity
A2 = moderate activity
A3 = severe activity

Why Is a METAVIR Score Helpful?
Your METAVIR score is one of many "tools" your doctor can use to help determine your treatment and monitor your progress. Sometimes a score of two or greater suggests that treatment should begin. This is not always the case, because individualized treatment can also be recommended for people with a lower score.
Like most things, the METAVIR system has its strengths and weaknesses. Other scoring systems are available, such as the Knodell score (also called the histologic activity index, or HAI). However, the METAVIR score is simple to use and is popular in many clinics.

http://hepatitis.about.com/od/diagnosis/a/Metavir.htm

Your metavir score is activity 2 fibrosis 1

The scales are 2 different scales but say the same thing about your liver condition
Helpful - 0
Avatar universal
thank you mr ( copy man )
but I want more explanation !!
what are these no. mean ?
best drug available now ?

you said : Your report shows both of these scales.
I want to know what are these scales ?
Helpful - 0
Avatar universal
There are two scales that are used throughout the world, Your report shows both of these scales. My interpretation is your liver is in good shape. Stage1 on the Metavir scale.

Are you considering treating the HCV or wait for possibly better drugs to come out?

Best of luck
Helpful - 0
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