Your Liver Biopsy Report: Key Insights for Patients

Pathology report that is difficult to understand?

Dr.
Chen, I apologize for bothering you again.
Today, I went to the hospital to obtain a copy of my pathology report.
This was an important examination that led to the decision to undergo interferon therapy.
However, due to the rushed nature of my outpatient visit at that time, I was unable to fully understand what the results meant and whether they could replace the viral load tests as a basis for treatment.
I will summarize the contents of the report here and would appreciate it if you could help me understand my condition.
Currently, after completing the interferon therapy, I have returned to my previous regimen of taking liver-protective medications and am awaiting regular check-ups, without any more aggressive treatment options.
Should I consider switching to another hospital for a second opinion?
DIAGNOSIS: Liver, needle biopsy:
1.
Chronic active hepatitis with mild necroinflammatory activity and mild fibrosis (grading 1/4).
2.
Fatty change.
The specimen submitted consists of 2 cords of liver tissue, measuring up to 0.7 cm in length.
All sections were stained with Masson’s trichrome for fibrous grading.
Summary of microscopic findings:
HAI score A.
Ishak Modified HAI Grading (necroinflammatory score) (shown as patient’s score/maximal score of each parameter):
1) Periportal or periseptal interface hepatitis (piecemeal necrosis) = 1/4.
2) Confluent necrosis = 0/6.
3) Focal (spotty) lytic necrosis, apoptosis, and intralobular inflammation = 1/4.
4) Portal inflammation = 1/4.
B.
Staging (Scheuer system for fibrosis and cirrhosis) (4-tiered): score = 1/4.
Status of specimen:
Fragmentation: not fragmented.
Evaluable portal areas: complete = 4 in number; incomplete = 1 in number.
Other findings:
Fatty change: present and marked.
Nuclear dysplasia: absent.
[Special stain x 1]

Mr. Wang, 30~39 year old female. Ask Date: 2006/12/16

Dr. Chen Jianhong reply Gastroenterology and Hepatology

Hello! Your liver biopsy report indicates that your hepatocytes are inflamed (chronic active hepatitis) and there is stage 1 liver fibrosis.
The liver biopsy and viral load tests are different; I'm not sure if you have had your viral load tested (HBV DNA or HCV RNA) (we don't know if you have hepatitis B or C).
Has your ALT level increased again? Have you tested for bilirubin levels? What is your current viral load? If you are a hepatitis B carrier, you need to provide your HBeAg and anti-HBe reports; without these reports, we cannot give appropriate advice.
Would you consider getting a second opinion at another hospital?

Reply Date: 2006/12/16

More Info

Understanding your liver biopsy report is crucial for managing your health, especially after undergoing treatment like interferon therapy. Based on the information you've provided, your biopsy results indicate that you have chronic active hepatitis with mild necroinflammatory activity and mild fibrosis, graded as 1 out of 4. Additionally, there is evidence of fatty change in your liver tissue.

Breakdown of Your Biopsy Report
1. Chronic Active Hepatitis: This diagnosis suggests that there is ongoing inflammation in your liver, which is a response to various factors, including viral infections (like hepatitis B or C), alcohol consumption, or autoimmune diseases. The term "chronic" indicates that this condition has persisted for at least six months.

2. Mild Necroinflammatory Activity: The report indicates a mild level of necroinflammation, which refers to the death of liver cells (necrosis) and inflammation. The grading of 1 out of 4 suggests that while there is some damage, it is not severe.

3. Mild Fibrosis: Fibrosis is the formation of scar tissue in the liver due to chronic inflammation. A score of 1 out of 4 indicates that there is some fibrosis present, but it is still in the early stages. This is important because significant fibrosis can lead to cirrhosis, which is a more serious condition.

4. Fatty Change: The presence of fatty change (steatosis) in the liver can be due to various factors, including obesity, diabetes, alcohol use, or certain medications. This condition can further complicate liver health and may require lifestyle modifications.

5. HAI Score: The Ishak Modified HAI grading system assesses the level of necroinflammatory activity and fibrosis. Your scores indicate that while there is some inflammation, it is not extensive, and the fibrosis is also mild.

Implications for Treatment
Your biopsy results are important for guiding your treatment plan. While the biopsy provides valuable information about the state of your liver, it does not replace the need for viral load testing (HBV DNA or HCV RNA). These tests measure the amount of virus in your blood and are crucial for determining the effectiveness of antiviral treatments and the need for further intervention.

Given that you have completed interferon therapy and are now on maintenance with liver-protective medications, it is essential to continue monitoring your liver function and viral load. If your liver enzymes (ALT and AST) are elevated or if you experience any new symptoms, further evaluation may be necessary.

Should You Seek a Second Opinion?
If you feel uncertain about your current treatment plan or if your symptoms persist, seeking a second opinion from another hepatologist or liver specialist can be beneficial. They can provide additional insights and may suggest alternative treatment options or further diagnostic tests to ensure that your liver health is being adequately managed.

Conclusion
In summary, your liver biopsy indicates chronic active hepatitis with mild fibrosis and fatty change. While these findings are concerning, they are manageable with appropriate medical care. Regular follow-ups, lifestyle modifications, and possibly further testing for viral load are essential components of your ongoing care. If you have any doubts or concerns, do not hesitate to consult with another healthcare provider for reassurance and guidance. Your health is paramount, and understanding your condition is the first step towards effective management.

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