Do I have cirrhosis based on my biopsy report?

Question

Hello doctor,

Please interpret the liver biopsy report shown below. Kindly explain the stage of fibrosis and confirm whether cirrhosis is present or not. Pathological diagnosis, on liver parenchyma biopsy, steatohepatitis with perisinusoidal and periportal fibrosis was shown.

Note: The biopsy shows preservation of the architecture. Trichrome and reticulin stains highlight foci of perisinusoidal and periportal fibrosis. The portal tracts show patchy chronic inflammation composed predominantly of small lymphocytes. Interface activity is not identified. The interlobular bile ducts are intact without injury. The lobular parenchyma is notable for 30% macrovesicular steatosis. Rare hepatocytes show ballooning degeneration with Mallory hyaline inclusions. There are scattered foci of inflammatory activity throughout the parenchyma. Cholestasis is not seen. The hepatic vasculature is unremarkable. The iron stain shows trace storage iron. PAS stain after diastase digestion is negative for diagnostic cytoplasmic inclusions. Clinical data: Patient is a 48-year-old male with fatty liver and elevated LFTs, presents for liver. Parenchymal biopsy. Operation: none provided. Operative findings: none provided. Clinical diagnosis: fatty liver. Tissue submitted: A/1. Liver parenchyma biopsy. Gross description: Part A is received in formalin, labeled with the patient's name, Liver parenchyma biopsy and consists of 4 tan-brown cylindrical soft tissue fragments (ranging from 0.1-0.6 inches in length by 0.04 inches diameter) which are submitted in toto. A1: 4 fragments.

Kindly guide.

Answer 1

Hello,

Welcome to icliniq.com.

The most common cause of periportal and perisinusoidal fibrosis with chronic inflammatory cell infiltration is due to steatohepatitis in both alcoholic and non-alcoholic individuals (attachment removed to protect the patient's identity). However, chances are very high for alcoholics.

Periportal fibrosis can occur due to Schistosoma mansoni residing in some pockets in the Middle East. Your report does not suggest frank portal cirrhosis. LFT (liver function test) will indicate the functional condition of the liver. If it responds to the treatment, reversal is possible; otherwise, it may lead to frank portal cirrhosis.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Schistosoma mansoni can cause this type of condition without knowing your tour habits. If you have never been out of your country, then this possibility is ruled out. Often, this is a common question for pathologists to assess the staging and prognosis of the patient. It is very difficult to stage fibrosis.

Moreover, clinical data and lab reports are important. So far, with the information given in the report, there is no portal invasion of fibrosis and no interlobular bridging of fibrosis. F1 to F4 staging is normally done to assess the stage of cirrhosis.

In my opinion, your diagnosis is not cirrhosis. It is liver inflammation due to fatty changes and chronic inflammation of the liver. Alcohol consumption in excess is an important cause. You did not mention that. So far, fibrosis is concerned, it is from 0 to 1. Do not panic. Give up Alcohol if you are used to it. You are obese and need to reduce your weight significantly.

I hope this helps.

Thank you.