Please interpret the liver biopsy report shown below. Kindly explain the what stage of fibrosis and confirm whether cirrhosis is present or not.
A. Liver parenchyma biopsy:
Steatohepatitis with perisinusoidal and periportal fibrosis.
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.
Patient is a 48-year-old male with fatty liver and elevated LFTs presents for liver.
Operation: none provided.
Operative findings: none provided.
Clinical diagnosis: fatty liver.
A/1. Liver parenchyma biopsy.
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 0.3-1.7 cm in length by 0.1 cm diameter) which are submitted in toto. A1: 4 fragments
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The most common cause of periportal and perisinusoidal fibrosis with chronic inflammatory cell infiltration is due to steatohepatitis in both alcoholic and non-alcoholic. However, chances are very high in alcoholics. Periportal fibrosis can occur due to Schistosoma mansoni residing at some pocket 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.
Thank you doctor,
Does the report provide enough details to determine the stage of fibrosis, i.e., F1, F2, F3, etc.? Also, is Schistosoma mansoni the only cause? How would a person who never traveled abroad get this condition?
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I told Schistosoma mansoni can cause this type of condition without knowing your tour habits. If you were never out of your country, then this possibility is ruled out. Often this is a common question to the 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 get panic. Give up Alcohol if you are used to it. You are obese and need to reduce your weight a lot.
I hope this helps.
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