Biopsies and confusion

[ceward204]

Here is my wifes Biopsys from Nov of 2020

STEATOHEPATITIS (SEE COMMENT),

'There are 9 portal tracts represented. A trichrome stain shows extensive pericellular fibrosis and bridging fibrosis. A PAS with diastase is negative for alpha-1-antitiypsin inclusions. A reticulin stain shows a maintained architecture. A Prussian Blue stains is negative for siderosis. For additional findings, see template in comment section. The control tissues are staining appropriately.

COMMENT:

NAFLD Activity Score (NAS) Components (per NASH

CRN Scoring System)

- Steatosis: Grade 3 of3 (>66%)

- Ballooning: Grade 2 of 2 (Moderate/marked, many)

- Lobular Inflammation: Grade 3 of 3 (> 4 foci per 20X optical field)

- Histopathologic Interpretation of Nonalcoholic Steatohepatitis per NASH CRN: NASH

- Liver Fibrosis (NASH CRN System): Stage 2 (Bridging)

- Bridging Fibrosis: Many

Other Disease Activity

- Mallory Bodies: Many

Follow up Biopsys

June 2021

DIAGNOSIS:

A) SUBMITTED AS 20G CORES X3

(NEEDLE BIOPSY):

- STEATOHEPATITIS (SEE COMMENT).

MICROSCOPIC:

There are 9 portal tracts represented. A

trichrome stain shows no pericellular

fibrosis and bridging fibrosis. A PAS with

diastase is negative for alpha-1-antitrypsin

inclusions. A reticulin stain shows

a maintained architecture. A

Prussian Blue stains is negative for siderosis.

For additional findings, see template in comment

section. The control tissues are staining

appropriately.

COMMENT:

NAFLD Activity Score (NAS) Components (per NASH

CRN Scoring System)

- Steatosis: Grade 1 of 3 (5-33%)

- Ballooning: Grade 0 of 2 (none/none)

- Lobular Inflammation: Grade 1 of 3 (<2 foci per

20X optical field)

- Histopathologic Interpretation of Nonalcoholic

Steatohepatitis per NASH CRN: NAFLD

- Liver Fibrosis (NASH CRN System): Stage 1

(minimal)

- Bridging Fibrosis: none

Other Disease Activity

- Mallory Bodies: none

As those who have followed my wife passed in January of 2023, 3 of the four doctors said she had no cirrhosis and was dealing with a drug-induced hemolytic reaction, coupled with an AKI from Vancomycin that finally caused her to die in her sleep from renal failure.

As part of grieving... as the one doctor who kept saying... you are struggling to accept the diagnosis?

Yes... I am.. as the other 3 said, there is no cirrhosis.

The Doctor who said she had cirrhosis based his diagnosis on the ultrasound report.

"CLINICAL HISTORY/PROVISIONAL DIAGNOSIS: 58-year-old with NASH cirrhosis and increased bilirubin in the setting of normal LFTs. Rule out biliary obstruction.

COMPARISON STUDY: Prior ultrasound performed on August 10, 2022

EXAM DESCRIPTION: Limited abdominal ultrasound with Doppler

The gallbladder is not distended or thick-walled. A small amount of gallbladder sludge is noted no cholelithiasis is seen. No pericholecystic-free fluid is seen. No biliary dilatation is seen, and the common bile duct measures 0.5 cm.

The right hepatic lobe measures approximately 21.9 cm. The liver parenchyma is mildy echogenic in keeping with fatty infiltration. No focal solid hepatic lesions are identified. The liver contour appears mildly irregular. The visualized portal veins appear patent with the appropriate directional flow. Flow Rate is normal at 24cm/s

The right kidney measures approximately 11.2 cm and demonstrates no hydronephrosis. IMPRESSION:

1. Enlarged and fatty liver

2. No cholelithiasis or biliary dilatation is seen. A small amount of gallbladder sludge is noted.

Her Blood work

Albumin 3.3 normal

Bilirubin Total 2.5 high

Bilirubin direct .2 normal

AST 18

ALT 17

GGT 45

LD 118

Phosphate 89

I am not asking for opinion, I am pointing out, how easy it is for someone to make a mistake.