translate US and biopsy reports please??

[Paul05]

Hi everyone, i hope you are all doing well.

i have recently had a US and liver biopsy and wondered if anyone here is able to translate them into something i can understand

the reports read:

US:

there are a number of apparent polypoid small lesions in the gallbladder measuring maximally 4.5mm. some seem to move freely and i suspect represent small calculi. the left lobe of the liver is rather atrophic and the right lobe is slightly echogenic diffusely.

BIOPSY:

the architecture is disturbed with a nodular process. the portal tracts are fibrotic, expanded and there is portal - portal and portal - venous bridging. most of the portal tracts contain dense collections of lymphocytes admixed with some plasma cells and focal neutrophils. there is some bile duct damage, but no obvious granuloma formation is seen. there is also a focal spread of the inflammatory infiltrate into the parenchyma. no alpha one antitripsyn, iron or copper accumulation is seen.

clinical diagnosis of primary billary cirrhosis with elements of autoimmune hepatitis. there is an established cirrhosis with moderate to severe inflammation.

obviously the diagnosis has been confirmed by these tests but there seems to be alot in these reports that i simply do not understand what they mean so any help would be very much appreciated.

take care everyone.

[chynablue]

I am not a doctor. Talk to your doctor and believe what they say, not me. But I know waiting can be torture, so...

Polypoid lesions are typically benign (non-cancerous) spots. You should be OK here, but they will look again next time you have imaging done just to be sure it hasn't changed.

Calculi indicate particles in the gallbladder - large ones would be called gallstones, a lot of smaller calculi would be called gallbladder "sludge" (treatable with medication). I suspect that if that was the case, then your summary would have noted possible gallstones or sludge. So, I would say that these calculi are most likely of no concern because they are so small. Tiny calculi are normal and typically passed through the gallbladder without consequence. Its only really a problem if it can block a duct, which doesn't look like the case here.

Atrophic means small. This could be the way your liver has always been. Again, they will check later to see if this has changed.

Echgenic diffusely means fatty deposits here and there. It sounds like its not enough to get a diagnosis of fatty liver disease, or else they would have indicated that in the summary. Keep an eye on your diet, though and see what the doctor says.

Nodular process means spots or lesions, usually non-cancerous. You should be OK there.

Fibrotic means scar tissue and bridging is most likely scar tissue. Portal-portal and portal-venous indicates where they say the scar tissue, but I don't know specifically where they are talking about, I would assume near the portal vein and/or bile ducts. They state that scar tissue is observed, so it is present, but the amount is not really indicated. That's why the summary says "established cirrhosis". Further tests can determine whether this is causing an issue with liver function or not, so don't freak out. The doctor can elaborate and they might do additional tests to see if liver function and circulation is impaired.

Lymphocytes and neutrophils are white blood cells sent out by the immune system. This could be normal, a slight infection, or autoimmune - more testing would determine which. That is probably why they mentioned elements of autoimmune hepatitis.

Granuloma indicates inflammation, and you have none, so that's good.

Focal spread means that there is spreading around a central point.

Inflammatory infiltrate means the white blood cells spreading into the surrounding tissues.

Parenchyma means tissue, like liver tissue.

So, "a focal spread of the inflammatory infiltrate into the parenchyma" means something like they saw a small area of white blood cells (lymphocytes and neutrophils) and they were spreading into the surrounding tissues.

Its just a fancy, drawn out way of saying that there was some inflammation, but not bad enough inflammation to see granulomas.

All of this is summarized at the end of the report:

clinical diagnosis of primary billary cirrhosis (treated with Ursodiol medication) with elements of autoimmune hepatitis (managed with steriods or other immune suppressive meds). there is an established cirrhosis (keep an eye on that with regular imaging) with moderate to severe inflammation (inflammation leads to tissue damage which leads to scarring, so they will monitor to make sure the medications are keeping this to a minimum going forward).

I am not specifically trained on reading imaging reports, and I am not an ultrasound tech or a biopsy lab tech. I would say that overall, I'm probably about 75-80% correct with what I'm saying, so take it with a huge grain of salt.

I hope that helps.

[Paul05 in reply to chynablue]

wow thank you chynablue, that is a great reply, i really appreciate it.

i understand that everyone on here are not doctors but when it comes to something like this where i understand the diagnosis was confirmed by the biopsy but all the rest of it i had no clue and what seems like an age to wait to see the doc, it was really playing on my mind and a reply like that helps a huge amount to put my mind at rest a little.

i have more bloods to be done next week and a doc visit in may when i can ask him all the hundreds of questions running in my head lol but again thank you so much for your help.

take care

paul

[chynablue in reply to Paul05]

I know, its like, "polypoid lesions"? what the hell is that?  Am I dying?!? and then you struggle with fear and anxiety for months only for the doctor to say, oh that's nothing.

[Paul05 in reply to chynablue]

Yeah that's exactly it, all types of things running through your head and not knowing what it means only makes things worse, but thankfully we have people like you that can shed a little light on the subject