My lab report - help Aubrey and others

[Guest guest]

Hi all:

If you remember, I was diagnosed with PSC during my gallbladder surgery and

have been waiting for my appointment with the transplant doctor which is

January 14th. I have an appointment with a new gastro doctor this coming

Monday. I spent all day Friday going from place to place picking up x-rays,

cat scans, hida scans, lab reports, and the liver biopsy and the slides to

take with me to the doctor.

This is the report that was in the envelope with the liver biopsy slides.

I tried to read it, but it is confusing except for the next to the last

sentence which is pretty clear. I haven't been able to see my new lab work

that was done last week, they insisted that it had to only be faxed to the

gastro doctor and wouldn't let me see it (it is their policy). So I don't

know if there have been changes in it since the GB surgery. Any input on

what this report says would be helpful. Also, I have a question, how can

they tell I have fibrosis in my small bile ducts with only a needle biopsy?

Wierd. Also, during my gallbladder surgery the doctor was doing it

laproscopically and ran into web like tissue that kept him from reaching the

gall bladder. They had to laser their way through. He said it was a sticky

substance and that some of my innerds are stuck together with it. Is this

like an endometreosis (sp?) ?

I wonder if that is the same stuff on my liver?

Thanks,

Judy

Preoperative Diagnosis: Chronic Subacute cholecystitis

Post Operative Diagnosis: Same

Tissue Removed A. Gallbladder

B. Liver Biopsy

Date of Surgery: 11/22/99

Gross Examination:

A - Received in formalin and labeled gallbladder is an intact gallbladder

that measures 7x2.5x2 cm. The serosal surface is gray-tan and congested.

The cystic duct is closed off with a metal clip. The gallbladder mucosal

surface is dark green and velvety. The gallbladder contains dark green

mucoid fluid. The gallbladder wall measures 0.2 cm in thickness. No stone

are identified. Representative sections are submitted in one block.

B - Received in formalin and labeled liver biopsy are multiple fragments of

dark yellowish tan needle core fragments of soft tissue, measuring in

aggregate 1.2 x 0.3 x 0.1 cm. The specimen is submitted in its entirety in

one block. Reticulin, trichrome, PAS with and without diastase and iron

stains are requested.

MICROSCOPIC EXAMINATION: 11/24/99

A - Sections examined.

B - Multiple microscopic sections of the needle core biopsy material of the

liver show liver parenchyma and portal spaces. The liver parenchyma show

benign normal hepatocytes with preserved canalicular architecture. The

hepatocytes show normal mild plemorphism. The cell membranes are intact.

There is no evidence of single cell necrosis. The nuclei show normal

chromatin distribution and small nucleoli. There is no evidence of Mallory

hyaline. There is very mild focal fatty change. There is no evidence of

granulomas, acute and chronic inflammation, piecemeal necrosis, viral

inclusions, dysplasia or neoplasia. The portal spaces show concentric

discoid fibrosis surrounding the bile ducts. It appears that the fibrous

process affects primarily small ducts. In some other areas, there is

ductular proliferation and occasional atropy with the appearance of small

ducts.

The following stains were done:

Trichrome - There is concentric fibrosis around small bile ducts and portal

spaces.

Reticulin - Normal reticulin canalicular framework. No evidence of collapase.

There is fibrosis around small bile ducts.

Iron - Negative.

PAS with and without diastase - Essentially negative.

DIAGNOSIS:

A - Gallbladder: Chronic cholecystitis.

B - Liver (needle core biopsy): Benign liver tissue with morphologic changes

strongly suggestive of primary sclerosing cholangitis. Clinical and

radiological correlation is recommended. (See Microscopic description).