November 6, 2000
I had to have another liver biopsy before beginning the HALT-C study. They had tried to get the NIH to use my April 2000 biopsy but they didn't want that one. It went real well. Dr. Bonacinni did the biopsy at USC University Hospital. I didn't even use a sedative this time. He deadened the skin, then the muscle, which is what can cause that right shoulder pain, then jabbed away. He had to jab me twice, which didn't thrill me but it wasn't bad.

I didn't have to lay on a sandbag or even on my right side. I thought that was kind of weird, but he said studies now show that isn't necessary. They wanted to keep me overnight, I guess that is their usual protocol, but I threw a fit and they finally let me go home. I had no shoulder pain, and just a little bit of pain in the right upper quadrant area. I do have a real nice purple bruise and a hole there now! I got the results on November 8 and they are:

MICROSCOPIC DESCRIPTION:
    Sections of needle biopsy of liver reveal distorted lobular architecture due to marked fibrous expansion of portal tracts with portal-to-portal bridging. There is also sinusoidal collagen deposition both in the periportal and in some of the perivenular zones. Within the portal tracts there is mild to moderate mononuclear inflammation with focal piecemeal necrosis and cuffing of the hepatocytes. The parenchyma exhibits 2+ macrovesciular and focal microvescular fatty change. The fat appears periportal to midzonal in distribution. Scattered foci of hepatocytolysis with aggregates of Kupffer cells are seen in the parencyma. No Mallory bodies, colestasis or granulomas are seen. Both the DIPAS and the iron stains are negative.

DIAGNOSIS:
    Liver, chronic hepatitis (typeC), moderate portal fibrosis with portal-to-portal bridging and moderate necroinflammatory changes.

NOTE:
    The histology activity index (Ishak Score) is 6/18 for necroinflammation and 3/6 for fibrosis.
 

October 28, 2002
My second biopsy for the study was done on this date. I am half way through the study. This was the easiest biopsy I have done to date! They gave me the same drug that I had for the endoscopy and don't even remember the biopsy at all! When I remember the name of the drug I'll post it! (brain fog is alive and well!)

MICROSCOPIC DESCRIPTION:
    Sections of needle biopsy of liver reveal partially distorted lobular architecture due to portal fibrosis and occasional portal-to-portal fibrosis bridging. Within the expanded portal tracts there is mild to moderate mononuclear inflammation consisting of lymphocytes and macrophages. The interlobular bile ducts are identified and appear normal. There is focal spillover of inflammation with cuffing of the hepatocytes and rare piecemeal necrosis. The parenchyma exhibits 3+ macro and microvesicular fatty change in a diffuse fashion. There is focal perivenular and pericellular sinusoidal collagen present. There is also mild Kupffer cell hyperplasia and rare focal necrosis in the parenchyma. No Mallory bodies are seen. There is no dysplastic change seen. The special stains including iron and the DIPAS are negative. Rare glycogenated nuclei are seen in the periportal zones.

DIAGNOSIS:
    Liver, chronic hepatitis (type C) with bridging fibrosis and mild necroinflammation.

NOTE:
    The histology activity index (Ishak score) is 4/18 for necroinflammation and 3/6 for fibrosis. In comparison to the previous biopsy (11/6/00) there is reduced necroinflammation and increased fatty change. Fibrosis stage remains the same.