My biopsy specimen contains portions of at least eight portal areas. There is moderate chronic inflamation in the portal areas with moderate periportal fibrosis and a hint of possible early bridging fibrosis. There are rare neutrophiles within the portal areas. the limiting plates of the portal areas are focally obscured though convincing piece meal necrosis is not identified. there is minimal proliferation of bile ductules. There is slight to moderate fatty metamorphosis of the hepatocytes. A trichrome stain confirms the moderate increase in fibrosis tissue around the portal areas and early bridging fibrosis.The iron stain reveals no stainable iron with a strongly positive control. Would you please help me understand what this means and how would you grade the inflamation and scarring. I also have severe itching Would this have anything to do with proliferation of the bile ductules
 

It is difficult to give you a certain opinion of this biopsy, because we have to assume that the description is correct and reliable. If we were to change that to the Ischak score, it will be between 4-5 grading and a 3 staging score. This means a moderate degree of the inflamatory process, and a moderate degree of fibrosis. This is not a cirrhotic liver. The histology has to be considered together with other factors as the duration of the infection, to assess the fibrosis progression rate, HIV status, genotype, viral load age ,and general health.