Doctor to English translation, please
February 14, 2009 6:49 AM   Subscribe

YANADFilter: Help me decode my biopsy pathology report into lay terms. I am seeing my doctor soon, but I'm curious what this all means in the meantime. Google is getting me medical journals.

A little background first. I have been getting lumps on my legs for about 10 years now. After getting insurance, I finally got them checked out. Had one removed and sent to the lab. After some wrangling, I got the hospital to release the report to me yesterday after waiting a while in which it was never sent to my primary care doctor.

This is what it says:

"Fibroadipose tissue with acute and chronic inflammation, granulation tissue, and foreign body giant cell reaction"

It sounds like some sort of immune reaction. Is that right? How are acute AND chronic inflammation possible in the same growth?

As far as the bumps go, there's no apparent outside trigger. No injuries or accompanying symptoms. Sometimes they are slightly red and a tiny bit painful, usually when they are new. They tend to go away after a month or three and new ones eventually pop up. I've lived with them long enough to essentially figure out they were benign years ago.

But what does this report mean and what might be the cause? Is this some normal finding or should I expect more testing? Are there illnesses I might be at risk for based on these findings? Basically, what should I expect? (And anything I might have overlooked that I should ask the doctor specifically?)
posted by anonymous to Health & Fitness (6 answers total)

Fibroadipose tissue: Fat tissue with fibrous scarring in it
Acute and chronic inflammation: Yes, it is completely possible to have acute and chronic inflammation in the same growth.
Foreign body giant cell reaction: The cells (macrophages) are reacting to some sort of foreign body -- dirt, glass, splinters, a bullet, whatever -- that's in the tissue.

All in all, I would suspect that you are chronically getting some tiny particles in your tissues. Do you do anything that would cause this? Do you work in construction or some other field where tiny bits of stuff are flying at your legs? Rock climbing? Alternatively, do you scratch or otherwise irritate the bumps? It's possible that you're introducing the foreign material if you're fiddling with the bumps, and the giant cell reaction is secondary.
posted by LittleMissCranky at 7:23 AM on February 14, 2009

Erythema Nodosum
posted by hydropsyche at 7:28 AM on February 14, 2009

So far what you've got is a list of symptoms. Like chronic inflammation isn't a disease per se, but is caused by a disease or something else. LittleMissCranky did a good job of decoding what it means, basically you've got an immune reaction going on within the fatty layers under the skin on your legs. Chronic and acute inflammation is definitely possible, particularly since you've had this for a while. For example, you may have chronic underlying inflammation throughout the fatty tissue which has also flared up to become acute within the irritated lump that was biopsied. Granulation tissue is just where the flesh is healing after an injury by the way, and acute inflammation can cause tissue damage (via that giant cell reaction) so this is probably a side effect of inflammation rather than something else.

It seems like a fairly specific pattern of inflammation so presumably (hopefully!) a doctor looking at it will recognise the pattern and make a diagnosis from it. Erythema Nodosum definitely seems to match, although I'm not a doctor so don't know if something else would match as well. Lab reports aren't always useful to a lay person on their own as they only show what is happening not why it's happening or what has caused it, but that part is what a doctor is trained for.

If you do have any journal articles you want decoded feel free to email me.
posted by shelleycat at 3:17 PM on February 14, 2009

I'm a pathologist.
The interpretation on your report is called a 'descriptive diagnosis,' meaning the pathologist is telling your physician exactly what he is seeing in the tissue that was submitted in the biopsy. It's a non-diagnosis. This tells you really nothing, except that it's nothing serious (ie. nothing malignant), and that those lesions are really inflamed (probably not news to either you or your doctor). There are thousands upon thousands of different things that could cause those histologic findings. But I'll translate:

Fibroadipose tissue: exactly what it sounds like, loose and/or dense connective tissue intermixed with fat. Just what you would expect in the subcutaneous tissue.

acute inflammation: The pathologist is seeing polymorphonuclear cells (ie. neutrophils) in the tissue.

chronic inflammation: The pathologist is seeing mononuclear inflammatory cells (ie. lymphocytes and plasma cells) in the tissue

granulation tissue: collections of numerous small capillaries along with inflammation. The body's typical response to tissue injury (ie. it is repairing some damage).

foreign body giant cell reaction: Collections of epitheliod histiocytes, some of which may have coalesced to form giant cells. This does not mean that there are actually any foreign bodies there, just the type of reaction pattern that is seen under the microscope usually in association with foreign bodies.
posted by i_am_a_Jedi at 5:27 PM on February 14, 2009 [2 favorites]

What a Jedi, great answer!

the only thing you can really say is you have something similar to hives. A reaction to something that your body doesn't like. It doesn't have to be a foreign body from outside. My sister gets these on the legs every time there's egg in any foodstuff she eats.

Have you tried some dietary exclusions to rule out allergies?
posted by Wilder at 1:09 PM on February 15, 2009

I brought up erythema nodosum because that is a description of condition that is a lot like what the pathology reports say. As should be clear from my link, even if that is what you have, it has many, many different causes. Don't listen to people on the internet for an ultimate diagnosis, but do your own research based on what your doctor says.
posted by hydropsyche at 6:21 AM on February 16, 2009

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