56 



cliroiiic passive congestion due to compres- 

 sion of the vena porta by a mucli enlarged 

 lymphatic gland of the hilus of the liver must 

 also be taken into account. 



The process was evidently acute and 

 recent, the subject being a young male, 22 

 years old, whose clinical history is unknown. 



The autopsy was made 10 hours after 

 death. 



From the protocol we extracted the 

 liver description and the anatomic diagno- 

 sis. 



¿iVíT- Liver enlarged; left edge in contact 

 with the left abdominal wall covering the 

 stomach, spleen and hft kidney. 



Weight 3.200 grs. 



A lymphatic gland enlarged to about 

 the size of a hen's egg enveiops the com- 

 mon bile duct like a short sleeve; it is yello- 

 wish and soft. On section the pulp is found 

 to be yellowish and gelatinous. 



Bile ducts perfectly permeable, not 

 compressed by the above-mentioned gland. 



Liver surface reddish brown, capsule 

 smooth, transparent, shining. On the antero- 

 superior surface some white lines ramified 

 like branches, which form a net with large 

 meshes. In certain parts of the surface, small 

 yellowish confluent spots with clear edges 

 can be seen through the capsule; their dia- 

 meter is about 3 or 4 mm. 



General color of surface of section dark 

 brownish-red. Lobular outlines indistinct; 

 connective tissue not increased. 



There are small confluent yelllowish 

 areas of different sizes, the largest 3 or 4 

 •mm. in diameter, the smallest hardly visible 

 distributed over the whole of the liver, but 

 especially in certain regions a round the cap- 

 sule. Hepatic tissue around these are^s, and 

 all over the liver, dark brDwnish red in 

 color. 



After fixing in lOo/o formol, the spec- 

 imens changed from the general brownish 

 red color, when fresh, to a more or less 

 marked brown. After the piece was fixed 

 the small foci of necrosis became more dis- 

 tinct, looking like small opaque spots of a 

 light yellowish-green color, the larger ones 



measuring 2-3 nun. in diameter, neither pro- 

 minent nor depressed. (Plate 32, Fig. 2). The 

 hepatic tissue forms a slender ring of more 

 accentuated brown color (congestion) than 

 the rest of the tissue. 



In some places, there are 2 or 3 small 

 foci almost touching each other, the zone 

 of hepatic tissue that separates them not 

 being more than 2 or 3 mm. wide; about 

 3 or 4 cms. from such a group one finds 

 other similar groups. The distribution of 

 the lesions is thus irregular; in certain 

 regions, chiefly around the capsule, the 

 kind of group just described; in other re- 

 gions mostly in central part of the organ, 

 the foci are fewer, and appear as isolated 

 spots in the midst of the dark brownish 

 mass of the liver tissue, (dark brownish-red 

 when fresh). 



Anatomic diagnosis: 



Icterus. 



hyperplasia, hypcrnemia et necrosis he- 

 patis. 



Hyperplasia nodonim lymphoticomm he- 

 paticarnm et lumbaruni. 



Nephritis parenchymaiosa chronica. 



Hyperlrophia et dilatatio ventricnli sinistri. 



Oedema pulmonuni. 



Pleuritis chronica adhaesiva. 



Leptomeningitis chronica, (syphilis ?). 



Hypoplasia lienis. 



Microscopic description 



Fragments of the liver, in which the 

 lesions were very marked, were removed 

 at the time, fixed in ZENKER-FORMOL 

 (ZENKER'S LIQUID without acetic acid). 



The paraffin sections were stained by 

 hematoxylin-eosin; other fragments were 

 fixed in lOo'o formol and stained by Schar- 

 lach R-hematoxylin. 



Some of the lesions were distributed 

 over the whole liver, others were focal le- 

 sions. 



A) Focal lesions 



I will describe two of the most typical 

 of these lesions, of which there are many 

 variations, some of them representing more, 



