TILE LIVKE. 603 



tuberculous inflammation in some other part of the body, or a part of 

 acute general miliary tuberculosis, is most frequently characterized by 

 the formation of larger and smaller miliary tubercles, which may be 

 either within or between the liver lobules or in the walls of the bile 

 ducts. Many of the tubercles are too small to be seen with the naked 

 eye; others may be just visible as grayish points; still others may 

 be from 1 to 3 mm. in diameter, with distinct yellowish -white cen- 

 tres. Microscopical examination shows considerable variation in the 

 structure of the tubercles in different cases, as well as in the same liver. 

 Some of them, usually the smaller ones, consist simply of more or less 



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FIG. 368. A MlI.IARY '1 UBKKCLE OK THE LlTEK. 



Shows a cheesy centre and giant cells. 



circumscribed collections of small spheroidal cells, which are not mor- 

 phologically distinguishable, so far as the form and arrangement of the 

 cells are concerned, from, simple inflammatory foci, or from the diffuse 

 masses of lymphatic tissue which occur normally in the liver. 



In other forms we find a well-marked reticulum with larger and 

 smaller spheroidal and polyhedral cells, with or without giant cells. In 

 still other forms there is more or less extensive cheesy degeneration (Fig. 

 368). The larger forms are conglomerate, being composed of several tu- 

 bercle grauula joined together to form a single nodular mass. The liver 

 cells at the seat of the tubercle are destroyed, and the interstitial tissue 

 and blood-vessels are either destroyed or merged into the tubercle tissue. 

 In the periphery of the tubercles the liver cells may be in a condition 

 of coagulation necrosis, and the tissue round about may be infiltrated with 

 small spheroidal cells. There is in some cases a new formation of gall 

 ducts or of structures which resemble these, and which in transverse sec- 



