604 THP; LIVER. 



tioDS resemble giant cells. Tubercle bacilli, frequently in small numbers, 

 but often in great abundance, may be found within the tubercles. 



Tuberculosis of the liver may be associated with cirrhosis, or waxy 

 and fatty degeneration. 



Much more rarely than the above form there are found in the liver 

 more or less numerous scattered tuberculous masses from the size of a pea 

 to that of a walnut or larger, with cheesy centres and usually a new 

 growth of connective tissue in the periphery. These so-called solitary 

 tubercles of the liver may be softened at the centres. Tuberculous inflam- 

 mation of the. gall ducts may give rise to numerous scattered, cheesy 

 nodules, as large as a pea or larger, which may be softened at the centre 

 and stained yellow with bile. Small cavities may thus be formed. 1 

 This lesion is rare and seems to be more frequent in children than in 

 adults. 



Perihepatitis. Acute exudative inflammation of the serous covering of 

 the liver, with the formation of fibrin, may occur as a part of acute gen- 

 eral or localized peritonitis, or over the surface of abscesses, tumors, 

 hydatids, etc. , of the organ, when these lie near or approach the surface ; 

 or it may be secondary to acute pleurisy. 



Chronic perihepatitis, resulting in the thickening of and formation of 

 new connective tissue in and beneath the capsule of the liver, may be 

 secondary to an acute inflammation of the capsule, or it may be chronic 

 from the beginning and associated with chronic pleurisy, chronic peri- 

 tonitis, and cirrhosis. In this way more or less extensive adhesions of 

 the liver to adjacent structures may be formed ; or, by contraction of the 

 new-formed connective tissue, considerable deformity of the liver may 

 be produced. The capsule is sometimes uniformly thickened, sometimes 

 the new tissue occurs in more or less sharply circumscribed patches. The 

 surface is sometimes roughened from little, irregular projecting masses 

 of connective tissue. Microscopically the new-formed tissue is usually 

 dense and firm, but it may be loose in texture and contain many cells. 

 Not infrequently bands or masses of connective tissue run inward from 

 the thickened capsule between the superficial lobules, causing localized 

 atrophy of the parenchyma. 



HYPERPLASIA OF LYMPHATIC TISSUE IN THE LIVER. 



In some forms of leukaemia and pseudo-leukaemia the liver is not in- 

 frequently enlarged and soft and besprinkled with small white spots, or 

 streaked with narrow whitish, irregular bands, or it may be of a diffuse 

 grayish color. Microscopical examination shows this change to be due 

 to an accumulation of cells resembling leucocytes, either along the portal 

 vein, or diffusely through the liver tissue, or in small circumscribed 

 masses. The amount of accumulation of these small cells varies much, 

 but is sometimes so great as seriously to compromise the liver cells. The 

 origin of these new cells is not yet definitely known. They may be, and 



1 See for a study of tuberculous cavities in the liver, Fletcher, Journal of Pathology 

 and Bacteriology, vol. vi., p. 147, 1900, bibl. 



