Disseminated lobular necrosis of the liver with jaundice (hepar necroticum cum ictero of Curschmann and H. Oertel) : and a case of acute hepatic atrophy in secondary syphilis / by F. Parkes Weber.

  • Frederick Parkes Weber
Date:
1909
Catalogue details

Licence: In copyright

Credit: Disseminated lobular necrosis of the liver with jaundice (hepar necroticum cum ictero of Curschmann and H. Oertel) : and a case of acute hepatic atrophy in secondary syphilis / by F. Parkes Weber. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    liead of the pancreas pressing on the common hile-cluct. The gall- bladder and all the extra-hepatic and intra-he[)atic bile-ducts wei-e dilated with green bile, d’he liver was enlarged, weighing 91 oz., and was greenish in colour. I’ieces were removed for microscopic examina- tion. There were several moderately enlarged lymphatic glands in the neighbourhood of the head of the pancreas and in the mesentery, but otherwise no metastatic tumours were seen. The spleen was somewhat enlarged, weighing IG oz. The kidneys did not appear diseased. Microscopic Examination}—The growth in the head of the panci-eas was carcinomatous, and the enlarged lymphatic glands were found to be secondarily infiltrated. The splenic swelling seemed to be due, at all events in part, to engorgement of the organ with blood. The Liver.—Microscopic sections showed a decided increase of interacinous tissue, fibrous rather than cellular, constituting a kind of sclerosis of interacinous (monolobular or rather uni lobular) distribu- tion. Within the acini the columns of liver-cells appeared somewhat shrivelled and abnormally separated from each other, the spaces between them being occupied by dilated blood-capillaries. Many of the liver- cells and bile capillaries were crammed with bile pigment (or rather, inspissated bile). But what chiefly attracted one’s attention was the presence in the hepatic parenchyma of multiple, scattered, sharply defined, circular “ islands ” of tissue which had undergone some necrotic change {see plate). These necrotic islands mostly occupied the whole of a lobule (acinus) ; their average diameter probably equalled that of the lobules. The liver-cells in these areas seemed to have faded or “ melted away,” leaving a scanty “ cobwebby ” meshwork of degenerated ground substance (capillary walls, &c.), containing a few nuclei and fat globules. In the central portions of these areas the necrotic debris was often either deeply stained with bile pigment, apparently by imbibition, or evidently replaced by an actual extravasation of bile from the over- distended bile capillaries. In some of the necrotic areas, however, especially in their central zones, a subsequent small cell-infiltration had succeeded the changes just mentioned. The central portions of these areas were filled with round cells, and the bile-stained debris had been more or less completely absorbed or formed a narrow zone around the central mass of round cells. Outside this zone there was a clearer zone occupied by the meshwork left by the atrophied liver-cells—i.e., consist- ing of degenerated remnants of capillaries, fat globules, &c. Outside this ' For the microscoi)ic sections in tliis case I am greatly imlcbtecl to ^Mr. E. H. Shaw, and also to Dr. Chapuis, one of the House Physicians at tlic (ierinan Hospital.
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