Rarely an abscess, which has not yet reached the stage of liquefaction, may be seen in a solid stage because the connective tissue may still be in a stage of semi-dissolution and the hepatocytes though dead may be unliquefied. Under such circumstances, Clark and Meleney^1,2 have labelled this abscess as a "solid, pultaceous mass".
We have been on the look out for evidence of solid amoebic liver abscess at autopsy. Figures 18 a,b,c,d,e,f show necrotic tissue of the abscess in various stages of liquefaction ranging from liquid, through semi-solid to solid. Figure 19 shows a specimen where multiple solid lesions in the liver look more like reticulosis or secondary deposits when in fact histopathology convincingly demonstrated the presence of E. Histolytica. This patient also had amoebic lesions in the colon.
In experimental amoebic liver abscess produced in golden hamsters usually the liver is seen riddled with large patchy necrotic areas. However, in some hamsters, a solid lesion has been encountered (Fig. 20).
Solid amoebic liver abscess may also be seen in clinical practice. The author has seen eighteen such cases all of whom were males. In these cases, the diagnosis was confirmed by the presence of fever, pain and tenderness over the hepatic area, a strongly positive l.H.A. test, presence of a cold area on the liver scan and rapid clinical response to amoebicidal drugs. The cold area on the liver scan disappeared in all the cases within twelve weeks. These patients were needled for diagnostic aspirations. No pus could be obtained in any of them, irrespective of the size of the abscess (Fig. 21) or the bore of the needle used.³
Based on our experience at autopsy and experimental model, we have labelled such cases as having a solid amoebic liver abscess.⁴
Finally, Pai⁵, who has done ultrasonic liver scans on patients with an amoebic liver abscess, noticed that a part of an abscess and sometimes even a whole abscess was solid, thus further substantiating our findings.

References

1. Clark, H C, Am. J. Trop Med., 1925, 5, 157.
2. Melenev, H E, J. Am. Med. Ass., 1934, 103, 1230
3. Paul MiIroy, Brit. J. Surg, 1960, 47, 502.
4. Kapoor, O P. and Mistry, C J, Paper read at XXXIXth Annual Conference of Association of Physicians of India, Madras, Jan 1979.
5. Pai, R R. Personal communication.