Pathological investigation on fatty liver associated with total parenteral nutrition: A study of 19 autopsy cases.

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I have investigated the pathological features of the liver and the microscopic features of the kidneys in 19 autopsy cases of fatty liver associated with total parenteral nutrition (TPN-fatty liver group) and compared them with the liver of 94 normal control autopsy cases and hepatic biopsy specimens of 20 patients with alcoholic fatty liver (alcoholic fatty liver group). In the TPN-fatty liver group, liver weight and its ratio to body weight were significantly greater than those of normal controls (p<0.01), and the liver showed proportional enlargement. Microscopically, large fat droplets were observed in the hepatocytes of centrilobular zone in almost all cases in this group. The incidence of perivenular fibrosis and of bile ductular proliferation, which were characteristic findings in the TPN-fatty liver group, was significantly higher than that in alcoholic fatty liver group (p<0.01). Nuclear vacuole was observed in 8 cases of TPN-fatty liver, nuclear glycogen was disclosed in 5 and nuclear lipid was detected in 11. Nuclear lipid may be misidentified as nuclear glycogen, since both are characterized by nuclear vacuole on HE staining. Focal fatty change and/or vacuolization was observed in renal tubular epithelia in 7 of TPN-fatty liver cases.
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