MASSIVE MACROPHAGE LIPID-ACCUMULATION PRESENTING AS HEPATOSPLENOMEGALY AND LYMPHADENOPATHY ASSOCIATED WITH LONG-TERM TOTAL PARENTERAL-NUTRITION THERAPY FOR SHORT-BOWEL SYNDROME

We present a unique case of massive splenomegaly, hepatomegaly and lym phadenopathy caused by lipid-laden macrophages in a 50 year old white female with short-bowel syndrome treated with long-term total parenter al nutrition. Using transmission electron microscopy and special stain s we were able to show that the total parenteral nutrition lipid compo nent was composed of lipid droplets and micelles morphologically ident ical to those found in lipid-laden macrophages which had accumulated i n the patient's reticuloendothelial system leading to massive splenome galy, hepatomegaly (without evidence of steatosis) and lymphadenopathy , While this phenomenon has been reported in animal models, no human c ases have been previously reported. HUM PATHOL 29:651-655. Copyright ( C) 1998 by W.B. Saunders Company.