Focal fatty change of the liver. A review and a case associated with continuous ambulatory peritoneal dialysis.

Focal fatty change (FFC) of a liver with unequivocal normal architecture is rare. A review of the literature revealed 39 histologically well-documented cases. Well-known steatogenic conditions were present in most of these cases. Focal ischaemia or a varying rate of mobilization of fat in the liver have been suggested as a cause of the focality of the lesions. FFC occurring in a diabetic patient on continuous ambulatory peritoneal dialysis (CAPD) is presented. The FFC in this and in ten previously reported cases associated with CAPD and intraperitoneal insulin therapy had a unique subcapsular distribution, which may suggest a specific pathogenetic mechanism involving insulin. The clinical significance of FFC in the differential diagnosis from other fatty lesions of the liver is summarized.