In liver and spleen specimens of 12 patients with Niemann-Pick disease types A or B, sphingomyelin was increased 15-45-fold, total phospholipids 4-10-fold and cholesterol 3-6-fold over the normal values. The storage pattern was qualitatively similar in both types but the degree of accumulation was less in type B. In Niemann-Pick disease type C (16 cases), sphingomyelin was increased 3.5-fold in liver and 6-fold in spleen. In all forms of Niemann-Pick disease, bis(monoacylglycero)phosphate was markedly elevated. Glycosphingolipids were studied in six cases with type C, three cases with type B and two cases with type A. Glucosylceramide showed the largest increase from the normal pattern in all types of Niemann-Pick disease. Highest values were recorded in type C, 14- and 35-fold normal concentrations in liver and spleen, respectively. Other neutral glycosphingolipids, particularly lactosylceramide, were also elevated, and a 2-4-fold increase of ganglioside GM3 occurred. The fatty acid profiles of the sphingolipids showed only minor alterations. In contrast to the largely dominating sphingomyelin storage found in liver and spleen of Niemann-Pick disease types A and B, the major characteristic of the lipid storage in Niemann-Pick disease type C was the absence of any prevailing accumulation and, thus, the concept of this disorder as a primary sphingomyelin storage disease is not founded.