In patients with MCADD, the inability to metabolize medium-chain fatty acids leads to an accumulation of these fatty acids in cells. This accumulation can cause cellular damage and affect the overall histological structure of tissues. Histologically, this is often observed as increased lipid droplets within cells, particularly in the liver, heart, and skeletal muscles. The presence of excess lipids can disrupt normal cellular function and lead to steatosis or fatty degeneration.