(Nekros: in Greek means dead body, Necropollis: city of dead) .

“Necrosis is the morphological changes caused by progressive degradative

action of enzymes on lethally inured cell". Could be defined as death of
group of cells in living organism.

So,

Necrosis begins with an impairment of the cell’s ability to maintain

homeostasis, leading to an influx of water and extracellular ions
Morphology of Necrosis

(A) Microscopic Morphology

(1) Changes in Nucleus

One of three from:

(a) Pyknosis
It refers to "condensation & shrinkage of DNA into a solid mass of
increased basophilia" .

(b) Karyorrhexis
It refers to " fragmentation of pyknotic (condensed) nuclear mass".
Nucleus disappears in one or two days.

( c) Karyolysis (( karyon: nucleus))

It refers to " fading of basophilia of chromatin" due to digestion of
DNA by DNAases activated by decreased pH.
(2) Changes in Cytoplasm
(a) Increased eosinophilia (acidophilia) due to loss of RNA
(basophilic) & denaturation of cytoplasmic proteins.

(b) Digestion of cytoplasmic organelles. Cytoplasm becomes

Vacuolated & appears moth – eaten.
 (B) Gross Morphology (Types of Necrosis)

(1) Coagulative Necrosis.

(2) Liquefactive Necrosis.

(3) Caseous Necrosis.

(4) Fat Necrosis.

(5) Fibrinoid Necrosis.

(6) Gangrenous Necrosis.

It refers to " preservation of basic outline of coagulated cell
for some days".

 Coagulative necrosis typically occurs in solid organs such

as kidney, heart and adrenal gland usually as a result of
deficient blood supply and anoxia.
Examples
 All hypoxic death of cells (except in brain), e.g myocardial
infarction.
 Denaturation of protein is the basic mechanism of coagulative
necrosis

 The injury and the subsequent increasing acidosis

denatures not only the structural proteins but also the enzymatic
proteins, thus blocking the cellular proteolysis.
It refers to "progressive catalysis of cell structure, with the loss of basic
outline of cell.

 It is characterized by softening and liquifaction of tissue.

It is the type of necrosis that occurs due to autolytic and heterolytic

actions of enzymes that convert the proteins of cells into liquid.

Digestion of cell by enzymes:

This digestion is of two types

 Autolysis: Digestion of cell by enzymes derived from their own lyosomes
 Heterolysis: Digestion of cell by enzymes derived from lysosmes of leukocytes
Examples
 Ischemic necrosis of brain
 Suppurative inflammation
 Distinctive type of necrosis which shows combined features of
both coagulative and liquefactive necrosis.
 Characterized by the presence of soft, dry, cheesy
homogenous necrotic material.
 It is not liquified

Examples
 Principally in the center of tuberculous granuloma (special
type of chronic inflammation).
 Fat necrosis is a special form of cell death occurring at two
anatomically different locations but morphologically similar
lesions.

It occurs in two forms:

• Enzymatic fat necrosis acute pancreatitis.

• Traumatic fat necrosis Trauma of female Breast

 Fat necrosis ,white chalky deposits
with calcium soap formation (arrows)
in the mesentery.

C
A
 It refers to "immunologic injuries to arteries & arterioles
characterized by accumulation of fibrin, immunoglobulins &
other plasma proteins within walls of affected vessels.

 Mostly seen in two conditions

 Auto immune diseases e.g
Rheumaic fever
SLE
 Malignant hypertension

Fibrinoid necrosis in the wall of blood vessel in case

of polyarterities nodosa. White arrow shows bright
pink area of necrosis in the vessel wall surrounded by
necrotic debris. Rupture of blood vessels causes local
hemorrhage (blue arrow) .
 Gangrene is massive necrosis of tissue with superadded
putrefaction.

 It is the clinical condition in which extensive tissue necrosis is

complicated to a variable degree by secondary bacterial
infection.

 Gangree= Necrosis + infection + putrefaction

Types of Gangrene:
I-Dry gangrene.
II-Wet (moist ) gangrene.
III-Infective gangrene.
IV- Gas gangrene.
 Gangrene
I- Dry gangrene.
Usually seen in the limbs secondary to chronic deprivation &
insufficient blood supply "senile gangrene“. The causes of
arterial occlusion:-
Thrombosis.
Embolus
Surgical legation.
-The affected part of the limb is :

1- Black in color due to formation of iron sulphide after degradation of

haemoglobin.

2-The foul smell results from the formation of hydrogen sulphide by the
action of the saprophytic bacteria e.g. bacillus subtilis on the necrotic
tissue .

3-Mummification and dryness and shrinkage of the dead tissue due to

fluid evaporation.

4-Line of demarcation: an area of inflammatory response between the

viable living tissue and the necrotic tissue. (only seen in dry gangrene).

5-Line of separation: granulation tissue growing from the healthy area

forming a groove between the gangrenous tissue and the healthy tissue,
this groove may deepens until separation of the gangrenous part occurs
(auto amputation) leaving a conical stump.

6- Minimal putrefacation, and better prognosis than other types.

 B A

Dry gangrene of the foot. The gangrenous area is dry, shrunken and dark and is
separated from the viable tissue by clear line of separation.
Diabetic gangrene
 It occurs in poorly controlled D.M.

 Start at the toe or sole of the foot after minor injury.

 Atherosclerosis is more common in Diabetic patients.

secondary to Hyperglycemia acting as a "good media " for
bacteria and hypercholersterolaemia.
II- Wet (moist gangrene)
• Result from sudden arterial and venous occlusion as seen in
cases of strangulated hernia, intussusception or volvulus of
the intestine.
• No fluid evaporation.
• Abundant Bacterial presence with rapid invasion of the
necrotic tissue producing moist gangrene and severe
toxaemia.

volvulus intussusception
 Item Dry gangrene Moist gangrene

1 Site Extremities Internal organ &extremities

2 Cause Gradual arterial occlusion Sudden complete arterial

&venous occlusion
3 Consistency Dry & mummified Moist & macerated

4 Putrefaction Slow Rapid

5 Edema Absent Marked

6 Evaporation Present Absent

7 Toxemia Mild Marked

8 Line of Well formed Poorly formed

demarcation
9 Line of Present Absent
separation
 III- infective gangrene
This type of gangrene is characterized by the fact that the
offending bacteria causes both tissue Necrosis and
putrefaction " primary gangrene" examples: -

1-Noma pudenda: gangrenous lesion affecting Vulva in females

and scrotum in males " fournier's gangrens" skin necrosis and
gangrene in scrotal skin leaving exposed testis.

2-Cancrum oris: infective gangrene of the mouth and cheeks

of severely malnourished debilitated children in areas of
famines
IV - Gas gangrene

“In this type of gangrene bacterial infection causes necrosis

and then gangrene with abundant gas formation in the tissue”

 Gas gangrene=wet gangrene + gas formation

 The organism usually of clostridiusm family (Cl.Welchii,

Cl.Perfringens) following contamination of deep wound
and lacerations with soil.

 This is a primary gangrene.