Qianqian Han

Department of pathology, West China Hospital

 Cell death Gross Slides

Coagulative necrosis 3 16

Liquefactive necrosis 79, 93

Gangrene 12,13

Caseous necrosis 11 17

Sequelea of necrosis 84,50

Granulation tissue 23
Necrosis

Coagulative necrosis

Caseous necrosis

Liquefactive necrosis

Gangrene
 Coagulative Necrosis
• Gross morphology
– the lesion is grayish-white or yellowish-white, and
exhibits a firm texture
• Histopathology
– Preserved tissue architecture
– No cell architecture (eosinophilic, anucleate cells)
– Congesting vessels and inflammatory cell infiltration are
easy to be found in interstitial tissue
 G1-8.Coagulative necrosis of the spleen
(anemic infarct of the spleen)
Case abstract:
The patient was a 25 years old
man and died of subacute
bacterial endocarditis (SBE).
Note:
• Why is the necrotic region
wedge-shaped?
• What does the dark red
congestive hemorrhagic strip
look like under microscope?

http://115.28.176.223:9033/blbb_show.html?zid=25
Gross 3. Infarct of spleen
A wedge-shaped kidney infarct (yellow) with
preservation of the outlines
Coagulative necrosis of the kidney
(anemic infarct of the kidney)

Blue circle: Wedge-shaped pale

region
Red circle: red region surrounded
pale region
Slide 16.
Coagulative necrosis of kidney (anemic infarct of the kidney)
 normal

Coagulative necrosis
Coagulative necrosis
When the protein was denatured and solidified and the hydrolysis of
lysosome enzyme was weak, the necrotic area was grayish yellow,
dry and solid.
Microscopically, the fine structure disappeared, but the outline of
the tissue structure was preserved, and hyperemia, bleeding and
inflammatory zones were formed around the necrotic area.
It can occur in all tissues except the brain, mostly in the heart, liver,
kidney, spleen and other parenchyma organs.
Necrosis

Coagulative necrosis

Caseous necrosis

Liquefactive necrosis

Gangrene
 Caseous Necrosis
• Gross morphology
• the necrotic tissue is yellow-white, and looks like cheese
• Histopathology
no ghost outline of original tissue
• No tissue architecture
• No cell architecture
acellular pink
• surrounded by a collection of macrophages and other inflammatory cells

Granuloma
 G1-9. Caseous necrosis of the kidney
(renal tuberculosis)
Case abstract:
• A 41 years old
female patient, had
hematuria, strangury
and pollakiuria for
half year.
• Physical
examination: urine
culture was positive
for tubercle bacilli. A
left nephrectomy
was performed.

http://115.28.176.223:9033/blbb_show.html?zid=26
 G1-9. Caseous necrosis of the kidney
(renal tuberculosis)
Case abstract:
• A 41 years old female
patient, had
hematuria, strangury
and pollakiuria for
half year.
• Physical examination:
urine culture was
positive for tubercle
bacilli. A left
nephrectomy was
performed.

http://115.28.176.223:9033/blbb_show.html?zid=26
Gross 11.
Renal
tuberculosis
Gross 84. Chronic fibro-
cavitative pulmonary TB

A tuberculous lung
with a large area of
caseous necrosis
containing yellow-
white and cheesy
debris.
Tubercular lymphadenitis
Slide 17. Tubercle (tuberculosis of the lymph node)

The tubercles are composed of epithelioid cells and (or) Langerhans

multinucleate giant cells.
Necrosis

Coagulative necrosis

Caseous necrosis

Liquefactive necrosis

Gangrene
 G1-11. Liquefactive necrosis of the brain
Case abstract
• A 17 years old female had
headache, vomiting and loss
of vision for 7 days. She had
had a history of tympanitis.
Several days later she died
of central respiratory
insufficiency.
Tips
• This is a cut piece of brain.
Note the highly congestion
of surface blood vessels and
broadening gyri.
• In cut surface you could
find one or two round space
contained yellow to white
necrotic material.
http://115.28.176.223:9033/blbb_show.html?zid=28
Gross 93 Liquefactive necrosis ( Abscess of the brain)
An abscess in the brain, showing dissolution of the tissue

ectocinerea
 G1-12. Liquefactive necrosis of the liver
(Amoebic liver abscess)
Case abstract
• The patient was a 37 years
old male. He had a right
epigastric pain for 4 months
and died of cachexia
Tips
• The liver is enlarged
• In cut surface there are one or
several cysts
• In the inner wall there are many
floc-like residual tissue pieces.
The fluid in the cysts is brown
and sticky, just like jam, but now
it has flowed away.

http://115.28.176.223:9033/blbb_show.html?zid=29
Gross 79. Amoebic liver abscess

brown pus (anchovy sauce pus)

Necrosis

Coagulative necrosis

Caseous necrosis

Liquefactive necrosis

Gangrene
G1-13. Wet gangrene of the small intestine
Case abstract
• A 37 years old woman was administrated
with acute abdomen. She had vomiting and
strong abdominal pain. A laparotomy was
performed. Surgeon found ileus and resected
a part of small intestine. Then an
enteroanastomosis was performed.
Tips
• The intestine is dark, swollen and dull.
• the border between dark bowel and
adjacent bowel is not clear
Note:
• Why did the surgeon resect not only the
dark part of small intestine, but also a
part of adjacent looked “normal” bowel?

http://115.28.176.223:9033/blbb_show.html?zid=30
 G1-14. Dry gangrene of the foot
Case abstract:
• A 52 years old male had an
intermittent pain of right toes for 3
years. Then his right toes lost
sentience and became dark and dry. A
surgical operation was performed to
resect his toes in order to save his life.
Tips:
• The toes are shrinking, dark and dried.
• The border between the lesion and
normal tissue is clear.
Note:
In which conditions does dry gangrene
happen?

http://115.28.176.223:9033/blbb_show.html?zid=31
 G1-15. Dry gangrene of the hand

Case abstract
• A 27-year-old Japanese climber was
rescued after trapped in Mount
Gongga for 19 days in 1982. He was
critically ill for starving, cold and
experiencing multiorgan failure,
severe frostbite and secondary
infection.
• A surgical operation was performed
to resect his fingers and feet to save
his life.
Tips
• Observe the specimen and describe it
by yourself.

http://115.28.176.223:9033/blbb_show.html?zid=32
Gross 12. Gangrene of foot
Gross 13. Wet gangrene of the small intestine
Sequelae of necrosis
Gross 84. Chronic fibro-
cavitative pulmonary TB

A tuberculous lung
with a large area of
caseous necrosis
containing yellow-
white and cheesy
debris.
Gross 50. Gastric peptic ulcer
 pyknosis karyorrhexis karyolysis

Under high power magnification, you can find the basic morphologic features of cell
death: pyknosis, karyorrhexis and karyolysis.
Basic pathologic changes of Necrosis
Gross morphology：
• Coagulative necrosis: the lesion is grayish-white or
yellowish-white, and exhibits a firm texture

• Liquefactive necrosis: the necrotic tissue liquefies

and heals by cyst formation

• Caceous necrosis: the necrotic tissue is yellow-white,

and looks like cheese
Basic pathologic changes of Necrosis

Histopathology：
• the necrotic nuclei present pyknosis, karyorrhexis
and karyolysis

• the cytoplasm shows increased eosinophilia

• congesting vessels and inflammatory cell infiltration

are easy to be found in interstitial tissue