Necrosis and apoptosis

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 Apoptosis – programmed cell death

Irreversible • Cells shrink leading to cell death

injury: Necrosis – Cell death after irreversible injury.

Apoptosis and • Injured cell tends to swell first and the burst if stimuli
Necrosis progressive
• Wide variety of factors including injurious agents can
cause necrosis

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 Necrosis
• Gross morphology: • Microscopic morphology
• Pale, soft and friable • Pyknosis
• Sharp line/demarcation of inflamed sections • Karyorrhexis
• Karyolysis
• Absence of nucleus
• Increased cytoplasmic eosinophilia
• Pale, ghost-like appearance (Advanced stages)

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Image source:
https://o.quizlet.com/bD9Qz7pD1yLb8oeinVFWkw_b.png

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Cellular
Characteristics of
necrosis
• Rupture of lysosomes
• Nuclear changes (Pyknosis, Karyorrhexis,
and Karyolysis)
• Presence of large densities
• ER and mitochondrial lysis
• Deformation of cell membrane

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Types of Necrosis

Coagulative Caseation Liquefactive Gangrenous

Fat necrosis Zenker’s necrosis Focal necrosis

Coagulation • Cells are dead but tissue architecture is still intact and maintains a solid
necrosis consistency

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Caseation necrosis
• Both cellular and tissue architecture are lost.
• Cheesy consistency
• Accumulation of debris within the affected area

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Liquefactive necrosis
• Complete dissolution of necrotic tissue
• Cells undergo self-digestion due to the massive increase of
inflammatory cells

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Gangrenous • Initially coagulative necrosis which are further complicated by different factors.
• Dry – Necrotic tissue secondary to infarction leading to mummification
necrosis • Moist – Necrotic tissue further degraded by saprophytic bacteria leading to putrefaction
• Gas – Necrotic tissue further degraded by anaerobic bacteria leading to gas accumulation
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Fatty necrosis
• Enzymatic – Leaked pancreatic lipase destroys
adipose tissues
• Traumatic – Occurs when adipose tissues are
crushed
• Abdominal fat – Highly specific for omental and
mesentery adipose tissues

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 Zenker’s
necrosis
Necrosis of striated muscles and often
a sequela to hyaline degeneration

https://www.researchgate.net/publication/326650889/figure/fig1/AS:941935200051210@1601586260794/a-At-the-heart-pale-yellowish-
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white-necrotic-muscle-fibers-arrows-b-In-the-heart.png
https://www.researchgate.net/publication/348111200/figure/fig1/AS:9758 https://www.researchgate.net/publication/258639498/figure/fig4/AS:6695860222
64103702531@1609675541863/Macroscopic-examination-of-the-liver-

Focal necrosis
07502@1536653156569/Liver-biopsy-with-scattered-foci-of-cell-necrosis-
numerous-grey-white-foci-from-pinhead-to-chickpea.jpg
and-lymphocytic-infiltration-without.ppm

Presence of numerous small white foci in random distribution in the liver and kidney
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 Rigor mortis

Algor mortis

Sequela to Livor mortis

Postmortem clotting
necrosis are Hemoglobin and bile imbibition

postmortem Pseudomelanosis

changes Bloating

Organ displacement

Softening of tissues

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 Apoptosis (programmed cell death)
• Triggering factors • Extrinsic pathway
• Withdrawal of growth stimuli • Death receptor
• Death signals • Intrinsic pathway
• DNA damage • Mitochondrial involvement

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Mechanism of
apoptosis

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Characteristics of
an apoptotic cell
• Shrunken cells
• Condensed chromatin
• Fragmented cytoplasm
• Presence of Cytoplasmic buds
• Absence of inflammation

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