Definition:

Necrosis is spectrum of morphological changes that follow cell death in living tissues resulting from
denaturation of intracellular proteins or degradative action of enzymes on irreversibly injured cell.

The hallmark of necrosis is loss of integrity of cell membrane.

Types of necrosis:

1. Coagualative necrosis:
a. Most common type.
b. Caused due to sudden cessation blood flow in organs like the heart,kidney and spleen.
c. Seen in myocardial infarction.
2. Liquefactive necrosis: Seen in brain
3. Caseous necrosis: most commonly seen when cell death is attributed to Mycobacterium
tuberculosis.
4. Fibrinoid necrosis: seen in immune reactions involving blood vessels.
5. Fat necrosis: seen in breast and pancreas.
6. Gangrenous necrosis:
a. It is of two types: Dry gangrene and wet gangrene.
b. Dry gangrene seen in lower limbs
c. Wet gangrene is seen when the overlying gangrenous tissue is devitalized, bacterial
infection is superimposed.

Morphology of caseous necrosis

Caseous necrosis is encountered most often in foci of tuberculous infection

The term “caseous” (cheeselike) is derived from the friable white appearance of the area of necrosis

On microscopic examination, the necrotic area appears as a collection of fragmented or lysed cells and
amorphous granular debris enclosed within a distinctive inflammatory border; this appearance is
characteristic of a focus of inflammation known as a granuloma.

A granuloma is a focus of chronic inflammation consisting of a microscopic aggregation of macrophages

that are transformed into epithelium-like cells, surrounded by a collar of mononuclear leukocytes,
principally lymphocytes and occasionally plasma cells.

In the usual hematoxylin and eosin–stained tissue sections, the epithelioid cells have a pale pink granular
cytoplasm with indistinct cell boundaries, often appearing to merge into one another. The nucleus is less
dense than that of a lymphocyte, is oval or elongate, and may show folding of the nuclear membrane.

Frequently, epithelioid cells fuse to form giant cells in the periphery or sometimes in the center of
granulomas.