Necrosis

• Necrosis - type of cell death associated with loss of

membrane integrity and leakage of cellular contents
causing dissolution of cells, due to the degradative
action of enzymes.
• Enzymes are from lysosomes and migrant WBCs.
• Necrotic cells become digested and phagocytosed or
become calcified
• Necrotic focus - surrounded by inflammation
 Morphology of necrosis
• Changes in the cytoplasm
• Changes in the nucleus
 Types of necrosis

• Coagulative necrosis
• Liquefactive necrosis
• Caseous necrosis
• Fat necrosis
• Fibrinoid necrosis
• Gangrene
 Coagulative necrosis
• Form of necrosis in which the underlying tissue
architecture is preserved for several days
• The affected tissues has a firm texture
• Mechanism: Usually due to ischemia. Denaturation
of structural and enzymatic proteins blocking
complete proteolysis of dead cell.
• Micro: conversion of normal cells into their
‘tombstones’ i.e. outlines of the cells are retained
• Eg: Kidney, liver, spleen, heart
Example of coagulative necrosis.
Wedge-shaped pale area of coagulative
necrosis in the cortex of the kidney.
 Liquefactive necrosis
• Type of necrosis in which the dead cells are
completely digested, transforming the tissue into a
liquid viscous mass.
• Mechanism: Degradation of tissue by the action of
powerful hydrolytic enzymes
• Micro: Cystic space containing necrotic cell debris and
macrophages filled with phagocytosed material.
• Eg: Bacterial and fungal infections – abscesses,
hypoxic brain injury – cerebral infarcts
The liver shows a small abscess here filled with many neutrophils.
This abscess is an example of localized liquefactive necrosis
Liquefactive necrosis
Liquefactive necrosis - brain
Liquefactive necrosis - brain
 Caseous necrosis
• Type of necrosis which resembles dry cheese - soft,
granular and yellowish.
• Combination of coagulative and liquefactive necrosis
• Mechanism: Histotoxic effects of lipopolysaccharides
in the capsule of tubercle bacilli.
• Micro: Amorphous granular pink appearance
• Eg: foci of TB infection
Caseous necrosis, with
confluent cheesy tan
granulomas in the
upper portion of the
lung in a patient with
tuberculosis.
TB lung
Caseous necrosis
 Fat necrosis
• Refers to focal areas of fat destruction
• Mechanism: Liberation of pancreatic lipases from
injured/inflamed tissue. The lipases split the
triglyceride esters in the fat cells into fatty acids. The
fatty acids combine with calcium to produce grossly
visible chalky white areas (fat saponification)
• Micro: shadowy outlines of necrotic fat cells with
basophilic calcium deposits.
• Eg: Traumatic – eg: breast
Enzymatic – eg: pancreatitis
Fat necrosis - gross
Fat necrosis
 Fibrinoid necrosis
• Form of necrosis characterised by deposition of
fibrin-like material which has the staining
properties of fibrin
• Mechanism: Deposition of complexes of antigens
and antibodies in the walls of arteries.
• Micro: Brightly eosinophilic, hyaline-like material
deposition in the vessel wall surrounded by
nuclear debris of neutrophils
• Eg: Vasculitis
Fibrinoid necrosis