Necrosis

Definition
• spectrum of morphologic changes that follow
cell death in a living tissue
• Results from progressive degradative action of
enzymes on the lethally injured cell
• Characterized by denaturation of cytoplasmic
proteins, breakdown of cell organelles and cell
swelling
• Morphologic appearance of necrosis results
from
1) enzymic degradation of the cell
2) denaturation of proteins
• The catalytic enzymes are derived from
-the lysosomes of the dead cells-> autolysis
- the lysosomes of leukocytes-> heterolysis
• The process takes hours to develop
• E.g myocardial infarction becomes
histologicaly evident after 4-12 hrs
 Microscopy
-eosinophilia
-vacuolated cytoplasm
-calcification
 Nuclear changes
1) karyolysis –basophilia of the chromatin fade
2) pyknosis –nuclear shrinkage
3) karyorrhexis –nuclear fragmentation
• Ultimately most necrotic cells disappear by
enzymatic digestion and fragmentation with
phagocytosis
• If necrotic cells are not destroyed and
reabsorbed they become calcified->
dystrophic calcification
 Types of necrosis
• The necrotic cells can have several
morphologic patterns
 Coagulative necrosis
• the basic tissue architecture is preserved at
least for some days
• The tissue exhibit firm texture
• The injury causes denaturation of both
structural and enzymatic proteins and so
blocks the proteolysis of the cell
• Is characteristic of hypoxic cell death in all
tissues except the brain
• A good example is myocardial infarction
• The dead cells persist for weeks before being
removed by phagocytosis
 Liquefactive necrosis
• characteristic of focal bacterial infection and
hypoxic cell death of brain tissue
• Infections stimulate accumulation of
inflammatory cells
• Digestion of the dead cells
• When this occurs due to acute inflammation it
is called pus
 Gangrenous necrosis
• cell death in a limb due to loss of blood supply
• It is a type of coagulative necrosis
• When there is superimposed bacterial
infection-> liquefactive (wet gangrene)
 Caseous necrosis
• distinctive form of coagulative necrosis
encountered in tuberculosis.
• Grossly looks like white and cheesy
• On microscopic exam it apopears amorphous
granular debris surrounded by granulomatous
inflammation
• Unlike coagulative necrosis the tissue
architecture is completely obliterated
 Fat necrosis
• Occurs during acute pancreatitis due to
release of activated lipases
• Enzymes digest and liquefy fat cells
• Bind to calcium forming chalky white
appearance (called fat saponification)
• On histologic examination
-shadowy outlines of necrotic fat cells
-basophilic calcium deposits
-surrounded by inflammatory cells