Difference between revisions of "Necrosis"

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'''Necrosis''' is a type of cell death that is characterized by inflammation.
[[Image:Seminoma with necrosis -- high mag.jpg|thumb|right|Necrosis (left of image) in a [[seminoma]] (right of image). [[H&E stain]].]]
'''Necrosis''' is a type of cell death that is characterized by inflammation.  


==Classic types - Robbins<ref name=Ref_PBoD21-22>{{Ref PBoD|21-22}}</ref>==
It is always pathologic. The [[differential diagnosis]] of necrosis is very broad; it is important to ''not'' be focused only on [[cancer]] and infections.
 
==Classic types==
As per ''Robbins'':<ref name=Ref_PBoD21-22>{{Ref PBoD|21-22}}</ref>
*Coagulative.
*Coagulative.
*Liquefactive.
*Liquefactive.
Line 8: Line 12:
*Fatty necrosis.
*Fatty necrosis.
*Fibrinoid.
*Fibrinoid.
===Coagulative===
Features:<ref name=Ref_PCPBoD8_6>{{Ref PCPBoD8|6}}</ref>
*General: most common; proteinlysis > autolysis/heterolysis.
*Where/when: all tissue except the brain.
*Microscopic: cell outlines present.
===Liquefactive===
Features:<ref name=Ref_PCPBoD8_6>{{Ref PCPBoD8|6}}</ref>
*General: proteinlysis < autolysis/heterolysis.
*Where/when: infections, brain, abscess.
*Microscopic: nothing left; pink on H&E.
===Other classic types===
*Gangrenous: coagulative necrosis in ischemic limb.
*Caseous: cheesy material; [[tuberculosis]].
*Fat: adipose tissue, e.g. pancreatitis.
*Fibrinoid: immune complex mediated; bright-pink in vessel walls.


==Other types==
==Other types==
*Cystic medial necrosis.
*[[Cystic medial necrosis]].
*Acute tubular necrosis.  
*[[Acute tubular necrosis]].  
*Contraction band necrosis.
*[[Contraction band necrosis]].
*Dirty necrosis.
*Dirty necrosis.
*Radiation necrosis.


==Gross==
==Gross==
Coagulative necrosis:
*Soft.
*Soft.
*Grey or white.
*Grey or white.
Liquefactive necrosis:
*Mushy, grey.
*Porridge-like consistency.
Image:
*[http://library.med.utah.edu/WebPath/CINJHTML/CINJ025.html Liquefactive necrosis (utah.edu)].


==Microscopic==
==Microscopic==
Features:
Features:<ref name=Ref_PCPBoD8_4>{{Ref PCPBoD8|4}}</ref>
*Dead cells - pink (on [[H&E stain|H&E]]).
*Dead cells - (too much pink on [[H&E stain|H&E]]) - one of the following:
**Anucleate cells ("Ghost cells")/outlines of cells - usu. subtle.
*#Anucleate cells ("Ghost cells") - outlines of cells only.
***Fluffy appearance.
*#*Usually subtle.
*[[Neutrophils]] (very common).
*#*Fluffy appearance.
*#Karyolysis - nucleus disintegrating.
*#Karyorrhexis - nucleus fragmenting.
*#Pyknosis - nuclear strinkage.
*#*Weak sign.
*Inflammation - typically [[neutrophils]] (very common).


DDx of necrosis:
DDx of necrosis:
*Fibrin.
*Fibrin.


Images (necrosis):
Notes:
*Inflammation is a reactive phenomenon; it requires blood flow.
**Post-mortem it is not found.
 
===Images===
<gallery>
Image:Cat_scratch_disease_-_very_high_mag.jpg | Necrosis in [[cat scratch disease]]. (WC/Nephron)
Image:Histiocytic_necrotizing_lymphadenitis_-_very_high_mag.jpg | Necrosis in [[histiocytic necrotizing lymphadenitis]]. (WC/Nephron)
Image:Systemic_lupus_erythematosus_lymphadenopathy_-_high_mag.jpg | Necrosis in [[SLE lymphadenopathy]]. (WC/Nephron)
Image:Fat_necrosis_-_high_mag.jpg | Fat necrosis - high mag. (WC/Nephron)
Image:Necrotic_bone_and_inflammation_-_alt_--_intermed_mag.jpg | Necrotic [[bone]]. (WC/Nephron)
File:Pathology Brain Radiation Necrosis 2.jpg | Radiation necrosis in the CNS. (WC/Tdvorak)  
</gallery>
www:
*[http://www0.sun.ac.za/ortho/webct-ortho/tb/tb-histology.html Necrosis at the centre of a granuloma (sun.ac.za)].
*[http://www0.sun.ac.za/ortho/webct-ortho/tb/tb-histology.html Necrosis at the centre of a granuloma (sun.ac.za)].
*[http://www.biomedical-engineering-online.com/content/9/1/10/figure/F7?highres=y Necrosis (biomedical-engineering-online.com)].
*[http://www.biomedical-engineering-online.com/content/9/1/10/figure/F7?highres=y Necrosis (biomedical-engineering-online.com)].
*[http://www.nature.com/bmt/journal/v39/n9/fig_tab/1705646f1.html Necrosis (nature.com)].
*[http://www.nature.com/bmt/journal/v39/n9/fig_tab/1705646f1.html Necrosis (nature.com)].
*[http://moon.ouhsc.edu/kfung/jty1/Com08/Com08Image/Com801-1-09.gif Necrosis (ouhsc.edu)].<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/Com08/Com801-1-Diss.htm http://moon.ouhsc.edu/kfung/jty1/Com08/Com801-1-Diss.htm]. Accessed on: 3 November 2010.</ref>
*[http://moon.ouhsc.edu/kfung/jty1/Com08/Com08Image/Com801-1-09.gif Necrosis (ouhsc.edu)].<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/Com08/Com801-1-Diss.htm http://moon.ouhsc.edu/kfung/jty1/Com08/Com801-1-Diss.htm]. Accessed on: 3 November 2010.</ref>
*[http://commons.wikimedia.org/wiki/File:Cat_scratch_disease_-_very_high_mag.jpg Necrosis in cat scratch disease (WC)].
 
*[http://commons.wikimedia.org/wiki/File:Histiocytic_necrotizing_lymphadenitis_-_very_high_mag.jpg Necrosis in histiocytic necrotizing lymphadenitis (WC)].
==Stains==
*[http://commons.wikimedia.org/wiki/File:Systemic_lupus_erythematosus_lymphadenopathy_-_high_mag.jpg Necrosis in SLE lymphadenopathy (WC)].
*[[Martius scarlet blue stain]] - fibroid necrosis = red.
 
==Sign out==
<pre>
LESION, ANTERIOR RECTUS WALL, SURGICAL BIOPSY:
- EXTENSIVE FAT NECROSIS.
- NO EVIDENCE OF MALIGNANCY.
</pre>
 
===Micro===
The sections show fibroadipose tissue with abundant foamy histiocytes and necrotic adipocytes. Scattered chronic inflammatory cells, including plasma cells eosinophils and lymphocytes, are present. Focally hemosiderin-laden macrophages are identified. Multi-nucleated giant cells are seen. No definite epithelium is identified. Some reactive fibroblasts are present. No significant nuclear atypia is identified.
 
==See also==
==See also==
*[[Basics]].
*[[Basics]].
*[[Apoptosis]].


==References==
==References==
{{Reflist}}
{{Reflist|2}}


[[Category:Basics]]
[[Category:Basics]]

Latest revision as of 03:35, 14 July 2016

Necrosis (left of image) in a seminoma (right of image). H&E stain.

Necrosis is a type of cell death that is characterized by inflammation.

It is always pathologic. The differential diagnosis of necrosis is very broad; it is important to not be focused only on cancer and infections.

Classic types

As per Robbins:[1]

  • Coagulative.
  • Liquefactive.
  • Gangreneous.
  • Caseous.
  • Fatty necrosis.
  • Fibrinoid.

Coagulative

Features:[2]

  • General: most common; proteinlysis > autolysis/heterolysis.
  • Where/when: all tissue except the brain.
  • Microscopic: cell outlines present.

Liquefactive

Features:[2]

  • General: proteinlysis < autolysis/heterolysis.
  • Where/when: infections, brain, abscess.
  • Microscopic: nothing left; pink on H&E.

Other classic types

  • Gangrenous: coagulative necrosis in ischemic limb.
  • Caseous: cheesy material; tuberculosis.
  • Fat: adipose tissue, e.g. pancreatitis.
  • Fibrinoid: immune complex mediated; bright-pink in vessel walls.

Other types

Gross

Coagulative necrosis:

  • Soft.
  • Grey or white.

Liquefactive necrosis:

  • Mushy, grey.
  • Porridge-like consistency.

Image:

Microscopic

Features:[3]

  • Dead cells - (too much pink on H&E) - one of the following:
    1. Anucleate cells ("Ghost cells") - outlines of cells only.
      • Usually subtle.
      • Fluffy appearance.
    2. Karyolysis - nucleus disintegrating.
    3. Karyorrhexis - nucleus fragmenting.
    4. Pyknosis - nuclear strinkage.
      • Weak sign.
  • Inflammation - typically neutrophils (very common).

DDx of necrosis:

  • Fibrin.

Notes:

  • Inflammation is a reactive phenomenon; it requires blood flow.
    • Post-mortem it is not found.

Images

www:

Stains

Sign out

LESION, ANTERIOR RECTUS WALL, SURGICAL BIOPSY:
- EXTENSIVE FAT NECROSIS.
- NO EVIDENCE OF MALIGNANCY.

Micro

The sections show fibroadipose tissue with abundant foamy histiocytes and necrotic adipocytes. Scattered chronic inflammatory cells, including plasma cells eosinophils and lymphocytes, are present. Focally hemosiderin-laden macrophages are identified. Multi-nucleated giant cells are seen. No definite epithelium is identified. Some reactive fibroblasts are present. No significant nuclear atypia is identified.

See also

References

  1. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 21-22. ISBN 0-7216-0187-1.
  2. ↑ 2.0 2.1 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 6. ISBN 978-1416054542.
  3. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 4. ISBN 978-1416054542.
  4. ↑ URL: http://moon.ouhsc.edu/kfung/jty1/Com08/Com801-1-Diss.htm. Accessed on: 3 November 2010.
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