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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 | 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 18: | Line 22: | ||
Features:<ref name=Ref_PCPBoD8_6>{{Ref PCPBoD8|6}}</ref> | Features:<ref name=Ref_PCPBoD8_6>{{Ref PCPBoD8|6}}</ref> | ||
*General: proteinlysis < autolysis/heterolysis. | *General: proteinlysis < autolysis/heterolysis. | ||
*Where/when: infections, brain. | *Where/when: infections, brain, abscess. | ||
*Microscopic: nothing left. | *Microscopic: nothing left; pink on H&E. | ||
=== | ===Other classic types=== | ||
*Gangrenous: coagulative necrosis in ischemic limb. | *Gangrenous: coagulative necrosis in ischemic limb. | ||
*Caseous: | *Caseous: cheesy material; [[tuberculosis]]. | ||
*Fat: adipose tissue, e.g. pancreatitis. | *Fat: adipose tissue, e.g. pancreatitis. | ||
*Fibrinoid: immune complex mediated; bright-pink in vessel walls. | *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 | *Dead cells - (too much pink on [[H&E stain|H&E]]) - one of the following: | ||
* | *#Anucleate cells ("Ghost cells") - outlines of cells only. | ||
* | *#*Usually subtle. | ||
*[[ | *#*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> | ||
*[ | |||
==Stains== | |||
*[[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]] | ||