Difference between revisions of "Necrosis"

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


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===Other classic types===
===Other classic types===
*Gangrenous: coagulative necrosis in ischemic limb.
*Gangrenous: coagulative necrosis in ischemic limb.
*Caseous: chessy material; tuberculosis.
*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.
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*[[Contraction band necrosis]].
*[[Contraction band necrosis]].
*Dirty necrosis.
*Dirty necrosis.
*Radiation necrosis.


==Gross==
==Gross==
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===Images===
===Images===
<gallery>
<gallery>
Image:Cat_scratch_disease_-_very_high_mag.jpg | Necrosis in cat scratch disease (WC/Nephron)
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: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: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: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>
</gallery>
www:
www:
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===Micro===
===Micro===
The sections show fibroadipose tissue with abundant foamy histiocytes and necrotic adipocytes.  Scattered chronic inflammatory cells within plasma cells eosinophils and lymphocytes are present.  Focally hemosiderin-laden macrophages are identified. Multinucleated giant cells are seen.  No definite epithelium is identified.  Some reactive fibroblasts are present.  No significant nuclear atypia is identified.
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==

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

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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.