Irreversible cell injury

2024/10/9

Lecture by Dr. Talal. J. Hussein

Sagia Abbas
Necrosis
• The term necrosis was first used by morphologist to refer
to a series of changes that accompany cell death ,largely
resulting from the degrative action of enzymes on lethal
injured cells.
• Necrotic cells are unable to maintain membrane
integrity ,and their contents often leak out.
• The enzymes responsible for digestion of the cell are
derived either from lysosomes of the dying cells
themselves or from the lysosomes of leukocytes that are
recruited as part of the inflammatory reaction to the dead
cells.
 Necrosis
• It is local death of cells or tissue inside living tissue/body. The
necrotic area is well defined, structureless, opaque and yellow to
dark brown.
• Causes of necrosis:
1- Ischemia: inadequate arterial blood supply to an organ due to
obstruction of the blood flow.

2- Cold, heat, electricity or radiation.

3- Mechanical injury.

4- Chemical injury.
There are nuclear and cytoplasmic changes accompanied with necrosis
The nuclear changes include:

1. Pyknosis: Condensation of chromatin. (Shrunken

mass). Nuclear shrinkage
2. Karyorrhexis: Fragmentation of chromatin. Nuclear
fragmentation.
3. Karyolysis: Dissolution of chromatin by DNAases.
Nuclear fading.
Loss of the nucleus in dead cells. (Takes 1-2 days.)
b) Cytoplasmic changes:
The cytoplasm become more glassy homogeneous
appearance than viable cells, mostly because of the
loss of glycogen particles and its border disappear.
 NORMAL NECROSIS
Microscopically the fine structural details of the affected
tissue (and cells) are lost but their outlines are maintained.
The nucleus is lost.
The cytoplasm is converted into homogeneous deeply
eosinophilic.
Types of necrosis:
1. Coagulative necrosis
2. Liquefactive necrosis
3. Gangrene necrosis
4. Caseous necrosis
Coagulative necrosis

• In which the component cells are dead but the basic

architecture is preserved for at least several days.
• The affected tissues take on a firm texture.
• Presumably the injury denatures not only structural
proteins but also enzymes and so blocks the
proteolysis of the dead cells as a
result ,eosinophilic ,anucleate cells may persist for
days or weeks.
 • Gross appearance:
• A wedge –shaped
kidney infarct yellow
with preservation of the
outlines.
Coagulative necrosis in Kidney
Microscopic appearance of coagulative necrosis
B, Microscopic view of the
edge of the infarct ,with
normal kidney(N)and
necrotic cells in the infarct
(I).The necrotic cells show
preserved outlines with
loss of nuclei , and an
inflammatory infiltrate is
present(difficult to discern
at this magnification).
Liquefactive necrosis
• Is seen in focal bacteria or, occasionally ,fungal infections,
because microbes stimulate the accumulation of
inflammatory cells and the enzymes of leukocytes digest
the tissue.
• For obscure reasons ,hypoxia death of cells within the
central nervous system often evokes liquefactive necrosis.
• Whatever the pathogenesis , liquefaction completely
digests the dead cells , resulting in transformation of the
tissue into a liquid viscous mass.
• If the process was initiated by acute inflammation ,the
material is frequently creamy yellow and called pus.
Liquefactive necrosis
Liquefactive
necrosis. An
infarction in the
brain
,showing
dissolution of
the tissue.
Microscopic appearance of liquefactive
necrosis
liquid viscous
mass.
 Gangrenous necrosis
• Is not a distinctive pattern of cell death ,the term is still
commonly used in clinical practice .It is usually applied
to a limb , the lower leg ,that has lost its blood supply
and has under generally gone coagulative necrosis
involving multiple tissue layers.
• When bacterial infection is superimposed ,coagulative
necrosis is modified by the liquefactive action of the
bacteria and the attracted leukocytes so called wet
necrosis.
 Gangrene
• Massive necrosis with putrefaction
• Necrosis due to cut in blood supply.
• Putrefaction due to superimposed saprophytic bacteria. (they
live on dead organisms or organic matter and depend on them
for food) Types of gangrene:
Infective gangrene or
Dry gangrene Moist gangrene Gas gangrene
When the coagulative pattern is dominant the affected
parts shrink and appear contracted (dry); the process is
termed dry gangrene .
Conversely, when the liquefactive action is more
prominent, the affected parts are swollen (oedematous);
the term wet gangrene is used.
Gas gangrene is a bacterial infection that produces
tissue gas in gangrene. This deadly form of
gangrene usually is caused by Clostridium
perfringens ...
 Caseous necrosis
• Is encountered most often in foci of tuberculosis
infection .
• The term is derived from the friable yellow –white
appearance of the area of necrosis .
Gross appearance of Caseous necrosis
• Caseous necrosis .A
tuberculous lung
with a large area of
caseous necrosis
containing yellow –
white and cheesy
debris.
Microscopic appearance of Caseous necrosis
• The necrotic
focus appears as
a collection of
fragmented cells
with an
amorphous
granular
appearance.
Thank you for listening