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Necrosis

The document discusses cell injury and necrosis, detailing the cellular responses to stress and the types of necrosis including coagulative, liquefactive, caseous, fat, and fibrinoid necrosis. It explains the microscopic and electron microscopic findings associated with necrosis, as well as the characteristics of different types of gangrene. The document also highlights the mechanisms and morphological features of dry, wet, and gas gangrene.

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Kiran Deep
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4 views

Necrosis

The document discusses cell injury and necrosis, detailing the cellular responses to stress and the types of necrosis including coagulative, liquefactive, caseous, fat, and fibrinoid necrosis. It explains the microscopic and electron microscopic findings associated with necrosis, as well as the characteristics of different types of gangrene. The document also highlights the mechanisms and morphological features of dry, wet, and gas gangrene.

Uploaded by

Kiran Deep
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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CELL INJURY

NECROSIS
Dr.V.Shanthi,
Associate Professor, Department of Pathology
Sri Venkateswara Institute of medical sciences
Tirupathi
CELL INJURY
Cellular responses to stress & injurious stimuli
Normal cell (homeostasis)

Injurious stimuli like reduced oxygen


Altered physiologic stimuli and
supply, chemical injury and microbial
non lethal injurious stimuli
infection
CELL INJURY
CELL ADAPTATIONS
Acute and transient Progressive and severe
• HYPERPLASIA
• HYPERTROPHY IRREVERSIBLE CELL INJURY
• ATROPHY REVERSIBLE CELL INJURY
• METAPLASIA CELL DEATH
• DYSPLASIA
NECROSIS AND APOPTOSIS
NECROSIS
Definition

Necrosis refers to spectrum of morphologic changes that


follow cell death in living tissue, largely resulting from the
progressive degradative action of enzymes on lethally
injured cell
NECROSIS
• The morphologic appearance of necrosis is the result of
denaturation of intracellular proteins & enzymatic digestion of the
cell
• The enzymes are derived from either lysosomes of the dead cells
themselves (Autolysis) or from the lysosomes of the immigrant
leukocytes (heterolysis )
NECROSIS
Microscopic appearance

Cytoplasmic changes
• Increased eosinophilia – Due to denatured proteins and loss of cytoplasmic RNA
• Glassy homogenous appearance – loss of glycogen particles
• Moth eaten appearance of cytoplasm – enzymatic digestion of cytoplasmic
organelles
• Whorled phospholipid masses derived from damaged cell membranes – myelin
figures
• Calcifications – fatty acids derived from phospholipid masses
NECROSIS
NECROSIS
Electron microscopic findings

Necrotic cells are characterized by


Discontinuities in plasma and organellar membrane

Swollen mitochondria with large amorphous densities

Intracytoplasmic myelin figures

Aggregates of fluffy material representing denatured proteins


ELECTRON MICROSCOPIC FINDINGS
ELECTRON MICROSCOPIC
FINDINGS

MYELIN FIGURES
NECROSIS
Microscopic appearance

Nuclear changes

Due to non-specific break down of DNA , 3 patterns are identified


Karyolysis – fading of basophilia of chromatin due to enzymatic
degradation of DNA by endonucleases
Pyknosis – nuclear shrinkage & increased basophilia

Karyorrhexis – pyknotic nucleus undergoes fragmentation


NECROSIS
NECROSIS

Types of necrosis
• Coagulative necrosis

• Liquefactive necrosis

• Caseous necrosis

• Fat necrosis

• Fibrinoid necrosis
NECROSIS
COAGULATIVE NECROSIS
• There is preservation of basic outline of the cell
• The increasing intracellular acidosis denatures not only structural
proteins but also the enzymes & so blocks the proteolysis of the
cell
• E.g. Myocardial infarct
• This is characteristic of hypoxic death of cells in all tissues except
the brain
COAGULATIVE NECROSIS
COAGULATIVE NECROSIS
COAGULATIVE NECROSIS
NECROSIS

LIQUEFACTIVE NECROSIS
Characterized by digestion of dead cells
resulting in transformation of the tissue into a
liquid viscous mass
NECROSIS
LIQUEFACTIVE NECROSIS
• Is characteristic of focal bacterial, or occasional fungal infections
because microbes stimulate the accumulation of inflammatory
cells
• If the process is initiated by acute inflammation, the material is
creamy yellow because of the presence of dead white cells &
called pus
• E.g. hypoxic death in central nervous system
LIQUEFACTIVE NECROSIS
NECROSIS

GANGRENOUS NECROSIS
• The term is applied to a limb , usually lower leg that has lost its
blood supply & has undergone coagulation necrosis.
• When bacterial infection is superimposed , coagulative necrosis
is modified by the liquefactive action of the bacteria & the
attracted leukocytes (wet gangrene )
GANGRENE

Types of the gangrenes


Dry gangrene – dead necrotised tissue remains uninfected.

Wet gangrene -necrotic tissue becomes infected.

Gas gangrene – Wet gangrene infected by one of the gas


forming Clostridia
DRY GANGRENE
 Gangrene begins in distal part of limb due to ischemia

 Causes-

◦ Atherosclerosis of anteries supplying limb


◦ Thromboangitis obliterans
◦ Raynauds disease
◦ Trauma
◦ Ergot poisoning
 Due to ischemia tissues undergoes infarction andline of separation is
formed between the necrotic tissue and healthy tissue
 At the margins of necrotic tissue, granulation tissue develops
DRY GANGRENE
Morphology
 Grossly the affected part is dry shrunken and dark in color resembling the
mummified foot.
 Black color is due to release of hemoglobin from the hemolysed RBC’s which are
acted upon by the hydrogen disulfide produced by bacteria which results in the
formation of black iron sulphide
 Gradually the gangrenous tissue falls from the healthy tissue at the line of
separation.
 Because of the risk of infection it should be surgically separated
WET GANGRENE
Wet gangrene typically occurs in the organs with venous blockage
or both venous and arterial blockage
Diabetic foot –High glucose content in the necrosed tissue
favours bacterial growth
Bed sores –In bed ridden patients at the pressure on the sites
like sacrum, buttocks and heel
Also in organs like bowel (due to strangulated hernia, volvulus
or intusscesception ) lung, mouth, cervix and vulva
WET GANGRENE
Morphologic features:
Grossly the affected part is black, rotten, and soft and pulpy

The affected part is dark due to same reason as in dry gangrene

Microscopically the tissue shows coagulative necrosis with


extensive areas of hemorrhage
Line of demarcation between variable and necrosed tissue
is absent
GANGRENOUS NECROSIS
Dry gangrene Wet gangrene
Site Lower limbs More common in
bowel
Mechanism Arterial occlusion More commonly
venous occlusion,
less often arterial
occlusion
Macroscopy Organ is dry, Moist, soft swollen
shrunken and black and dark
Line of demarcation Present between No line of
gangrenous and demarcation
healthy part
Presence of bacteria Bacteria fail to Numerous bacteria is
survive present
GANGRENOUS NECROSIS
Gas gangrene
It is wet gangrene infected by one of the gas forming
Clostridia (Gram positive anaerobic bacteria)
Gas forming Clostridia enters the tissue through a
contaminated wound or as a complication of operation on
colon which normally contains Clostridia
Clostridia rapidly spreads through tissues especially in
muscles and cause extensive necrosis and massive edema
Gas gangrene
Morphology
Gross – the affected part is edematous, swollen and has
crepitations on palpation due to accumulation of gas in tissues
Microscopically

◦ Muscle fibres undergo coagulative necrosis with liquefaction

◦ At the periphery, a zone of leukocytic infiltration, oedema and


congestion are found
NECROSIS

CASEOUS NECROSIS
• Distinctive form of coagulative necrosis most often
encountered in tuberculous infection
• The term caseous is derived from cheesy white gross
appearance of area of necrosis which is friable and white
CASEOUS NECROSIS
NECROSIS

CASEOUS NECROSIS

Microscopic appearance
• Necrotic focus – collection of fragmented or lysed cells and
amorphous granular debris enclosed with in distinctive
inflammatory border – granulomatous reaction
GRANULOMA FORMATION IN CASEOUS NECROSIS
GRANULOMA
GRANULOMA
NECROSIS

FAT NECROSIS
• It is descriptive term for focal areas of fat destruction , typically
occurring as a result of release of activated pancreatic lipases into
the substance of pancreas & the peritoneal cavity
• The fatty acids released combine with calcium to produce grossly
visible chalky white areas (fat saponification)
FAT NECROSIS
NECROSIS
FAT NECROSIS

Microscopic appearance
Necrosis take the form of shadowy outlines of necrotic fat
cells, with basophilic calcium deposits surrounded by an
inflammatory reaction
FAT NECROSIS
FAT NECROSIS
NECROSIS
FIBRINOID NECROSIS
Special form of necrosis seen in immune reactions involving blood
vessels
Occurs when complexes of antigens and antibodies are deposited
in the walls of arteries
Along with these complexes fibrin which has leaked out of vessels
give bright pink amorphous appearance called fibrinoid (Fibrin
like)
FIBRINOID NECROSIS
THANK YOU

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