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A quick summary of the 6 types of

necrosis
Jun 4, 2012

Q. I can’t seem to get the different types of necrosis straight (liquefactive,

fibrinoid, etc.). Any help?
A. There are basically six distinct patterns of necrosis. It’s important to
know about these, because they can give you a clue as to why the tissue
died. We’ll go through these in bullet form to make it easy to compare.
Coagulative
• See this in infarcts in any tissue (except brain)
• Due to loss of blood
• Gross: tissue is firm
• Micro: Cell outlines are preserved (cells look ghostly), and everything
looks red

Liquefactive
• See this in infections and, for some unknown reason, in brain infarcts 2
• Due to lots of neutrophils around releasing their toxic contents,
“liquefying” the tissue
• Gross: tissue is liquidy and creamy yellow (pus)
• Micro: lots of neutrophils and cell debris
Caseous
• See this in tuberculosis U a
• Due to the body trying to wall off and kill the bug with macrophages
• Gross: White, soft, cheesy-looking (“caseous”) material
• Micro: fragmented cells and debris surrounded by a collar of
lymphocytes and macrophages (granuloma)

Fat necrosis
• See this in acute pancreatitis
• Damaged cells release lipases, which split the triglyceride esters within
fat cells
• Gross: chalky, white areas from the combination of the newly-formed
free fatty acids with calcium (saponification)
• Micro: shadowy outlines of dead fat cells (see image above); sometimes
there is a bluish cast from the calcium deposits, which are basophilic

Fibrinoid necrosis
• See this in immune reactions in vessels
• Immune complexes (antigen-antibody complexes) and fibrin are
deposited in vessel walls
• Gross: changes too small to see grossly
• Micro: vessel walls are thickened and pinkish-red (called “fibrinoid”
because the deposits look like fibrin deposits)

Gangrenous necrosis
• See this when an entire limb loses blood supply and dies (usually the
lower leg)
• This isn’t really a different kind of necrosis, but people use the term
clinically so it’s worth knowing about
• Gross: skin looks black and dead; underlying tissue is in varying stages of
decomposition
• Micro: initially there is coagulative necrosis from the loss of blood supply
(this stage is called “dry gangrene”); if bacterial infection is
superimposed, there is liquefactive necrosis (this stage is called “wet
gangrene”)
2
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What happens after brain What's necrotic in What's the difference

tissue dies? fibrinoid necrosis? between ischemic and
hemorrhagic brain
infarcts?

80 Comments
← Older Comments
Anson on December 26, 2015 at 12:01 pm

THANK YOU VERY MUCH! I’m much more prepared now for my
upcoming mid-term examination. ^^

Carol on January 18, 2016 at 4:41 am

It was really helpful!thanks very much

nidakhan on January 21, 2016 at 1:47 pm

Thanks it is very helpful for me

2
Sara on February 6, 2016 at 8:22 am

I hate hate hate this subject