Lab No.

3 for 3rd Stage

Irreversible cell injury

(necrosis)
Necrosis refers to a sequence of morphologic changes
that follow cell death in living tissue or organ.
The morphologic appearance of necrosis is the result
of enzymatic digestion of the cell and denaturation of
proteins.
In necrosis there are cytoplasmic and nuclear changes.
Cytoplasmic changes:-
1- Necrotic cell is more eosinophilic than viable cells
attributable in part to loss of the normal basophilia
imparted by the RNA in the cytoplasm and in part to
the increased binding of eosin to denatured
intracytoplasmic proteins.
2- The cell may have more glassy homogenous
appearance than normal cells mainly as a result of the
loss of glycogen particles.
Nuclear changes:- the nuclear changes assume
one of three patterns:
1- pyknosis: characterized by nucleus shrinkage
and increased basophilia so transformed into
small round mass.
2- karyorrhexis: the pyknotic nucleus become
fragmented into several particles.
3- karyolysis with time there is progressive
disintegration of chromatin with subsequent
disappearance of nucleus.
pyknosis
Karyorrhexis
hepatocytes: Nuclear changes (fragmented), (Karyorrhexis)
Types of cell necrosis
A- coagulative necrosis
1-preservation of the basic outline of the coagulated cells
for at least some days.
2-the most common cause is ischemia except the brain
which undergo liquefactive necrosis.
3- The affected tissues exhibit a firm texture.
B- Liquefactive necrosis
1- complete digestion of dead cells by enzymes and thus
the necrotic area is eventually liquefied.
2- microscopically diagnosed as cyst filled with WBCs,
debris and fluid.
3- the most common cause is bacterial and some time
fungal infection.
C- Fat necrosis
This is a specific pattern of cell death in adipose tissue
due to action of lipase, most commonly seen in acute
pancreatitis, but its could be seen after trauma.
D- Caseous necrosis
1-It is a distinctive form of necrosis encountered most
often in the center of granuloma of tuberculosis(T.B.).
2- the term caseous is derived from the cheesy, white
gross appearance of the central necrotic area.
3-microscopically, the necrotic focus is composed of
structure less, amorphous granular debris enclosed
with in a distinctive ring of granulomatous
inflammation.
E- Fibrinoid necrosis
Occur in arterial wall, the cause is hypertension.
Characterized by intense eosinophilic material deposit
within the arterial wall.
F- Gangrenous necrosis
It is not a distinctive pattern of cell death, the term is
still commonly used in surgical clinical practice. It is
usually applied to a limb, generally the lower leg, that
has lost its blood supply and has undergone
coagulation necrosis. When bacterial infection is
superimposed, coagulative necrosis is modified by the
liquefactive action of the bacteria and the attracted
leukocytes (so-called wet gangrene).
Examples
Fatty necrosis of breast
It is an uncommon and innocuous lesion that is
significant only because it produce a mass.
Causes
1-trauma to the breast.
2-FNAB(fine needle aspiration biopsy).
3- core biopsy.
Macroscopically
Mass, tender, small in size, rarely more than 2 cm in
diameter sharply localized.
Microscopically
1- fat necrosis consists of irregular steatocytes with no
peripheral nuclei.
2- there is intervening pink amorphous necrotic material
and chronic inflammatory cells, in which lipophages
(macrophages containing lipid giving their cytoplasm a
foamy appearance) and plasma cells may be present in
large number.
3- interstitial fibrosis.
 Microscopically fat necrosis of breast consists of irregular
steatocytes with no peripheral nuclei and intervening pink
amorphous necrotic material and inflammatory cells, including
foreign body giant cells responding to the necrotic fat cells
 fat necrosis at high magnification, some lipid-laden
macrophages(lipophage) are seen between the necrotic adipose
tissue cells. The most common etiology is trauma,
Tuberculosis(TB)
It is a communicable chronic granulomatous disease
caused by mycobacterium tuberculosis. Its usually
involve the lungs but may affect any organ or tissue in
the body. Typically the center of tubercular granuloma
undergo caseous necrosis.

Risk factors for developing TB

1-poverty.
2- crowding.
3-malnutrition.
4- alcoholism.
5-chronic debilitating illness .‫الفقر‬
like -1 DM ,chronic renal

failure and etc. .‫ االزدحام‬-2

.‫ سوء التغذية‬-3

.‫ إدمان الكحول‬-4

.‫ والفشل الكلوي املزمن وما إلى ذلك‬DM ‫ مرض موهن مزمن مثل‬-5
Clinical feature
Anorexia, weight loss, lassitude sleep sweating, evening
pyrexia.

Grossly
1- Granulomatous disease grossly appears as irregularly
sized rounded nodules that are firm and tan. Larger
nodules may have central necrosis known as caseation.
2- The caseous material is soft, friable, whitish, cheesy
material
‫ املساء‬،‫ تسول النوم التعرق‬،‫ فقدان الوزن‬،‫فقدان الشهية‬

.‫الحمى‬

‫بشكل صارخ‬

‫ يظهر املرض الحبيبي بشكل صارخ على أنه عقيدات مستديرة‬-1

‫ أكبر‬.‫غير منتظمة الحجم تكون ثابتة وسمرة‬

.caseation ‫قد تحتوي العقيدات على نخر مركزي يعرف باسم‬

‫ مادة جبنية‬،‫ بيضاء‬،‫ قابلة للتفتيت‬،‫ املادة الكازية ناعمة‬-2

Here is the gross
appearance of a lung
with tuberculosis.
Scattered tan
granulomas are present,
mostly in the upper lung
fields. Some of the
larger granulomas have
central caseation.
 Caseous necrosis

T.B. Lung. Caseous necrosis (cheese martial)

yellowish whitish friable material.
Microscopically
1- the TB characterized by granuloma formation which is
0.5-2mm in diameter and its formed by collection
epithelioid cells (transformed macrophage) usually
surrounded by a rim of lymphocytes and some time
fibroblast.
2- the caseous necrosis occupy the center of granuloma,
it has distinctive amorphous granular pinkish debris.
3- Langhans giant cell is seen with in the granuloma, this
cell is formed by fusion of several epithelioid cells, so it
appear as large cell with one cytoplasm and several
nuclei which arranged at periphery as horseshow.
 Caseous necrosis: (lung T.B.)
caseous granuloma.(central cassation )
langhan’s giant cell.
Note the pink, amorphous region in the center of this
granuloma at the upper right, and ringed by epithelioid
cells at the left and lower areas of this photomicrograph.
This is the microscopic appearance of caseous necrosis.
 Well-defined granulomas are seen here. They have
rounded outlines. The one toward the center of the
photograph contains several Langhans giant cells.
Lang hanz giant cell (horse show ) causes
necrosis with TB bacilli
Myocardial infarction
This is an example of coagulative necrosis, this disease
occure following occlusion of a coronary artery , its
presented with sever chest pain radiated to the left arm
associated with sweating and vomiting.

Risk factors:
1- hyperlipidemia.
2- hypertention.
3- DM.
4- smoker.
5- obesity.
6- male sex.
7- stressful condition.
8- family history of disease.
Macroscopically
The infracted area appear geographic(map-like) , and
appear pallor than normal, the margins of the infarct
become better defined by the development of a narrow
rim of hyperemia.

Microscopically
1- the infracted cardiac muscle fibers exhibit patchy loss
of striation.
2-and become more intensely stained by eosin.
3-and most of cardiac muscle fibers have lost their nuclei.
4-there is marked infiltration by neutrophils into the
oedematous interstitium.
 This is the left ventricular wall which has been sectioned lengthwise to
reveal a large . myocardial infarction. The center of the infarct contains
necrotic muscle that appears yellow-tan. Surrounding this is a zone of red
hyperemia. Remaining viable myocardium is reddish- brown.
This is the normal appearance of myocardial fibers in longitudinal
section. Note the central nuclei and the syncytial arrangement of
the fibers, some of which have pale pink intercalated disks.
Coagulative necrosis: Increase cytoplasmic eosinophilia.
The myocardial cell nuclei have almost all disappeared.
There is beginning acute inflammation, loss of striation.