NECROSIS AND AUTOPSY

PATHOLOGY
Necrosis
NECROSIS
• Cell death due to disease or injury
• Death of group of cells or part of a tissue or organ
• May be secondary to earlier phase of cell
degeneration

• Necrobiosis- a slower process, refers to

physiologic death of cells with immediate
regeneration
CAUSES OF NECROSIS
• Ischemia or anoxia- cell death due to ischemia is
known as infarction, manifested by histologic
appearance called “coagulation necrosis’
• Physical agents
▫ Trauma
▫ Extreme heat or cold
▫ Radiant energy
▫ Electrical energy
• Chemical agents
• Biological products
MICROSCOPIC CHANGES DURING NECROSIS
• NUCLEAR CHANGES-
▫ Pyknosis- reduction in size and condensation of the nuclear material
▫ Karyorrhexis- segmentation and fragmentation of the nucleus,
where nuclear contents are broken up and released into the cytoplasm
▫ Karyolysis- dissolution of the nucleus where all basophilism is lost
and nucleus disappears

• CYTOPLASMIC CHNAGES- initially cell appear larger and

granular (‘cloudy swelling’). Later become more acidophilic, dense
and opaque
▫ Cell boundary is lost
▫ Nuclear death ultimately causes cytoplasmic death
Types of Necrosis according to Basic
Morphologic Changes
• Coagulation necrosis- consists of more or less rapid
coagulation of cytoplasm brought by leaking enzymes
• Liquefaction necrosis- refers to fairly rapid
enzymatic dissolution of cells with complete destruction
of cells
• Fat Necrosis- peculiar destruction of adipose tissue,
particularly found in pancreatic degenerations
 Continued…
• Caseous necrosis- form of cell death produced by
MTB. Necrotic tissue have appearacne of soft, friable
cheese.
• Gangrenous necrosis- massive death or necrosis
of tissue brought by combination of ischemia and
superimposed bacterial infection
▫ Types:
 Dry gangrene- arterial occlusion, producing ischemic
necrosis, and dessication/mummification
 Wet gangrene- venous occlusion, causing putrefactive
changes, with collection of offensive and foul-odor fluid
Types of Necrosis according to Location or
Extent
• Focal Necrosis- confined to specific organs or
particular structures, usually found as minute,
circumscribed lesions
▫ Found in liver, spleen, bone marrow, lymph nodes
▫ Usually seen in infectious disease such as typhoid and
diptheria
• Massive Necrosis- involves whole or greater part of
organ, exemplified by gangrene
Autopsy Pathology
AUTOPSY PATHOLOGY
• refers to postmortem examination of a body to
determine the cause of death or the nature of
pathological changes
• also known as necropsy
• the autopsy has served medicine in numerous
ways and continues to play evolving roles in a time
when technologies have dramatically improved
and when new diseases, naturally occurring or
iatrogenic, continue to arise on the medical
horizon
• the autopsy remains the singular opportunity for a
comprehensive and final history, physical
examination and laboratory medicine
SOMATIC DEATH
• refers to death or complete cessation of metabolic
and functional activities of the organism or body
as a whole, characterized by:

• 3 PRIMARY SIGNS:
1. Circulatory failure—cessation of cardiac
function, evidenced by absence of pulse and
heart beat
2. Respiratory failure—absence of 02 and
accumulation of CO2, loss of oxidative
processes necessary for life
3. CNS failure—loss of coordination of various
body functions, loss of reflexes
• 7 SECONDARY SIGNS (follow after death,
observed on post mortem examination):

1. Algor Mortis—first demonstrable change

observed, characterized by cooling of the body to
equalize that of the surrounding environment
▫ occurring at a rate of about 7°F per hour
▫ important in establishing the approximate time of
death
▫ accelerated during cold weather, in lean, malnourished,
dehydrated individuals, after long wasting diseases,
and severe hemorrhage
▫ slowed down in certain infectious diseases, when death
is followed by increase in temperature
2. Rigor Mortis—rigidity or stiffening of
the muscles, occurring about 6 to 12
hours after death, and persisting for 3 to
4 days
▫ first seen in muscles of the head and neck,
spreading towards the lower extremities, and
subsequently disappearing in the same
sequence
▫ the position usually affected by the muscular
activity at the time of death
3. Livor Mortis—purplish discoloration or
lividity of the skin in the dependent
portions of the body, due to stasis and
settling of blood into the dependent
vessels which usually dilate due to loss in
muscle tone
▫ Ecchymoses—discoloration disappears on
pressure, and reappears when pressure is
released, and on incision, oozing of the blood is
observed
4. Postmortem Clotting—occurs slowly,
immediately after death
▫ in contrast to ante-mortem thrombi,
postmortem thrombi show definite settling and
separation of the red cells from the plasma
▫ portions of the blood clot show a yellow
"chicken fat" appearance, while other parts
assume the shape of the vessel where they are
found, and are called "currant jelly" clots

• Dessication—drying and wrinkling of

the cornea and anterior chamber of the
eye due to the absorption of the aqueous
humour
5. Putrefaction—production of foul-smelling
gases, due to the invasion of the tissue by
multiplying saprophytic organisms,
associated with the following changes:
▫ greenish blue discoloration in the belly, due to
the formation of iron sulfide
▫ softening of the muscles, due to auto-digestion
▫ retraction of the cornea, due to absorption of
aqueous humour
▫ loss of rigor mortis, due to liquefaction of
coagulated myosin
▫ peeling off of the skin, with crepitation in the
subcutaneous tissue and swelling of the face
7. Autolysis—self-digestion of the cells, by
their own ferments, eventually
undergone by all the tissues of the body
▫ putrefactive bacteria which diffuse from their
intestinal location into the surrounding tissues,
enhance the destruction of cells
▫ post-mortem autolysis evokes no inflammatory
or cellular response so characteristic of ante-
mortem necrosis of cells
▫ progressive dessication, putrefaction and
autolysis will eventually produce total digestion
of the soft tissues
The Value of the Autopsy
Assure quality of medical care
Establish or confirm cause of death
Confirm, modify, or refute clinical diagnoses
Monitor therapeutic responses
Evaluate new operative, pharmacologic, and diagnostic approaches

Enhance education
Foster research
Discover new or previously unrecognized diseases
Provide essential information on disease manifestations
Provide essential organs and tissues for research and transportation
Heighten total patient care
Offer general psychoemotional benefits to the family
Establish basis of genetic counselling
Improve public health
Investigate and identify environmental, occupational, and life style-related
diseases
Evaluate new prostheses, (e.g., cadiac, vascular, orthopedic)
Allow forensic diagnoses
Improve hospital reimbursements and efficiency through more accurate
diagnostic-related groups (DRGs)
Improve accuracy of vital statistics
Provide information and assistance to legal and judicial systems
 Deaths for which Autopsy is Indicated

Unknown and unanticipated medical complications

Cause of death not known with certainty on clinical grounds

Help to relieve concerns and provide reassurance to the family or public
Unexpected or unexplained deaths

Occurring during or after any dental, medical, or surgical diagnostics

Apparently natural deaths and not subject to a forensic medical jurisdiction
Natural deaths subject to but waived by forensic medical jurisdiction
High-risk infectious and contagious disease
Obstetric deaths
Neonatal and pediatric deaths
Disclose a known or suspected illness that may bear on survivors or recipients
of transplant organs

Known or suspected environmental or occupational hazards

Patients who have participated in clinical trials