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What is necrosis? Definition Necrosis is the morphologic changes that follow cell death in living tissue.

A necrotic cell cannot reverse back to normal cell. Changes of necrosis occur due to: (1) Denaturation of proteins and (2)Enzymatic digestion of cell by-Autolysis (Which is the self-digestion of cells after their death. It occurs due to the action of its own enzymes like prosteases, lipases, esterases, ribonuclease, deoxyribonuclease mainly derived from lysosomes of the injured cell. These act at low pH.) -Heterolysis (It is the digestion of cells by enzymes from lysosomes of immigrant leucosytes, during inflammatory reactions. These changes take hours, e.g. 4 to 12 hours in myocardial necrosis.) Types of necrosis Coagulative necrosis develops when denaturation is the primary pattern, and liquifactive necrosis develops when enzyme digestion is dominant. Types 1 and 2 are basic types and others are distinctive types of necrosis. 1. Cogulative necrosis: This results primarily from denaturation of structural and enzymic proteins due to increasing intracellular acidosis of cell. The cellular shape, cell outlines and tissue architecture is maintained. This is structured necrosis. The cell takes acidophilic stain. Examples: Hypotoxic death of cells in all tissues except brain, e.g. infract of heart, kidney, spleen,. 2. Liquefactive necrosis or Colliquative necrosis: Enzyme digestion is dominant. This results from autolysis or heterolysis by action of powerful catalytic enzymes. Liquefactive necrosis occurs in : (a) Suppurative inflammation (b) Hypoxic death of cells within brain-infraction of brain. There occurs softening of the necrosed area. It then break up and turns into fl;uid. There may be a cyst formation (c)Caseous material as secondary change. 3. Caseous necrosis: This is a distinctive type of coagulative necrosis. It occurs most commonly in the tubercle which is a granuloma. The architecture in the necrosed area is lost and the cell outlines are not preserved. There is formation of soft, friable, amorphous granular debris resembling cheesy material. Lysis of macrophages results in the formation of caseating granulomas.

4. Fat necrosis: It occurs in adipose tissue due to action of lipase.They are of two types(A). Acute pancreatic fat necrosis: Enzymatic fat necrosis of pancreas and omental tissue occurs in acute pancreatic necrosis. There is patchy necrosis of pancreas and of fatty tissue throughout the abdopmen by pancreatic enzymes. (B). Traumatic fat necrosis: It occurs usually in the breast. The necrosed area may be surrounded by inflammatory changes with accumulation of neutrophils, lipid laden macrophages, giant cells and fibroblasts. Finally the area is replaced by scar tissue which may produce skin reaction and clinically may resemble scirrhous carcinoma. 5. Fibrinoid necrosis: It is a morphologic descriptive term of a variety of changes. There is necrosis of collagen. Fibrocytes undergo necrosis of collagen. Fibrocytes undergo necrosis and its fibres appear to degenerate. In this there is swelling and fragmentation of the collagen fibres. 6. Gangrenous necrosis: Gangrene is necrosis of tissue with superadded putrefaction by bacteria.