A quick summary of the 6 types of necrosis

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
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
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 at the top); 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”)

More pathology!

85 Comments

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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
Sara on February 6, 2016 at 8:22 am

I hate hate hate this subject
muhindo bivarton on February 7, 2016 at 12:02 pm

good work, thank u
dr.hansika on February 11, 2016 at 6:32 am

Thank u for such a good information
Kristine on February 11, 2016 at 9:37 am

I feel your pain, Sara! Maybe we can help make it less horrible.
humphrey on February 15, 2016 at 1:29 am

its very helpful
Lady B on March 13, 2016 at 5:26 am

Tanks so much it’s very helpful.
Daniel on March 15, 2016 at 6:56 am

Nice one. bt why is apoptosis called programmed cell death?
Kristine on March 18, 2016 at 8:08 am

Because it is controlled by gene products encoded by the cell’s own DNA. Cells have this pathway available in case they need it – and when it is triggered, it happens the same way every time (it’s programmed).
Abriham Amirote on March 21, 2016 at 12:12 pm

Thanks
Doreen on June 16, 2016 at 12:52 am

thanks…very helpful.
M on June 24, 2016 at 10:54 am

Thank you! You don’t know how much it helps me!! 🙂
Abu Jar on July 9, 2016 at 6:54 am

Thanks a lot. It is essay to memorize and write in exam.
Shirouh on August 25, 2016 at 5:49 am

Thanks alot its very helpful for my upcoming end exams
Minkhant on September 7, 2016 at 5:20 am

EZ af
Anna das on September 30, 2016 at 5:14 am

Thank you
kwesi on October 13, 2016 at 11:28 am

thanks a lot
love on October 27, 2016 at 3:22 pm

Thank you very much!!!! God bless you
ROHIT SHARMA NIGRA on December 20, 2016 at 12:26 am

thanks for you sir
Beauty on February 21, 2017 at 3:46 am

Very helpful to me.
dit on March 4, 2017 at 7:56 am

Really helpful
john on March 16, 2017 at 2:19 am

thanks i have learnt alot…be blessed
Rehab on October 2, 2017 at 8:36 pm

It’s really helpful
Daisy chepngetich on November 23, 2017 at 5:38 am

Thanks it’s helpful
Rob Goldin on January 11, 2018 at 3:43 am

Would you consider adding fat necrosis to this list?
Kristine on January 11, 2018 at 11:59 pm

Yes – it’s in there! It’s the fourth one down 🙂
sarah from Bangladesh on April 22, 2018 at 5:20 pm

how lucky I’m! at least I have found a place where I can learn pathology in a interesting way…

thank you soo much sir
tony777 on September 11, 2018 at 12:38 pm

very helpful………..everything in one bullet!
Diana on March 5, 2020 at 12:58 pm

It was of so much help .thanks!
Elizabeth Emefa Ayi on August 9, 2020 at 4:34 am

This is so interesting and easy to understand. This has been very helpful, thank you so much.
Unah Patienc Onyinyechi on November 11, 2020 at 1:08 am

Thanks so much it really helped me in my exam
Kristine on November 18, 2020 at 10:55 am

Yay!!
Ahmed Adem on May 23, 2021 at 1:44 pm

thank you very much! it really clarified my confusion