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Necrosis, Atrophy and Apoptosis

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Necrosis, Atrophy and Apoptosis.

Keeping organs and tissues in healthy state is impossible without "natural" physiological regeneration, ergo, death of cells. In 1972, this type of cell death was named apoptosis. Apoptosis is a mechanism of elimination of "old" and lethally damaged cells. In present day a connection between apoptosis and pathologic processes is beyond any doubt. Production of new medicines that control and regulate apoptosis, has given us new way of treatment of malignant tumors, viral infections, some diseases of nerves system, immunodeficiency and autoimmune disorders.

The death of cells may accrue in a living organism, when powerful factors are applied, that damage tissues and cause a massive death of cells and interstitial substance. This type of premature death is called necrosis. The dead cells stop every type of activity because of biochemical and structural changes. Necrosis is a part and in some cases the main component of most pathologic processes (inflammation, infarction etc.)

Atrophy- a process of minimization in size and quantity of different cell and tissue components. Which is accompanied by decrease in life expanse of tissues.

Knowledge of these important processes, necrosis apoptosis and atrophy is important for any specialist in any field of medicine, modern diagnostics, etiopathogenic therapy and prevention of diseases.

Objective: learn to recognize and differentiate the difference between these processes, recognizing the macro and microscopic sings, knowing what causes these changes, their mechanism, their outcomes and its meaning for the organism.

Specific objectives objectives of beginners state

Know how to:

1. State morphologic singes of necrosis apoptosis and atrophy. On organic and ultra structural levels.

1. Differentiate the normal structure, function of tissues, tractate normal sings of living cells and tissues.

2. Diagnose by macroscopic sings between coagulative and colliquative necrosis.

2. Recognize a normal microscopic structure of tissue, to know the normal structure of organs and tissues, differentiate parenchyma and strome.

3. Estimate possible outcomes and meaning of necrosis and apoptosis, in different locations. And know the mechanisms.

3. recognize a normal blood circulation system, lymph outflow and innervation of tissues

4. Know the morphologic differences between atrophy от agenesis, aplasia and hypoplasia.

5. Diagnose different types of atrophy by macro and microscopic sings.

6. Estimate the meaning of different types of atrophy for the organism.

Here are some questions for you, to help you test your knowledge.

Q.1. In a biopsy of an organ, the parenchyma is an epithelial cells that form girders, which make lobules. Between the lobules there are an artery vane and a canal.

Which organ is it?

1. Liver

2. Kidney

3. Pancreas

4. Mammary gland

5. Heart

Q.2. What parts of the cell are most important to maintain the life of the cell, and damage of which will mean death of a cell?

1. Secretory granules

2. Nucleolus

3. Nucleus

4. Pinocytisic vesicles

5. Mitochondrium

(Correct answers: 1-1, 2-3)

Additional information to enlarge your knowledge you can find in these sources and textbooks.

1. Prives M.G., Lisenko M.K., Bucshkovich V.I. – human anatomy – hypocrites – 2001, pages 376-473

2. Afanasyev U.M., Yurina I.A. - Histology, cytology and embryology – 1999-pages 155-197, 199-252.

3. Berezov T.T., Korovkin B.F., Biochemistry-1990-pages 427-436

Basic theoretic questions to help you focus your learning.

  1. Necrosis. Definition causes. Understanding the early morphologic changes. Direct and indirect necrosis.

  2. Morphologic sings of coagulative and colliquative necrosis. And basic clinical-anatomical forms.

  3. Examples of different type of necrosis, their causes, morphology and outcomes and meaning for the organism. Democratized inflammation, its meaning.

  4. Outcome and meaning of necrosis.

  5. Apoptosis, definition, meaning in normal and pathologic physiology. Morphologic sings of apoptosis, differences between apoptosis and necrosis. Regulation of apoptosis.

  6. Atrophy, definition, causes. Understanding of physiologic atrophy.

  7. General and local atrophy. Causes, macro and microscopic sings. Outcome and meaning.

Additional information

  1. Lecture on: "Necrosis. Atrophy. Apoptosis”.

  2. Graph of logical structure “necrosis” (supplement №1).

  3. Graph of logical structure “atrophy” (supplement №2).

  4. Algorithm of morphologic diagnostics of atrophy (supplement №3).

  5. Algorithm of morphologic diagnostics of necrosis (supplement №4).

  6. Shlopov B.G "Basis of human pathologic anatomy".

After learning all the theory above here are some questions to help you test your knowledge.

Q. №1. 77 year old male was operated because of moist gangrene on his right foot. He died of sepsis 10 days after an amputation of crus. The autopsy showed obliterating thrombus of popliteal artery, a lot of petrosal density plaque in the intima of that artery, which narrows its clearance. Name, which type of necrosis was the foot gangrene in this case?

1. Direct toxic necrosis

2. Indirect tropho-neurotic necrosis

3. Indirect circulatory necrosis

4. Indirect allergic necrosis

5. Direct infectious necrosis

Q. №2. A TB positive patient has enlarged lymph nodes on his neck. A biopsy was taken. On a macroscopic examination of the specimen the coroner noticed a restricted area, that had dry, crumbling, structurless , white-yellow masses, he figured it was:?

1. An infarction

2. Cheesy necrosis

3. Ceraceous necrosis

4. Fibrinogenous necrosis

5. Steato-necrosis

Q. №3. A patient with a significant atherosclerosis of his lower limbs noticed that his left big toe is black, dry, smaller in size comparing to his other foot, has a clear separation from the healthy tissues of the foot. Which type of necrosis does the patient have?

1. Dry gangrene

2. Pressure sore

3. Fibrinogenous necrosis

4. Moist gangrene

5. Gas gangrene

Q. №4. During an autopsy of a 70 year old male, with atherosclerosis, in the sub cortical area of his left hemisphere, there was a segment of inaccurate form, size 6х5х2 см, flabby consistency, structureless, gray, with a little sputum inside. What type of outcome of the process is in this case?

1. Aseptic resorbtion

2. Organization

3. Septic disintegration

4. Encapsulation

5. Petrification

Q. №5. A microscopic and electro-microscopic analyses of a liver showed some isolated cells had melted down to small fragments surrounded by a membrane. Some have organellas, others have parts of the nucleus with its membrane. With no inflammatory reaction. These changes are due to:?

1. Apoptosis

2. Atrophy

3. Necrosis

4. Hypoplasia

5. Dystrophy

Q. №6. During an operation, back from peritoneal regions a pediatric surgeon had noticed that, the right kidney of a 6 year old girl is smaller by a third then the left one. A diameter of the right kidney artery is 0,3 см, дуае – 0,4 см. The kidney got smaller because of?

  1. Physiological atrophy

  2. Pathological atrophy

  3. Agenesia

  4. Aplasia

  5. Hypoplasia.

Q. №7. On an autopsy of a 65 year old man, the coroner noticed that the cerebral arteries have lots of petrosal density atherosclerotic plaque, that narrow down its clearance. The frontal lobe is decreased in size. Frontal lobe decreased in size and volume. In the frontal lobe the gyri are well cutout because of uneven dilated sulci. These changes are due to:

1. Hypoplasia

2. Atrophy of pressure

3. Atrophy due to an insufficient blood circulation

4. Neurotic atrophy

5. Dysfunctional atrophy

Methodological instructions for students for practical classes:
"Necrosis, atrophy, apoptosis"

In the beginning of the class the students are tested, on their homework. Afterwards the students will be tested to know how well did they prepare for the class.

By oneself you should study the электронограммы, macro- and microslides, answer the questions. Microscopic features of necrosis are studied on cheesy necrosis microslides, foot gangrene, and grey softening of the brain. On microslides of cheesy necrosis and grey softening of the brain, you study the morphologic changes on necrosis. The manifestations of atrophy, you study on microslides of lung emphysema. Additionally you may use the algorithm of microscopic diagnostics of necrosis. (supplement #2), and algorithm description of microslides.

The class is finished with analyses of the individual work of each student by checking the student's description of the microslides. And test control of the knowledge.

Technological map of the class:

№ s/n


Session (min.)

Educational visual aid, means of training


Place of holding


Testing and correction of initial state.


Multiple choice questions

Study room


Individual work. Description of macro- and micro- preparations.


Supplements # 1,2,3,4. Algorithm of study macro and micro preparations.

Microscope, macro and micro preparations. Microphotographs.


Self testing and correction of the learned material.


Target educational tasks


Final test control


Test collection


Summery of the class


Supplement №1

Graph of logical structure: Necrosis




Types of gangrene



Clinical features

Moist colliquative necrosis





Meaning of necrosis of different localization

Dry coagulated necrosis

Types of coagulated necrosis



Morphological features


Morphological features


Macroscopic changes

Microscopic changes

Supplement №2

Graph of logical structure: Atrophy





Morphological changes

Types of atrophy





Decrease in function of organs



Supplement №3

Algorithm of morphologic diagnostics of atrophy

Kidneys and liver have granular surface, decrease in size, and mass

Mucous tunic is smooth, with no riffles

Heart, liver increased in size, tissues are brown in colour

Lungs enlarged in size, inconspicuous pink colour

Skin becomes darker, subcutaneous adipose tissue is thin, the tissue surrounding the inner organs is bright orange, the muscles are thin, heart, liver are smaller in size, brown colour

Decrease in amount and size of parenchyma cells. The amount of stroma cells is increased

General Atrophy

Granular atrophy

Smooth atrophy

Kidneys increases in size, on cutset, the pelvis and calyx are dilated. The tissue of kidney is thin

Gyri of hemisphere are smoothened, on cutest the ventricular system is dilated, contains a clear liquid

Size of cardio- and liver cells is decreased, with sediments of brown pigment

Alveolar septa are thin, in some the cavities of alveoli are dilated

Eccentric atrophy (lung emphysema)

Brown atrophy

Kidney, atrophy of pressure. (hydrocephaly)

Kidney atrophy of pressure. (hydronephrosis)


Supplement №4

On the body, limbs, in the lungs, digestive tract, mucous tunic of the bladder swelled, dirty-grey, fetid smell
lgorithm of morphologic diagnostic of necrosis

Size of organs is normal. In the organs detected a limited area which is dry, crumbles, grey-yellow colour

The muscles of frontal abdomen wall, adducting muscles of the hip are pale, dry, grey-yellow in colour

On the limbs detected dry, thick areas of black colour

In the cerebrum and spinal cord, areas of soft tissue with no structure

Cheesy necrosis

Ceraceous necrosis

Dry gangrene

Colliquative necrosis (grey softening of the cerebrum)

Moist Gangrene

Part of tissue structureless, when coloured hematoxylin and eosin, bright pink, with lumps of chromatin of the nucleus. (cariorecsis)

There is a coagulation of the myoplasm, the surrounding connective tissue is with out a change

No tissue structure is detected

No tissue structure is detected. The tissues contain lots of microorganisms

No tissue structure is detected, there are cavities, accumulation of fat-granular balls

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