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Sanjay Mukhopadhyay @smlungpathguy
, 14 tweets, 6 min read Read on Twitter
Necrosis = cell death (unlike apoptosis, it does not occur naturally and is not programmed)

This short #Tweetorial shows you some of the histologic flavors of necrosis. The stain in each of these pics is hematoxylin-eosin (H&E)

#pathology #pulmpath #pathtweetorial
First a question to test your knowledge. Necrosis with large numbers of neutrophils is called:
And now a few examples. Necrosis in colorectal carcinoma is often described as “dirty” because it contains nuclear debris. This makes it look purplish instead of pink.

#gipath #MedEd
Here’s necrosis in a pleomorphic carcinoma of the lung. Necrosis is at the bottom of the pic. You can almost discern elongated dead cells in there. Pleomorphic carcinoma is the WHO term for a type of sarcomatoid lung carcinoma

#pulmpath @JenniferBoland7
Here’s suppurative necrosis in an empyema. This is what we call “pus” when seen with the naked eye. There are hundreds of neutrophils in this type of necrosis. Bacterial infection is the most common cause. Suppurative granulomas should make you think blastomycosis.
Necrosis is a poorly differentiated squamous cell carcinoma. Nothing fancy...doesn’t it look a bit “dirty”?
Necrosis in a lung adenocarcinoma. I guess “dirty necrosis” isn’t all that specific ¯\_(ツ)_/¯
Necrosis in a mycobacterial granuloma. Is it “caseous”? This term (“caseating”) has to be one of the most meaningless in pathology. It means “cheese-like” (when seen with the naked eye), has no consistent microscopic counterpart and is FAR from specific for TB.
Can’t get a more classic “caseating granuloma” than this. Looked cheese like grossly too. Any guesses as to what bugs were found in it?

AFB? ❌
Histoplasma ✅

Just call this a necrotizing granuloma. Please. Please?
There’s nothing specific about pink necrosis either. Here’s necrosis in a melanoma.

Necrosis is a key feature in small cell lung carcinoma. It often contains nuclear fragments too.
Necrosis in squamous cell carcinoma often contains the ghosts of keratinized malignant cells. Some imagination is required here 😉
Now let’s see if we improved learning! What do you call necrosis that contains MANY neutrophils?

#pathologypoll #pathpoll #MedEd
Tweeples, please share your tips re: types of necrosis in different situations. Pics will be greatly appreciated.

Thank you for reading! 🙏🏾🙏🏾

🌹🌹🌹 End of Tweetorial 🌹🌹🌹
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