Caseous necrosis: Difference between revisions
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{{Short description|Form of cell death}} |
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'''Caseous necrosis''' is a form of cell death in which the tissue maintains a cheese-like appearance.<ref name="Cotran 2010. Pg. 16">Robbins and Cotran: Pathologic Basis of Disease, 8th Ed. 2010. Pg. 16</ref> The dead tissue appears as a soft and white '''proteinaceous dead cell mass'''. |
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{{Infobox medical condition |
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|image = Tuberculous lymph node with caseating granuloma 40X.jpg |
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|caption = Micrograph showing caseous necrosis of a tuberculous lymph node. H&E stain. Histological specimens are normally obtained from supraclavicular lymph nodes to demonstrate caseous necrosis. |
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|specialty = [[Pathology]] |
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|caption2 = Subpleural caseous necrosis ([[Ghon focus]]) |
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|complications = [[Lung cavity]] |
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|causes = [[Tuberculosis]] |
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'''Caseous necrosis''' or '''caseous degeneration'''<ref>{{Cite web|url=https://medical-dictionary.thefreedictionary.com/caseous+degeneration|title=caseous degeneration|website=TheFreeDictionary.com|access-date=2019-09-05}}</ref> ({{IPAc-en|ˈ|k|eɪ|s|i|ə|s}})<ref name="oxford" /> is a unique form of cell death in which the tissue maintains a cheese-like appearance.<ref name="Cotran 2010. Pg. 16">Robbins and Cotran: Pathologic Basis of Disease, 8th Ed. 2010. Pg. 16</ref> Unlike with [[coagulative necrosis]], tissue structure is destroyed. Caseous necrosis is enclosed within a [[granuloma]]. Caseous necrosis is most notably associated with [[tuberculoma]]. The dead tissue appears as a soft and white '''proteinaceous dead cell mass'''. |
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The term ''caseous'' means 'pertaining or related to [[cheese]]',<ref>{{Cite web|url=https://www.wordreference.com/definition/caseous|title=caseous - WordReference.com Dictionary of English|website=www.wordreference.com}}</ref> and comes from the Latin word {{Lang|la|caseus}} 'cheese'.<ref name="oxford">{{Cite web|url=https://www.lexico.com/definition/caseous|archive-url=https://web.archive.org/web/20210903080650/https://www.lexico.com/definition/caseous|url-status=dead|archive-date=September 3, 2021|title=Caseous | Meaning of Caseous by Lexico|website=Lexico Dictionaries | English}}</ref> |
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Frequently, caseous necrosis is encountered in the foci of [[tuberculosis]] infections.<ref name="Cotran 2010. Pg. 16"/> It can also be caused by [[syphilis]] and certain fungi. |
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==Histology== |
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In caseous necrosis no histological architecture is preserved (unlike with [[coagulative necrosis]]).<ref name=":4">{{Cite book |last=Cross |first=Simon S. |title=Underwood's Pathology |year=2013 |isbn=978-0-7020-4672-8 |edition=6th |pages=84|publisher=Churchill Livingstone }}</ref><ref name=":3">{{Cite book |title=Rubin's Pathology: Clinicopathologic Foundations of Medicine |publisher=Wolters Kluwer Health |year=2015 |isbn=978-1-4511-8390-0 |editor-last=Strayer |editor-first=David S. |edition=7th |location=Philadelphia |pages=35 |editor-last2=Rubin |editor-first2=Emanuel |editor-last3=Saffitz |editor-first3=Jeffrey E. |editor-last4=Schiller |editor-first4=Alan L.}}</ref> On microscopic examination with [[H&E]] staining, the area is acellular, characterised by amorphous, roughly granular eosinophilic debris of now dead cells,<ref name=":3" /> also containing interspearsed haematoxyphilic remnants of cell nucleus contents.<ref name=":4" /> This caseus necrotic center is enclosed within a [[granuloma]].<ref name=":3" /><ref name=":6">{{Cite book |title=Robbins and Cotran pathologic basis of disease |date=2015 |publisher=Elsevier/Saunders |isbn=978-1-4557-2613-4 |editor-last=Kumar |editor-first=Vinay |edition=Ninth |location=Philadelphia, PA |pages=43 |editor-last2=Abbas |editor-first2=Abul K. |editor-last3=Aster |editor-first3=Jon C.}}</ref> |
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==Appearance== |
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In caseous necrosis no histological architecture is preserved. On microscopic examination with [[H&E]] staining, it is characterized by acellular pink areas of necrosis surrounded by a [[granuloma]]tous inflammatory process. |
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Frequently caseous necrosis is characteristically associated with tuberculomas.<ref name=":4" /><ref name=":3" /><ref name=":6" /> |
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When the hilar [[lymph node]] for instance is infected with tuberculosis and leads to caseous necrosis, its gross appearance can be a cheesy tan to white, which is why this type of necrosis is often depicted as a combination of both coagulative and liquefactive necrosis. |
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==Pathophysiology== |
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However, in the lung, extensive caseous necrosis with confluent cheesy tan granulomas is typical. The tissue destruction is so extensive that there are areas of cavitation (also known as cystic spaces). See [[Ghon's complex]]. |
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This begins as infection is recognized by the body and [[macrophage]]s begin walling off the [[microorganism]]s or [[Pathogenic bacteria|pathogens]].<ref name="auto">{{Cite web|url=https://www.amboss.com/us/knowledge/Cellular_changes_and_adaptive_responses|title=Cellular changes and adaptive responses – Knowledge for medical students and physicians|website=www.amboss.com|access-date=2019-09-05}}</ref> As macrophages release chemicals that digest cells, the cells begin to die. As the cells die they disintegrate but are not completely digested and the debris of the disintegrated cells clump together creating soft granular mass that has the appearance of cheese.<ref name="auto"/> As cell death begins, the granuloma forms and cell death continues the inflammatory response is mediated by a type IV hypersensitivity reaction.<ref>{{Cite web|url=https://webpath.med.utah.edu/TUTORIAL/MTB/MTB.html|title=Tuberculosis|website=webpath.med.utah.edu|access-date=2019-09-05}}</ref> |
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Some data suggests that the epithelioid morphology and associated barrier function of host macrophages associated with [[granuloma]]s may prevent effective immune clearance of mycobacteria.<ref>{{Cite journal|last=Bhattacharya|first=Mallar|date=2016-11-09|title=Macrophages build a wall and the host pays for it|url=https://www.science.org/doi/10.1126/scitranslmed.aal0066|journal=Science Translational Medicine|language=en|volume=8|issue=364|pages=364ec178|doi=10.1126/scitranslmed.aal0066|s2cid=51606274|issn=1946-6234}}</ref> |
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<gallery> |
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Image:Caseous necrosis in lung tissue.jpg|Caseous necrosis in the lung |
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</gallery> |
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==References== |
==References== |
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{{Research help|Med}} |
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{{reflist}} |
{{reflist}} |
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==External links== |
==External links== |
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*[http://www.pathguy.com/~lulo/lulo0029.htm Microscope images of caseous necrosis] |
* [https://web.archive.org/web/20100204015722/http://www.pathguy.com/~lulo/lulo0029.htm Microscope images of caseous necrosis] |
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* [https://webpath.med.utah.edu/INFLHTML/INFL052.html Image of a hilar lymph node demonstrating caseous necrosis] |
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* [https://webpath.med.utah.edu/ENDOHTML/ENDO008.html Image of a caseating granuloma of tuberculosis in the adrenal gland] |
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{{Pathology}} |
{{Pathology}} |
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Latest revision as of 03:54, 21 June 2024
| Caseous necrosis | |
|---|---|
 | |
| Micrograph showing caseous necrosis of a tuberculous lymph node. H&E stain. Histological specimens are normally obtained from supraclavicular lymph nodes to demonstrate caseous necrosis. | |
_focus_(6596011395).jpg) | |
| Subpleural caseous necrosis (Ghon focus) | |
| Specialty | Pathology |
| Complications | Lung cavity |
| Causes | Tuberculosis |
Caseous necrosis or caseous degeneration[1] (/ˈkeɪsiəs/)[2] is a unique form of cell death in which the tissue maintains a cheese-like appearance.[3] Unlike with coagulative necrosis, tissue structure is destroyed. Caseous necrosis is enclosed within a granuloma. Caseous necrosis is most notably associated with tuberculoma. The dead tissue appears as a soft and white proteinaceous dead cell mass.
The term caseous means 'pertaining or related to cheese',[4] and comes from the Latin word caseus 'cheese'.[2]
Histology
[edit].jpg)
In caseous necrosis no histological architecture is preserved (unlike with coagulative necrosis).[5][6] On microscopic examination with H&E staining, the area is acellular, characterised by amorphous, roughly granular eosinophilic debris of now dead cells,[6] also containing interspearsed haematoxyphilic remnants of cell nucleus contents.[5] This caseus necrotic center is enclosed within a granuloma.[6][7]
Causes
[edit]Frequently caseous necrosis is characteristically associated with tuberculomas.[5][6][7]
A similar appearance can be associated with histoplasmosis, cryptococcosis, and coccidioidomycosis.[8]
Pathophysiology
[edit]This begins as infection is recognized by the body and macrophages begin walling off the microorganisms or pathogens.[9] As macrophages release chemicals that digest cells, the cells begin to die. As the cells die they disintegrate but are not completely digested and the debris of the disintegrated cells clump together creating soft granular mass that has the appearance of cheese.[9] As cell death begins, the granuloma forms and cell death continues the inflammatory response is mediated by a type IV hypersensitivity reaction.[10]
Some data suggests that the epithelioid morphology and associated barrier function of host macrophages associated with granulomas may prevent effective immune clearance of mycobacteria.[11]
References
[edit]- ^ "caseous degeneration". TheFreeDictionary.com. Retrieved 2019-09-05.
- ^ a b "Caseous | Meaning of Caseous by Lexico". Lexico Dictionaries | English. Archived from the original on September 3, 2021.
- ^ Robbins and Cotran: Pathologic Basis of Disease, 8th Ed. 2010. Pg. 16
- ^ "caseous - WordReference.com Dictionary of English". www.wordreference.com.
- ^ a b c Cross, Simon S. (2013). Underwood's Pathology (6th ed.). Churchill Livingstone. p. 84. ISBN 978-0-7020-4672-8.
- ^ a b c d Strayer, David S.; Rubin, Emanuel; Saffitz, Jeffrey E.; Schiller, Alan L., eds. (2015). Rubin's Pathology: Clinicopathologic Foundations of Medicine (7th ed.). Philadelphia: Wolters Kluwer Health. p. 35. ISBN 978-1-4511-8390-0.
- ^ a b Kumar, Vinay; Abbas, Abul K.; Aster, Jon C., eds. (2015). Robbins and Cotran pathologic basis of disease (Ninth ed.). Philadelphia, PA: Elsevier/Saunders. p. 43. ISBN 978-1-4557-2613-4.
- ^ "Pulmonary Pathology". Retrieved 2008-11-21.
- ^ a b "Cellular changes and adaptive responses – Knowledge for medical students and physicians". www.amboss.com. Retrieved 2019-09-05.
- ^ "Tuberculosis". webpath.med.utah.edu. Retrieved 2019-09-05.
- ^ Bhattacharya, Mallar (2016-11-09). "Macrophages build a wall and the host pays for it". Science Translational Medicine. 8 (364): 364ec178. doi:10.1126/scitranslmed.aal0066. ISSN 1946-6234. S2CID 51606274.