necrosis vs. apoptosis

[dorian24]

For some reason I got this confused on a question for NBME 13 -- described intense eosinophilic cytoplasm, fragmented nuclear chromatin, and cytoplasmic bleb formation -- just histologically, I know that necrosis has inflammation,but don't both have fragmented chromatin + eosinophilic cytoplasm + bleb formation? i.e., those are general characteristics of reversible/irreversible cell death?

Is there a way to distinguish apoptosis and necrosis simply based on these details of the question stem?

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[coldcase331]

For some reason I got this confused on a question for NBME 13 -- described intense eosinophilic cytoplasm, fragmented nuclear chromatin, and cytoplasmic bleb formation -- just histologically, I know that necrosis has inflammation,but don't both have fragmented chromatin + eosinophilic cytoplasm + bleb formation? i.e., those are general characteristics of reversible/irreversible cell death?

Is there a way to distinguish apoptosis and necrosis simply based on these details of the question stem?

From what you describe I would say apoptosis. Whenever I hear bleb formation, that's what I always go to. I normally think of necrosis as an "explosion" that doesn't have time to form nice blebs while it's dying. PLus I would usually like to hear about swelling as an initial step to necrosis.

 

[dorian24]

From what you describe I would say apoptosis. Whenever I hear bleb formation, that's what I always go to. I normally think of necrosis as an "explosion" that doesn't have time to form nice blebs while it's dying. PLus I would usually like to hear about swelling as an initial step to necrosis.

I was thinking about the "blebbing" that occurs with the reversible stages of cell death due to cell swelling (?) I guess without the swelling it would be more likely apoptosis ... since apoptosis = shrinkage?

 

[TUVIX]

I bet the answer was in the rest of the stem. What was the context?


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[coldcase331]

I was thinking about the "blebbing" that occurs with the reversible stages of cell death due to cell swelling (?) I guess without the swelling it would be more likely apoptosis ... since apoptosis = shrinkage?

Blebbing doesn't refer to swelling. Blebbing is specific to the "pinching off" of membrane vessicles. Swelling would have mentioned something about increasing cell size, ribosomes popping off the RER, etc.

 

[dorian24]

Blebbing doesn't refer to swelling. Blebbing is specific to the "pinching off" of membrane vessicles. Swelling would have mentioned something about increasing cell size, ribosomes popping off the RER, etc.

Oh ... so in this figure from FA the bottom part is apoptosis-related and the top is necrosis related ...?

 

[donovank730]

apoptosis is an atp mediated organized sequence of cell death. It has distinct pathological findings and the stem describes them word for word.

Necrosis is everything else, and can involve any sort of death you can image. It includes anything that is not apoptosis, aka, the cells programed self destruction sequence.

Also apoptosis= 1 cell

Necrosis typically involves a large area of cells because it may be due to ischemia or infection or things that are obviously involving more than 1 cell.

Highly Highly Higly recommend the pathoma section regarding this topic

 

[GoljansRightBicep]

I recently took NBME 13 and the question stem also stated that the cells were smaller than normal. That lead me to believe proteins were being systematically degraded and the membrane blebs were due to apoptosis not cellular swelling secondary to reversible cellular injury.

Definitely a tough question. The rest of the question stem was really useless too. Guy died in a MVA, but was "really sick" before dying suddenly in the car accident. The question was involving the liver and described bridging fibrosis and regenerative nodules IIRC.