Ischemic necrosis

The term ischemic necrosis describes a type of tissue injury that occurs when a part of the body does not get enough blood and oxygen. “Ischemia” means reduced or blocked blood flow. “Necrosis” means cell death. Together, ischemic necrosis means that cells and tissues have died because the blood supply was cut off or severely reduced.

What causes ischemic necrosis?

Ischemic necrosis can be caused by many different conditions that interfere with blood flow, such as:

• Blood clots: A clot in an artery can suddenly block blood flow to an organ or tissue.

• Atherosclerosis: The buildup of fatty deposits in blood vessels can reduce blood flow over time.

• Trauma or injury: Damage to blood vessels during an accident or surgery can cause ischemia.

• Low blood pressure or shock: A severe drop in blood pressure can limit blood flow to vital organs.

• Torsion or twisting of an organ: For example, testicular torsion or ovarian torsion cuts off the blood supply and can cause ischemic necrosis if not treated quickly.

Where can ischemic necrosis occur?

Ischemic necrosis can occur in almost any organ or tissue. Common examples include:

• Heart (myocardial infarction): When blood supply to part of the heart is blocked, leading to a heart attack.

• Brain (stroke): When blood flow to part of the brain is interrupted, causing brain cell death.

• Intestines: Reduced blood flow can lead to ischemic colitis or bowel infarction.

• Bone: Also called avascular necrosis, when the blood supply to a bone is cut off, causing collapse of the bone structure.

• Skin and soft tissues: Often seen in pressure ulcers or wounds where the blood supply has been reduced.

How is ischemic necrosis seen in a pathology report?

When a pathologist examines a tissue sample under the microscope, areas of ischemic necrosis look very different from healthy tissue. The cells may appear pale, shrunken, or fragmented, and the normal tissue structure is often disrupted. In many cases, the cells no longer contain nuclei (the control center of the cell). These dead cells, lacking nuclei, are sometimes referred to as ghost cells because their outlines remain, but their internal details have disappeared.

Because the tissue is damaged and the cells are no longer alive, it is often not possible to perform special tests on areas of ischemic necrosis. Tests such as immunohistochemistry or molecular studies usually require living or well-preserved cells. For this reason, pathologists prefer to analyze unaffected areas of the sample to obtain additional diagnostic information.

Why is ischemic necrosis important?

Finding ischemic necrosis is important because it indicates that part of the tissue was deprived of blood flow for a prolonged period, allowing cell death to occur. This finding can help explain symptoms such as pain, organ dysfunction, or tissue damage. It also helps guide treatment. For example, tissue with ischemic necrosis cannot recover, but prompt treatment may prevent further damage in nearby areas that are at risk.

Questions to ask your doctor

• What caused the ischemic necrosis in my case?

• How much tissue was affected?

• Does this explain my symptoms?

• What treatments are available to prevent further ischemia or damage?

• Will I need follow-up tests or ongoing monitoring?