of cells. A classic example of a necrotic condition is ischemia which leads to a drastic depletion of oxygen, glucose, and other trophic factors and induces massive necrotic death of endothelial cells and non-proliferating cells of surrounding tissues (neurons, cardiomyocytes, renal cells, etc.). Recent cytological data indicates that necrotic death occurs not only during pathological events but it is also a component of some physiological process. Activation-induced death of primary T lymphocytes and other important constituents of the immune response are caspase-independent and necrotic by morphology; hence, current researchers have demonstrated that necrotic cell death can occur not only during pathological processes, but also during normal processes such as tissue renewal, embryogenesis, and immune response. Pathogenesis Pathways Until recently, necrosis was thought to be an unregulated process. However, there are two broad pathways in which necrosis may occur in an organism. The first of these two pathways initially involves oncosis, where swelling of the cells occurs. Affected cells then proceed to blebbing, and this is followed by pyknosis, in which nuclear shrinkage transpires. In the final step of this pathway cell nuclei are dissolved into the cytoplasm, which is referred to as karyolysis. The second pathway is a secondary form of necrosis that is shown to occur after apoptosis and budding. In these cellular changes of necrosis, the nucleus breaks into fragments (known as karyorrhexis). Histopathological changes The nucleus changes in necrosis and characteristics of this change are determined by the manner in which its DNA breaks down: Karyolysis: the chromatin of the nucleus fades due to the loss of the DNA by degradation. Karyorrhexis: the shrunken nucleus fragments to complete dispersal. Pyknosis: the nucleus shrinks, and the chromatin condenses. Other typical cellular changes in necrosis include: Cytoplasmic hypereosinophilia on samples with H&E stain. It is seen as a darker stain of the cytoplasm. The cell membrane appears discontinuous when viewed with an electron microscope. This discontinuous membrane is caused by cell blebbing and the loss of microvilli. On a larger histologic scale, pseudopalisades (false palisades) are hypercellular zones that typically surround necrotic tissue. Pseudopalisading necrosis indicates an aggressive tumor. Treatment There are many causes of necrosis, and as such treatment is based upon how the necrosis came about. Treatment of necrosis typically involves two distinct processes: Usually, the underlying cause of the necrosis must be treated before the dead tissue itself can be dealt with. Debridement, referring to the