Caseous necrosis

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Micrograph showing caseous necrosis of a tuberculous lymph node. H&E stain.

Caseous necrosis is a form of cell death in which the tissue maintains a cheese-like appearance.[1] The dead tissue appears as a soft and white proteinaceous dead cell mass.


Frequently, caseous necrosis is encountered in the foci of tuberculosis infections.[1] It can also be caused by syphilis and certain fungi.

A similar appearance can be associated with histoplasmosis, cryptococcosis, and coccidioidomycosis.[2]


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 granulomatous inflammatory process.

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.

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.


  1. ^ a b Robbins and Cotran: Pathologic Basis of Disease, 8th Ed. 2010. Pg. 16
  2. ^ "Pulmonary Pathology". Retrieved 2008-11-21. 

External links

  • Microscope images of caseous necrosis
  • Image of a hilar lymph node demonstrating caseous necrosis
  • Image of a caseating granuloma of tuberculosis in the adrenal gland
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