The Natural History of Uterine Leiomyomas: Light and Electron Microscopic Studies of Fibroid Phases, Interstitial Ischemia, Inanosis, and Reclamation

Table 4

Comparison of necrosis, apoptosis, and inanosis.

	Necrosis (ischemic)	Apoptosis	Inanosis
Basic mechanism	Energy independent	Energy-dependent	Energy independent
Speed of Process	Rapid	Rapid	Slow
Individual cell versus groups of cells	Usually groups	Individual	Individual
Typical pattern	Regional groups of cells	Individual cells	Mottled (interspersed viable cells)
Histologic hallmark	Zonal (multicellular) coagulative necrosis	Apoptotic nuclear changes; tingible body macrophages	Myocyte tombstone
Nuclear changes	Pyknosis, karyorrhexis, or karyolysis	Pyknosis and karyorrhexis	Shrinkage and pallor
Cytoplasmic volume	Cell swelling	Cell shrinkage	Cell shrinkage
Cytoplasmic shape	Variable	Rounded	Normal
Cytoplasmic tinctorial features	Hypereosinophilic	Hypereosinophilic	Pallor
Relation of cell to adjacent cells or stroma	Variable	Detaches from neighboring cells	Maintains connection initially
Inflammation	Usually	No; macrophages	No
Disposition of dead cells	Phagocytosis	Phagocytosis	Gradual dissolution (Reclamation)
Release of cytoplasmic contents	Yes	No	Yes