[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Cell injury, adaptation and death](https://durgical.com/en/general-pathology/#a-injury) › Apoptosis vs necrosis: the comparison table

[General pathology](https://durgical.com/en/general-pathology/) · [Cell injury, adaptation and death](https://durgical.com/en/general-pathology/#a-injury)

# Apoptosis vs necrosis: the comparison table

- Topic

Apoptosis is quiet, single-cell and planned. Necrosis is messy, affects many cells and causes inflammation.

Updated 2026-11-01

## Key points

- Size: apoptosis shrinks the cell; necrosis swells it.
- Membrane: intact in apoptosis; ruptured in necrosis.
- Inflammation: absent in apoptosis; present in necrosis.
- Apoptosis can be physiologic; necrosis is always pathologic.
- Mild injury tends to cause apoptosis; severe injury with ATP loss causes necrosis.

## What it is

Apoptosis and necrosis are the two classic ways a cell dies, and the exam favourite is the comparison. Energy is a key switch: apoptosis needs ATP, while necrosis follows its loss, so the same insult can cause apoptosis when mild and necrosis when severe. Newer forms such as necroptosis blur the line: they are regulated, like apoptosis, but end in membrane rupture, like necrosis.

## Side by side

| Feature | Apoptosis | Necrosis |
| --- | --- | --- |
| Trigger | Programmed signal, DNA damage, growth factor loss, death ligands | Ischemia, toxins, trauma, infection: severe damage |
| Energy | Needs ATP | Follows ATP loss |
| Cells affected | Single cells | Groups and areas of tissue |
| Cell size | Shrinks | Swells |
| Nucleus | Condensed and fragmented into packets | Pyknosis, karyorrhexis, karyolysis |
| Membrane | Intact; phosphatidylserine exposed | Broken; contents leak |
| DNA cleavage | Orderly cuts between nucleosomes | Random breakdown |
| Clearance | Phagocytosis of apoptotic bodies | Digestion by lysosomal enzymes and neutrophils |
| Inflammation | None | Yes |
| Physiologic role | Often (development, immunity, hormone withdrawal) | Never |
| Examples | Councilman bodies in hepatitis, graft-versus-host disease, thymic selection | Infarcts, abscesses, caseous tuberculosis, pancreatitis |

## Clinical notes

- In a myocardial infarction both happen: necrosis in the core and apoptosis at the edge.
- Defective apoptosis allows tumour cells to survive; excessive apoptosis contributes to neuron loss in neurodegenerative disease.

## In the lab

- Apoptosis can be shown by caspase activation, annexin V binding to phosphatidylserine, or labelling of DNA breaks (TUNEL).
- Necrosis is detected clinically by enzymes that leak into the blood: troponin, CK, ALT and AST, lipase.

## Memory aid

Apoptosis whispers and leaves no mess; necrosis shouts, spills and calls the neutrophils.

## Test yourself

Think of the answer, then tap the question to see it.

## Which form of cell death requires ATP?

Apoptosis, because caspase activation and the orderly dismantling of the cell are energy-dependent.

## Why does necrosis cause inflammation while apoptosis does not?

In necrosis the membrane ruptures and the cell contents act as danger signals; apoptotic bodies are engulfed intact.

## What is a microscopic example of apoptosis in liver disease?

Councilman (acidophil) bodies in viral hepatitis: single shrunken, eosinophilic hepatocytes.

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## Related

- [Apoptosis: the intrinsic and extrinsic pathways](https://durgical.com/en/general-pathology/apoptosis-the-intrinsic-and-extrinsic-pathways/)
- [Patterns of necrosis: coagulative, liquefactive, caseous, fat, fibrinoid, gangrenous](https://durgical.com/en/general-pathology/patterns-of-necrosis-coagulative-liquefactive-caseous-fat-fibrinoid-gangrenous/)
- [Other forms of cell death: necroptosis, pyroptosis, ferroptosis](https://durgical.com/en/general-pathology/other-forms-of-cell-death-necroptosis-pyroptosis-ferroptosis/)
- [Reversible vs irreversible cell injury: the point of no return](https://durgical.com/en/general-pathology/reversible-vs-irreversible-cell-injury-the-point-of-no-return/)

## Related conditions

- [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/)
- [Viral hepatitis](https://durgical.com/en/conditions/viral-hepatitis/)
- [Acute pancreatitis](https://durgical.com/en/conditions/acute-pancreatitis/)
- [Tuberculosis](https://durgical.com/en/conditions/tuberculosis/)
- [Graft-versus-host disease](https://durgical.com/en/conditions/graft-versus-host-disease/)
- [Non-Hodgkin lymphoma](https://durgical.com/en/conditions/non-hodgkin-lymphoma/)

## Elsewhere in DurgiPedia

- [Cell injury, apoptosis and necrosis](https://durgical.com/en/histology/cell-injury-apoptosis-and-necrosis/)
- [Acute inflammation: vascular and cellular events](https://durgical.com/en/immunology/acute-inflammation-vascular-and-cellular-events/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [4.6 Tissue Injury and Aging](https://openstax.org/books/anatomy-and-physiology-2e/pages/4-6-tissue-injury-and-aging) (OpenStax (Rice University), 2022); [Autoimmune lymphoproliferative syndrome: MedlinePlus Genetics](https://medlineplus.gov/genetics/condition/autoimmune-lymphoproliferative-syndrome/) (MedlinePlus, US National Library of Medicine, 2024); [Gangrene: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/007218.htm) (MedlinePlus, US National Library of Medicine, 2024).

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Representative model, for educational purposes only.

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