Background: Dirty necrosis (Intraacinar necrosis/garland necrosis) is defined as the presence of cell remnants in the lumen of the gland. Dirty necrosis consisting of an eosinophilic mass, which is a mass originating from the cytoplasm of dead cells mixed with the remnants of the cell nucleus. The remnants of the cell nucleus are blue and the eosinophilic mass is pink in the background. Dirty necrosis results from the breakdown of carcinoma cells, which usually accumulate in the lumen of intact tubular glands, and may be associated with spontaneous events involving insufficient tumor vascular supply. Assessment of the presence of a dirty necrosis is considered a characteristic of colorectal carcinoma. Objective: This study was conducted to analyze the relationship between dirty necrosis and histopathological grading of colorectal adenocarcinoma. Methods: The study used 55 paraffin block samples of colorectal adenocarcinoma cases that had been diagnosed at the Anatomical Pathology Laboratory, H. Adam Malik Hospital, Medan and at the Anatomical Pathology Laboratory, Faculty of Medicine, Universitas Sumatera Utara, since 2019-2020. Dirty necrosis was assessed using H&E staining with 400x magnification assessed over the entire lumen of the gland, if <10% was considered absent and if >10% was considered present. Results: The results showed that there were 47 samples (85.4%) of dirty necrosis, while 8 samples (14.6%) did not. For the most histopathological grading, 42 samples (73.4%) were low grade, while the high grade was 13 samples (23.6%). Statistical tests between dirty necrosis and colorectal adenocarcinoma histopathological grading showed no significant relationship with p value = 0.376 (p >0.05). Conclusion: There was no statistically significant relationship between dirty necrosis and histopathological grading in colorectal adenocarcinoma.