Lymphatic

System 7
INTRODUCTION
The lymphatic system is composed of groups of cells, tissues, and
organs that monitor the body for harmful substances and combat to
eliminate them. Leukocytes, particularly lymphocytes, make up the
parenchyma of the lymphoid system and are found in diffuse lym-
phoid tissues, lymphoid nodules, and lymphoid organs. Lymphoid
organs are composed of lymphoid tissues surrounded by a connec-
tive tissue capsule. Lymphatic vessels allow communication among
lymphatic structures and with the blood vascular system. Due to
their important immunologic functions, structures of the lymphoid
system are found throughout the body but are more prominent
along the mucosa and at key points between the limbs and the trunk.

THE LYMPHATIC SYSTEM

LYMPHOID TISSUES
Structure Function Location
Diffuse lymphoid tissue
1. Relatively 1. Protection of 1. Lamina pro-
high concen- the body from pria of the
tration of 1 pathogens gastrointes-
leukocytes and initiation tinal (GI),
(primarily of immune respiratory,
lymphocytes, response and uri-
plasma cells, nary tract
eosinophils, mucosa;
and mac- dispersed
rophages) throughout
evenly distrib- lymphoid
uted in loose organs
connective
tissue matrix
(continued)

101
102 LIPPINCOTT’S POCKET HISTOLOGY

LYMPHOID TISSUES (continued)

Structure Function Location
Lymphoid nodules (follicles)
2. Dense aggre- 2. Protection of 2. Lamina
gate of mostly the body from propria
B lympho- pathogens of the GI,
cytes. When and initiation respiratory,
activated by of immune and uri-
antigens, lym- response nary tract
phoid nodules mucosa;
produce anti- dispersed
bodies throughout
lymphoid
organs;
most promi-
nent in ton-
2 sils, Peyer
patches,
and appen-
3 dix
3. Germinal 3. Site of 3. In the
center: lymphocyte center of
Lighter stain- proliferation, activated
ing central plasma cell lymphoid
4
area differen- nodules
tiation, and
antibody
production
4. Mantle zone 4. Composed of 4. Surround
(corona): Ring newly formed the germi-
of densely lymphocytes nal center
basophilic
area

Additional Concepts
• MALT (mucosa-associated lymphoid tissue): Diffuses lymphoid
tissues and lymphoid nodules that are closely associated with the
mucosa.
• GALT (gut-associated lymphoid tissue): The MALT in the GI
tract mucosa.
• BALT (bronchus-associated lymphoid tissue): The MALT in
the respiratory tract mucosa.
• Tonsils are an example of GALT; however, because they exhibit
a partial connective tissue capsule, tonsils are considered to be
lymphoid organs.
 CHAPTER 7 • LYMPHATIC SYSTEM 103

TONSILS
Structure Function Location
Palatine tonsils (tonsils)
Paired, dense Immune func- Either side of
collections of tion at the the oropharynx
lymphoid tissues entrance of between pala-
that contain: the orophar- topharyngeal
ynx and palatoglos-
sal arches
1. Nonkeratinized 3 1. Form the 1. Pharyngeal
stratified squa- 1 protective surface of
mous epithe- mucosal the tonsil
lium 2 lining
2. Crypts: Deep 2. Increase 2. Extend into
5
invaginations surface tonsillar
of lining epi- area for parenchyma
thelium with contact
a 4
lymphocyte between
infiltrate b the oro-
pharyngeal
content
and the
immune
cells
3. Incomplete 3. Separate 3. Between the
connective tis- tonsils from tonsil and
sue capsule underlying underlying
1 connective connective
tissue and tissue
wall them
off in the
2 event of
infection
4. Diffuse lym- 4–5. Immune 4. Throughout
phoid tissue 1 function tonsillar
parenchyma
5. Numerous lym- 5. Throughout
phoid nodules, tonsillar
many with parenchyma
prominent:
(continued)
104 LIPPINCOTT’S POCKET HISTOLOGY

TONSILS (continued)
Structure Function Location
Palatine tonsils (tonsils)
a. Germinal a. In the
centers center of
b. Mantle activated
zones lymphoid
(corona) nodules
b. Peripheral
margins
of ger-
minal
centers
Pharyngeal tonsil (adenoid)
Unpaired collec- Immune func- Roof of the
tion of lymphoid tion on the nasopharynx
tissue that roof of the
contains: nasopharynx
1. Ciliated pseu- 1. Form the 1. Pharyngeal
dostratified mucosal surface
columnar epi- lining
thelial lining 3
2. Incomplete 2. Separate 2. Between the
connective tis- 1 the tonsil tonsil and
sue capsule from underlying
underlying connective
connective tissue
tissue and
3
wall it off in
4 the event
of infection
3. Numerous lym- 3–4. Immune 3–4. Through-
phoid nodules function out tonsillar
4. Diffuse lym- parenchyma
phoid tissue
Lingual tonsil
Collection of lym- Surface of the
phoid tissue: posterior third
of the tongue
1. Nonkeratinized 1. Form the 1. Pharyngeal
stratified squa- mucosal surface
mous epithe- lining
lium
 CHAPTER 7 • LYMPHATIC SYSTEM 105

Structure Function Location

Lingual tonsil
2. Crypts: Wide 1 2. Increase 2. Extend into
invagination of surface tonsillar
lining epithe-
2 area for parenchyma
lium contact
3 between
4
oropharyn-
geal con-
tent and
immune
cells
3. Incomplete 3. Separate 3. Between the
connective tis- the tonsil tonsil and
sue capsule from con- underlying
nective connective
tissue tissue
4. Numerous lym- 4. Immune 4. Throughout
phoid nodules function tonsillar
and diffuse parenchyma
lymphoid
tissue

HISTOLOGIC LOOK-A -L IKES

Although all three tonsils exhibit similar parenchymal histology of
diffuse lymphoid tissue and lymphoid nodules, other structural fea-
tures help distinguish the three.

Palatine Tonsils Pharyngeal Tonsils Lingual Tonsils

Mucosal Nonkeratinized Ciliated pseu- Nonkeratinized stratified
epithelium stratified squamous dostratified colum- squamous epithelium
epithelium nar epithelium

Crypts Deep, branched, None Wide, short, and not

and numerous branched

Clinical Significance
• Tonsillitis: Inflammation of the tonsils as the result of bacterial
or viral infection. Red, swollen palatine tonsils with purulent
exudates (pus) are easily observed when the patient opens the
mouth and the tongue is depressed. Patients present with sore
throat, pain, fever, and dysphagia. In severe cases, the infection
may extend to involve the pharynx, larynx, and auditory tube.
106 LIPPINCOTT’S POCKET HISTOLOGY

LYMPH NODES
Structure Function Location
Macroscopic features
Numerous oval Filtration of Found
structures of lymph throughout
varying size the body along
throughout the the lymphatic
body vessels; more
numerous in
axilla, groin,
neck, and mes-
enteries
1. Convex side 1. Afferent lym- 1. Portion with
1 phatic vessels convex con-
enter tour
2. Hilum: 2. Efferent lym- 2. Concave
Indented phatic exit and area
area blood vessels
2 and nerves
exit and enter
3. Capsule with
3 3. Structural 3. Superficial-
trabeculae: support most protec-
Dense con- tive struc-
nective ture and its
tissue extensions
into the lym-
phatic tissue
Microscopic features
4. Outer 4. Screen the 4. Deep to
(superficial/ lymph for capsule
nodular) antigens, dif-
cortex: ferentiate into
Lymphoid 4 plasma cells,
nodules 5 and produce
composed antibodies
of mostly B upon con-
lymphocytes 6 tact with an
antigen
5. Inner (deep/ 5. T cells interact 5. Between the
para-) cortex: with antigen- outer cortex
Diffuse lym- presenting and the
phoid tissue cells medulla
composed
of mostly T
lymphocytes
 CHAPTER 7 • LYMPHATIC SYSTEM 107

Structure Function Location

Microscopic features
6. Medulla 6. Continued 6. Center of
composed of: filtration and the lymph
collection of node
4 lymph
a. Medullary a. Phagocy- a. Scattered
cords: 5 tosis, through-
Denser antibody out
collections production medulla
of B cells, b
plasma 6
cells, mac- a
rophages,
and reticu-
lar cells
b. Medullary b. Lymph flow b. In
sinuses: and collec- between
Lymphatic tion medul-
channels lary cords
between
the cords

Additional Concepts
• Lymph: Excess interstitial fluid that is collected and transported
to blood circulatory system. Along the way, lymph is filtered by
several lymph nodes for antigens or other potentially harmful
particles or cells.
• Flow of lymph through a lymph node: Afferent lymphatic vessel
→ subcapsular (cortical) sinus → peritrabecular (trabecular) sinus
→ medullary sinus → efferent lymphatic vessel (FIG. 7-1).

Clinical Significance
• Lymphadenitis: Reactive, inflammatory enlargement of lymph
nodes when lymphocytes respond to antigens by proliferating,
forming germinal centers and producing antibodies. Enlarged
lymph nodes are commonly referred to as swollen glands and can
be observed or palpated in the neck of a patient with oropharyn-
geal infection or in the axilla or groin of a patient with an infection
in the extremity.
• Sentinel node: The first lymph node or a group of lymph nodes
that the lymph from certain regions of the body passes through.
• Sentinel node biopsy: Procedure in which sentinel nodes are
removed to determine the presence of metastatic tumor cells to
108 LIPPINCOTT’S POCKET HISTOLOGY

Afferent
lymphatic
vessel
Subcapsular
sinus

Peritrabecular
sinus
Efferent
Medullary lymphatic
sinuses vessel

Figure 7-1. Flow of lymph through a lymph node. (From Cui D.

Atlas of Histology with Functional and Clinical Correlations.
Baltimore: Lippincott Williams & Wilkins, 2009:119.)

stage certain types of cancer. To identify sentinel nodes, surgeons

inject dye or radioactive fluid into the tumor or its surrounding
area then trace its path to find and biopsy the nodes.

THYMUS
Structure Function Location
Macroscopic features
Bilobed lym- Differentiation Superior
phoid organ: and maturation anterior medi-
of T lympho- astinum
cytes
1. Dense con- 1. Protection, 1. External-
nective tissue outer bound- most sur-
capsule ary of the face of the
organ organ
 CHAPTER 7 • LYMPHATIC SYSTEM 109

Structure Function Location

Macroscopic features
2. Trabeculae: 2. Form septa 2. Extend into
Dense con- that separate the paren-
nective tissue thymic lob- chyma from
extensions ules, carry the capsule
from the cap- vessels and
sule into the nerves
parenchyma
3. Cortex: Cell- 3. T-cell selec- 3. Deep to the
dense, baso- 1 tion and capsule
philic staining maturation
region 2 3
4. Medulla: 4. T-cell selec- 4. Central
Lighter-
4 tion, matura- region of
staining tion, storage, the organ
region and release
into circula-
tion
5. Thymic 5. Unclear 5. Scattered in
(Hassall) the medulla
corpuscles: 5
Eosinophilic,
spherical
structures
with concen-
tric layers
Microscopic features
Cortex com-
posed of:
6. Thymocytes: 6. Undergoing 6–8. Through-
6
Small, baso- selection and out cortex
philic devel- maturation and medulla
oping T cells
7
7. Epitheliore- 7. Form archi-
8
ticular cells tectural
(types I, II, framework,
III): Stellate 6 contribute to
cells with thymic-blood
larger, lighter-
8 barrier, partic-
staining ipate in T-cell
nuclei selection
7 7
8. Macrophages: 8. Phagocytose
Clear-staining unselected
cytoplasm thymocytes
(continued)
110 LIPPINCOTT’S POCKET HISTOLOGY

THYMUS (continued)
Structure Function Location
Microscopic features
Medulla com-
posed of more
epithelioreticu-
lar cells (types
IV, V, VI) and
loosely packed,
mature T cells
and:
5. Thymic
(Hassall)
corpuscles:
Concentric
bundles of
epitheliore-
ticular cells
5

Additional Concepts
• Blood-thymic barrier: Composed of continuous capillaries and
epithelioreticular cells that form a physical barrier between the
thymocytes and blood to protect the developing thymocytes
from antigen exposure, which can lead to compromised immune
function.
• Epithelioreticular cells versus reticular cells: Two different
groups of cells in terms of embryonic origin, morphology, and
function. Due to both cells’ involvement in the lymphoid system
and possession of “reticular” in the name, students often confuse
the two.
• Epithelioreticular cells: Epithelioid in shape (broad, large
cytoplasm), play a role in T-cell development, and only found
in the thymus.
• Reticular cells: Fibrocyte-like cells with thin, spindle-shaped
morphology that produce reticular fibers in most lymphoid
organs including the thymus.
 CHAPTER 7 • LYMPHATIC SYSTEM 111

SPLEEN
Structure Function Location
Macroscopic features
Single, fist-sized Filtration, Upper left
lymphoid organ: clearance of quadrant in
microorgan- peritoneal cav-
isms, antigens ity at 9–12 rib
from blood. level
Production
of antibodies,
removal of
abnormal eryth-
rocytes, hema-
topoiesis
1. White pulps: 1. Filter and 1–2. Through-
1
Cell-dense, 2 monitor out spleen
gray, nodular blood, pro-
areas duce antibod-
ies when
2 activated by
4 an antigen
3
2. Red pulps: 1 2. Filter blood,
Softer, red, destroy
less cell-dense 2 damaged or
areas altered eryth-
rocytes
3. Capsule: 3. Protection 3. Surrounds
Dense con- and coverage the spleen
nective tissue
4. Trabeculae: 4. Structural 4. Extensions
Dense con- support and of the cap-
nective tissue delivery of sular tissue
vessels into the
parenchyma
Microscopic features
White pulps:
5. Lymphoid 5. Screen blood 5. Throughout
nodules; for antigens the organ
mostly B cells and produce
with or with- plasma cells
out germinal and antibod-
centers ies
(continued)
112 LIPPINCOTT’S POCKET HISTOLOGY

SPLEEN (continued)
Structure Function Location
Microscopic features
6. Germinal cen- 6. B-cell prolif- 6. Center of
5 7
ter: Lighter- 8 eration, dif- lymphoid
staining area ferentiation nodule
to plasma
cells and anti-
6 body produc-
tion
7. Central artery: 7. Deliver blood 7. Periphery of
Branch of to white and a white pulp
splenic artery red pulps lymphoid
nodule
8. Periarterial 8. Immune 8. Immediate
lymphatic function vicinity of
sheath (PALS): the central
Aggregate of artery
T cells
Red pulps are
composed of:
9. Splenic cords 9. Screen blood 9. Throughout
(cords of and destroy red pulp of
Billroth): 9 irregular the spleen,
Network of erythrocytes in between
reticular cells, the sinu-
lymphocytes, soids
macrophages,
and plasma
cells in reticu-
lar connective 10
tissue
10. Splenic 10. Filtration 10. Throughout
sinuses: of blood and red pulp of
Sinusoids destruction the spleen,
lined by long, of irregular in between
parallel endo- erythrocytes splenic
thelial cells cords

Additional Concepts
• Spleen: A unique organ that serves both the lymphoid system
(providing immunologic function) and the circulatory system (fil-
tering blood, destroying erythrocytes, undergoing hematopoiesis
when induced).
 CHAPTER 7 • LYMPHATIC SYSTEM 113

• Open circulation: Process through which the spleen releases

blood from the central artery into the splenic cord, maximizing
exposure of blood cells to macrophages. Healthy erythrocytes can
easily pass through the sinusoidal endothelial cells to return to
circulation, whereas irregular, older cells are trapped in the cords
and soon engulfed by macrophages.
• Closed circulation: Process through which the spleen carries
blood from the central artery into the splenic sinusoids; the blood
is then directly returned to circulation.

Clinical Significance
• Splenomegaly: An enlargement of the spleen that may occur as
the spleen performs its normal function or as a result of a variety
of pathologic conditions such as sarcoidosis, leukemia, etc.
• Autosplenectomy: Splenic tissue loss as a result of multiple
infarction of the spleen. Patients with sickle cell anemia often
present with autosplenectomy as the result of repeated episodes of
abnormal blood cells clogging small vessels and causing infarction
of the tissue downstream. Patients are more susceptible to fulmi-
nant bacterial infections.

HISTOLOGIC LOOK-A -L IKES

Lymph Node Thymus Spleen
Parenchymal Cortex: Lymphoid Cortex: Densely White pulps:
organization nodules in outer cellular but no lym- Lymphoid folli-
cortex phoid nodules cles with central
Medulla: Medullary Medulla: Hassall arteries
cords and sinuses corpuscles. No cords Red pulps:
or sinuses Splenic cords
and sinuses
Erythrocytes Few Few Abundant
Unique features Subdivision of cortex Hassall corpuscles in No cortex or
into outer and inner the medulla medulla
cortex Lymphoid
follicles with
peripheral cen-
tral arteries