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Lymphoid System

Dr Jo Bishop

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Learning outcomes
At the end of this SDL learning exercise, you should be able to:

Describe the different components of the lymphoid system

Describe the functional histology of lymphoid tissue
Compare the structure and function of the various organs of the
lymphoid system
Describe the structure and distribution of lymphatic vessels
Describe the mechanism of lymph transport

Please have a notebook and pen to hand to review some of the questions asked throughout the
SDL. There is a worksheet that supports this package, further reading as well as a link to an
online quiz.

Virchow's node

Why might a lump here (in the left

supraclavicular area) indicate that
this patient has stomach cancer?
Read on to learn more about the
anatomy of the lymphoid system

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What is the lymphoid system?

The lymphoid (some books refer to it as the
lymphatic system) system plays a role in
defending the body against infection and
disease. This is achieved by draining surplus
extracellular tissue fluid, monitoring it and
removing any foreign material and fighting
infection.
NB. Lymph vessels and lymph nodes are often depicted in
green in anatomical drawings!!!

Components of the lymphoid system

Lymph is the fluid component of the system; normally clear
and watery with a composition similar to blood. Contains
lymphocytes and macrophages.
Lymphatic plexi are the lymphatic capillaries which are the
smallest vessels in the system; blind-ended and begin in the
extracellular spaces of most tissue.
Lymphatic vessels are a network of thin-walled valved
vessels. Originating from the lymphatic plexuses, the vessels
return excess interstitial fluid now lymph to the venous
system.

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Lymphatic plexus

Lymphatic capillaries
Interstitial fluid
(extracellular matrix)

Lymphatic vessel

Components of the lymphoid system

Lymphoid organs: Sites that produce lymphocytes and/or modulate
the lymphs composition (lymph nodes, thymus and spleen).
Lymph nodes: Small masses of lymphatic tissue found along the
lymphatic vessels that filter the lymph on its way to the venous
system.
Thymus: Lies posterior to the sternum (in the superior
mediastinum). Site of T-cell differentiation (refer to your LGRS).
Interestingly, the thymus involutes after puberty.
Spleen: Lies within the abdomen and has the largest collection of
lymphoid tissue. The spleen filters blood (NB. lymph nodes filter
lymph).

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Components of the lymphoid system

Lymphoid tissue are sites that produce lymphocytes.
Diffuse lymphoid tissue: Found as loosely aggregated
lymphocytes & connective tissue within mucous membranes
(e.g. within the respiratory tract).
Lymphoid nodules: Aggregated lymphocytes & connective
tissue with a supporting framework which are located for
example in various segments of the digestive tract as
Mucosa-Associated Lymphoid Tissue (MALT), Gut-Associated
Lymphoid Tissue (GALT) AND as large nodules known as
tonsils in the walls of the pharynx.

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Components of the lymphoid system

Lymphocytes are the cells within the lymph that elicit an
immune response following exposure to foreign material
(refer to this weeks LGRS).

Stop! Think! Look Up!

Lymphatic vessels occur almost everywhere in

the body (that capillaries are found).
Where in the body are lymphatic vessels
absent?

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The lymph journey

Interstitial fluid enters the lymphatic capillary

lymph then flows to larger lymphatic vessels

(superficial vessels and deep vessels)

lymphatic vessels lead to lymphatic trunks

Lymphatic trunks unite and form either the right lymphatic

trunk or the thoracic duct (AKA the left lymphatic duct)

Right lymphatic trunk drains lymph from bodys

right upper quadrant into right venous angle
(junction of the right subclavian vein and the
right internal jugular vein) Pink area
The thoracic duct drains lymph from the rest of
body into the left venous angle (junction of the
left internal jugular and left subclavian vein). The
thoracic duct begins as the cisterna chyli (sac) in
the abdomen and ascends through the thorax. Grey area

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Right lymphatic duct

Thoracic duct
Cisterna chyli
Lymphatic trunk

Lymphatic trunk
Pink area -area draining
to right lymphatic duct
Gray area area
draining to thoracic duct
Superficial lymphatic vessels
Deep lymphatic vessels

The lymph journey

Starts here

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Stop! Think! Look Up!

The pressure within the lymphatic system is

minimal, lower than the venous system

How is lymph propelled toward the lymphatic

duct?
Clues: lymphatic vessels have valves,
think about venous return....

Major lymph collecting vessels

There are two sets of lymphatic vessels that drain lymph from
the capillaries; the superficial lymphatics and the deep
lymphatics
Superficial lymphatics travel with superficial veins and can be
found in:

Subcutaneous layer next to skin

The loose connective tissue of the mucous membrane lining the digestive,
respiratory, urinary and reproductive tracts
The loose connective tissues of the serous membranes lining the pleural,
pericardial and peritoneal cavities

Deep lymphatics are larger and accompany large arteries and

veins and collect lymph from:

Skeletal muscle as well as organs in the neck, limbs and trunk

Visceral organs in the thoracic and abdominopelvic cavities

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Lymphatic trunks
5.

Within the trunk superficial and

deep lymphatic vessels converge
to form larger trunks called
lymphatic trunks which include:

5.

4.

4.
3.
3.

1.
2.
3.
4.
5.

Lumbar trunks
Intestinal trunks
Bronchomediastinal trunks
Subclavian trunks
Jugular trunks

1.
1.
2.

The collecting vessels

The lymphatic trunks empty
into two large collecting vessels
the Lymphatic ducts that
deliver lymph to the venous
circulation
*The right lymphatic duct
*Thoracic duct

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The thoracic duct:

Collects lymph from:

both sides of the body inferior to the

diaphragm
the left side of the body superior to
the diaphragm

Begins inferior to the diaphragm

at the level of L2 and ascends to
the base of the neck
Originates as the cisterna chyli
an expanded saclike chamber
that receives lymph from the
right and left lumbar trunks and
intestinal trunks
Enters the thoracic cavity
through the diaphragm (with the
aorta)

The thoracic duct:

At the T5 level the duct shifts

to the left and ascends with the
oesophagus to the level of left
clavicle
Lymph drains from the left
bronchomediastinal trunk, the
left subclavian trunk, and the
left jugular trunk and empties
into the left venous angle
(junction of the left internal
jugular and left subclavian vein)
Lymph from the entire body
below the diaphragm and the
left side of the head, neck and
trunk reenter the venous system
via the thoracic duct!!

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The right lymphatic duct:

Collects lymph from the right

side of the body superior to
the diaphragm
Drains lymph from bodys
right upper quadrant into
right venous angle (junction
of the right subclavian vein
and the right internal jugular
vein

Stop! Think! Look Up!

What is *lymphoedema (primary and
secondary)?
How is it treated?
Clues

*There is an excellent review of this within A&P resource online (clinical tab)

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Lymphoid organs: lymph nodes

Lymph nodes are small and

oval in shape and can range
from 1-25mm in size
There are hundreds of
nodes in the body
Lymph nodes are
distributed in areas that
are susceptible to injury
or invasion

Distribution of lymph nodes

Cervical lymph nodes monitor lymph nodes in the head

and neck
Axillary lymph nodes receive lymph arriving from the
trunk and the upper limb (also from the mammary glands
in women)
Inguinal lymph nodes monitor lymph arriving at the
trunk from the lower limbs
Thoracic lymph nodes receive lymph from the lungs,
respiratory passageways and mediastinal structures
Abdominal lymph nodes filter lymph from the urinary and
reproductive systems
Peyers patches, mesenterial lymph nodes, intestinal lymph
nodes receive lymph from the digestive tract

* We will review lymphatic drainage (of each organ/region) within each system block. It
will be important that you consider the lymph nodes (and vessels involved)

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Structure of lymph nodes

Lymph nodes are surrounded by a
dense fibrous capsule with
connective tissue strands known as
trabeculae dividing the node into
compartments
Two histologically distinct regions
make up the lymph node; the cortex
and medulla
The cortex contains densely packed
follicles superficially with germinal
cells containing dividing B cells. T
cells are located in the deeper
regions of the node. Dendritic cells
are also found in this region
Medullary cords contain both types
of lymphocytes

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Structure of lymph nodes

Lymph nodes contain large lymph

capillaries known as lymph
sinuses
Reticular fibers crisscross the
sinuses and act as a net as the
macrophages residing on them
phagocytize foreign material
within the lymph
An Immune response is also
elicited when the antigens within
the lymph leak into surrounding
lymphoid tissue and activate
lymphocytes

Circulation in the lymph nodes

Lymph enters the node through afferent
vessels
Lymph then moves through the
subscapular sinus and into smaller sinuses
(through cortex and medulla)
Lymph perculates through the medullary
sinus
Lymph exits the node at its hilum via
efferent lymphatic vessels
NB note that there are less efferent vessels draining the
node than afferent feeding it which slows the flow and
allows monitoring

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Stop! Think! Look Up!

Why do nodes enlarge? (often described as

swollen glands)
Why can lymph nodes become secondary
cancer sites?

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Thymus*

The thymus lies posterior to the manubrium of the

sternum in the superior portion of the mediastinum
The thymus is at its maximum size at puberty
Following puberty, the thymus involutes; it decreases
in size and its functional cells are replaced by
connective tissue

*review the endocrine workshop and your immunity LGRS

The thymus is covered

by a capsule which then
extends into the two
thymic lobes as septa;
dividing the two lobes
into lobules
The lobules are around
2mm in size and contain
an outer dense cortex
and a diffuse paler
central medulla

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Lymphoid stem cells are found in the cortex; they divide

and their daughter cells eventually mature into T cells and
migrate into the medulla

The clever part of the maturation process is that T cells

that recognise self and therefore normal tissue antigens
are destroyed
The remaining or surviving T cells escape through
specialised blood vessels but remain inactive in the Thymus

The blood-thymus barrier (similar to the blood-brain

barrier) prevents free exchange of fluid and therefore T
cells stimulation by circulating antigens
Thymic Hormones are produced by reticular cells that are
scattered between the lymphoid tissue the hormones
play a role in the differentiation of T cells

Thymic/Hassalss corpuscles are formed when reticular cells cluster

together (their function is unknown)

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RECAP
The thymus has an important role in the development
of a childs immune system
After puberty it atrophies
In some disease processes it enlarges such as in
myasthenia gravis a muscle weakness disease
Of interest:
Early histologists believed that the Thymus was the
graveyard for lymphocytes as the majority of
lymphocytes within were dead we now know that this
is the clever selection process
But why does it atrophy?

The spleen

It is the largest lymphoid organ and is around 12 cm long and can

weigh up to 160g
The spleen lies superficially in the left upper abdominal quadrant
between the 9th and 11th ribs
Its convex, costal surface fits the inferior surface of the
diaphragm and the curved bodies of the ribs.
The spleen is often only palpable when enlarged

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Functions of the spleen

Removes abnormal blood cells and other blood components

through phagocytosis
Stores iron from broken down red blood cells
Initiates an immune response by B and T cells following
the stimulation of circulating antigens in the blood
NB spleen filter the blood and lymph nodes filter the
lymph (immune surveillance and response)

Histology of the spleen

The spleen is surrounded by a capsule

Within the spleen you will find areas of white pulp and
red pulp

The white pulp are the lymphoid nodules and where the immune
function takes place
The red pulp contains large quantities of red blood cells (RBCs) and
form splenic cords and is the site where abnormal RBCs and
pathogens are destroyed

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Histology of the spleen

Lymphoid nodules: MALT

Mucosa Associated Lymphoid Tissue (MALT) are

strategically found in mucous membranes throughout
the body
MALT protects the body from pathogens that enter
the body
Examples of MALT include Peyers patches, tonsils
and appendix
Lymphoid nodules typically have indistinct boundaries
as they have no capsule (and average around a mm in
diameter) with a germinal centre containing activated
lymphocytes

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Lymphoid nodules: Tonsils

Tonsils form a ring of defence around the entrance of the

pharynx (throat) and appear as swellings in the mucosa

Palatine tonsils (paired) are found on either side at the posterior

end of the oral cavity (most often infected)
Lingual tonsils are found at the base of the tongue
The pharyngeal tonsil is located in the posterior wall of the
nasopharynx (when enlarged they are known as adenoids)
Tubal tonsils surround the opening of the auditory tubes in the
pharynx

Lymphoid nodules: Tonsils

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Peyers patches

Are aggregated lymphoid nodules with a similar structure

to tonsils located in the wall of the intestine

Lymphoid nodules

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Back to the first question

Why might a lump here (in the left
supraclavicular area) indicate that this patient
has stomach cancer?
Malignancies of the internal organs can reach an advanced stage before
giving symptoms.
Stomach cancer, for example, can remain symptomless while metastasising.
One of the first visible spots where these tumours metastatise is the left
supraclavicular lymph node. The left supraclavicular node is the classical
Virchow's node because it is on the left side of the neck where the
lymphatic drainage of most of the body (from the thoracic duct) enters
the venous circulation via the left subclavian vein.
Differential diagnosis of an enlarged Virchow's node includes lymphoma,
various intra-abdominal malignancies, breast cancer, lung cancer, and
infection (e.g. of the arm).

QUIZ
Please click here to review your knowledge of
the lymphoid system.

Good luck!

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Additional reading

Peckham M. Histology at a Glance. Oxford:

Wiley-Blackwell; 2011.
Pakurar AS, Bigbee JW. Digital Histology: An
Interactive CD Atlas with Review Text. 2nd
ed. Hoboken, United States: Wiley-Blackwell;
2010.

References used

Clinically Orientated Anatomy K.L. Moore &

A.F. Dalley
Human Anatomy (6th Edition) Martini,
Timmons & Tallitsch
Grays Atlas of Anatomy R.L. Drake & A.W.
Vogl
Human anatomy and physiology E.N.Marieb
& K.N. Hoehm

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