Lymph Nodes

■ Lymph nodes are bean-shaped, encapsulated structures, generally only 10 mm by 2.5 cm in size,
distributed throughout the body along the lymphatic vessels (

■ Each lymph node filters lymph and provides a site for B-cell activation and differentiation to antibody-
secreting plasma cells.

■ A lymph node has three functional but not physically separate compartments: an outer cortex, a
underlying paracortex, and an inner medulla adjacent to the hilum and efferent lymphatic.

■ Lymphatics enter at the cortex of a node, where B cells encounter antigens, proliferate in lymphoid
nodules, and then move into the deeper regions of the lymph node.

■ Most lymphocytes enter at the paracortex of the lymph node via HEVs located there only; most
lymphocytes in this region are T helper cells.

■ The medulla has medullary cords containing reticular fibers with many plasma cells, macrophages, and
other leukocytes; between the cords are lymph-filled medullary sinuses that converge at the efferent
lymphatic.

■ The medulla of a lymph node has two major components

1. Medullary cords = are branched cordlike masses of lymphoid tissue extending from the
paracortex. They contain T and B lymphocytes and many plasma cells.

2. Medullary = sinuses are dilated spaces lined by discontinuous endothelium that separate the
medullary cords. As shown in Figure 14–20, the lumens of medullary sinuses include a
meshwork of processes from reticular cells, which represent a final lymph filter. These sinuses
contain many macrophages and sometimes neutrophils if the lymph node is draining an infected
region. They are continuous with the cortical sinuses and converge at the hilum as the efferent
lymphatic vessel.

■ The region between the cortex and medulla, the paracortex does not have precise boundaries but can
be distinguished from the outer cortex by its lack of nodules. Unlike the superficial cortex, the
paracortex contains lymphoid tissue rich in T cells distinguishable by immunohistochemistry.

■ The lymph arriving at a lymph node contains antigens free in solution or bound to antibodies or
complement, still on microorganisms, or already internalized and transported by APCs. If draining from
an infected or inflamed region, lymph may also contain microorganisms and cytokines.
Spleen

■ The spleen contains the largest single accumulation of lymphoid tissue in the body and is the only
lymphoid organ involved in filtration of blood, making it an important organ in defense against blood-
borne antigens.

■ The spleen is a large lymphoid organ without a cortex/medulla structure; instead, it has two
intermingled but functionally different regions: white pulp and red pulp.

■ White pulp, only 20% of the spleen, is secondary lymphoid tissue associated with small central
arterioles that are also enclosed by PALS of T cells.

■ Red pulp, which filters blood, removes defective erythrocytes, and recycles hemoglobin iron, consists
of splenic cords with macrophages and blood cells of all kinds and splenic sinusoids.

■ The splenic sinusoids are lined by unusual endothelial cells called stave cells, which are elongated and
aligned parallel to the blood flow, with open slits between the cells.

■ Blood flow in red pulp is either a closed circulation, moving from capillaries into the venous sinusoids,
or an open circulation, with capillaries opening directly into the splenic cords.

■ Blood filtration in the open circulation involves interaction with splenic cord macrophages, which
remove old, swollen RBCs unable to slip between stave cells to reenter the venous blood flow

■ Blood flow through the splenic red pulp can take either of two routes

1. e closed circulation - capillaries branching from the penicillar arterioles connect directly to the
sinusoids and the blood is always enclosed by endothelium.

2. open circulation - capillaries from about half of the penicillar arterioles are uniquely open-
ended, dumping blood into the stroma of the splenic cords. In this route plasma and all the
formed elements of blood must reenter the vasculature by passing through narrow slits
between the stave cells into the sinusoids. These small openings present no obstacle to
platelets, to the motile leukocytes, or to thin flexible erythrocytes. However stiff or effete,
swollen RBCs at their normal life span of 120 days are blocked from passing between the stave
cells and undergo selective removal by macrophages.