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Lymphnode
FromWikipedia,thefreeencyclopedia

Lymphnode

Diagramofalymphnode,showingtheflowoflymphthroughthelymphsinuses.
Details

esystem[1][2](Lymphaticsystem)
Identifiers

ymphaticus(singular)nodilymphatici(plural)

www.unifr.ch/ifaa/Public/EntryPage/TA98%20Tree/Entity%20TA98%20EN/13.2.03.001%20Entity%20TA98%20EN.htm)

http://fme.biostr.washington.edu/FME/index.jsp?fmaid=5034)
Anatomicalterminology
[editonWikidata]

Alymphnodeisanovalorkidneyshapedorganofthelymphaticsystem,distributedwidelythroughout
thebodyincludingthearmpitandstomachandlinkedbylymphaticvessels.Lymphnodesaremajor
sitesofB,T,andotherimmunecells.Lymphnodesareimportantfortheproperfunctioningofthe
immunesystem,actingasfiltersforforeignparticlesandcancercells.Lymphnodesdonotdealwith
toxicity,whichisprimarilydealtwithbytheliverandkidneys.
Lymphnodesalsohaveclinicalsignificance.Theybecomeinflamedorenlargedinvariousinfections
anddiseaseswhichmayrangefromtrivialthroatinfections,tolifethreateningcancers.Theconditionof
thelymphnodesisveryimportantincancerstaging,whichdecidesthetreatmenttobeused,and
determinestheprognosis.Whenswollen,inflamedorenlarged,lymphnodescanbehard,firmor
tender.[3]

Contents
1 Structure
1.1 Capsule
1.1.1 Subcapsularsinus

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1.1.1 Subcapsularsinus
1.2 Cortex
1.3 Medulla
2 Function
3 Clinicalsignificance
4 Seealso
5 Additionalimages
6 References
7 Externallinks

Structure
Lymphnodesarekidneyorovalshapedandrangeinsize
fromafewmillimeterstoabout12cmlong.[4]Eachlymph
nodeissurroundedbyafibrouscapsule,andinsidethelymph
nodethefibrouscapsuleextendstoformtrabeculae.The
substanceofthelymphnodeisdividedintotheoutercortex
andtheinnermedulla.Thecortexiscontinuousaroundthe
medullaexceptatthehilum,wherethemedullacomesin
directcontactwiththehilum.[4]
Thinreticularfibersandelastinformasupportingmeshwork
1)Capsule2)Subcapsularsinus3)
calledareticularnetworkinsidethenode.Whitebloodcells
Germinalcentre4)Lymphoidnodule5)
(leukocytes),themostprominentonesbeinglymphocytes,are
Trabeculae
tightlypackedinthefollicles(Bcells)andthecortex(T
cells).Elsewhereinthenode,thereareonlyoccasional
leucocytes.AspartofthereticularnetworktherearefolliculardendriticcellsintheBcellfollicleand
fibroblasticreticularcellsintheTcellcortex.Thereticularnetworknotonlyprovidesthestructural
support,butalsothesurfaceforadhesionofthedendriticcells,macrophagesandlymphocytes.Itallows
exchangeofmaterialwithbloodthroughthehighendothelialvenulesandprovidesthegrowthand
regulatoryfactorsnecessaryforactivationandmaturationofimmunecells.[5]
Thenumberandcompositionoffolliclescanchangeespeciallywhenchallengedbyanantigen,when
theydevelopagerminalcenter.[4]
Lymphenterstheconvexsideofthelymphnodethroughmultipleafferentlymphaticvessels,toflow
throughthesinuses.Alymphsinuswhichincludesthesubcapsularsinus,isachannelwithinthenode,
linedbyendothelialcellsalongwithfibroblasticreticularcellsandthisallowsforthesmoothflowof
lymphthroughthem.Theendotheliumofthesubcapsularsinusiscontinuouswiththatoftheafferent
lymphvesselandisalsowiththatofthesimilarsinusesflankingthetrabeculaeandwithinthecortex.
Allofthesesinusesdrainthefilteredlymphaticfluidintothemedullarysinuses,fromwherethelymph
flowsintotheefferentlymphvesselstoexitthenodeatthehilumontheconcaveside.[4]Thesevessels
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aresmalleranddon'tallowthepassageofthemacrophagessothat
theyremaincontainedtofunctionwithinthelymphnode.Inthe
courseofthelymph,lymphocytesmaybeactivatedaspartofthe
adaptiveimmuneresponse.

Capsule
Thelymphnodecapsuleiscomposedofdenseirregularconnective
tissuewithsomeplainmusclefibers,andfromitsinternalsurface
Lymphnodehistology
aregivenoffanumberofmembranousprocessesortrabeculae,
consisting,inhumans,ofconnectivetissue,withasmall
admixtureofplainmusclefibersbutinmanyofthelower
animalscomposedalmostentirelyofinvoluntarymuscle.They
passinward,radiatingtowardthecenterofthegland,forabout
onethirdoronefourthofthespacebetweenthecircumference
andthecenterofthenode.Insomeanimalstheyaresufficiently
wellmarkedtodividetheperipheralorcorticalportionofthe
glandintoanumberofcompartments(follicles),butinhumans
thisarrangementisnotobvious.Thelargertrabeculaespringing
fromthecapsulebreakupintofinerbands,andtheseinterlaceto
formameshworkinthecentralormedullaryportionofthe
Lymphnodetissueshowing
gland.Inthesespacesformedbytheinterlacingtrabeculaeis
trabeculae
containedtheproperglandsubstanceorlymphoidtissue.The
glandpulpdoesnot,however,completelyfillthespaces,but
leaves,betweenitsoutermarginandtheenclosingtrabeculae,achannelorspaceofuniformwidth
throughout.Thisistermedthesubcapsularsinus(lymphpathorlymphsinus).Runningacrossitarea
numberoffinertrabeculofreticularconnectivetissue,thefibersofwhichare,forthemostpart,
coveredbyramifyingcells.
Subcapsularsinus
Thesubcapsularsinus(lymphpath,lymphsinus,
marginalsinus)isthespacebetweenthecapsule
andthecortexwhichallowsthefreemovementof
lymphaticfluidandsocontainsasparsityof
lymphocytes.[4]Itiscontinuouswiththesimilar
lymphsinusesthatflankthetrabeculae.[4]
Thelymphnodecontainslymphoidtissue,i.e.,a
Afferentandefferentvessels
meshworkorfiberscalledreticulumwithwhite
bloodcellsenmeshedinit.Theregionswherethere
arefewcellswithinthemeshworkareknownaslymphsinus.Itislinedbyreticularcells,fibroblastsand
fixedmacrophages.[4]
Thesubcapsularsinushasclinicalimportanceasitisthemostlikelylocationwheretheearliest
manifestationsofametastaticcarcinomainalymphnodewouldbefound.

Cortex

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Thecortexofthelymphnodeistheperipheralportion
underneaththecapsuleandthesubcapsularsinus.[6]The
subcapsularsinusdrainstotrabecularsinuses,andthenthe
lymphflowsintothemedullarysinuses.
TheoutercortexconsistsmainlyoftheBcellsarrangedas
follicles,whichmaydevelopagerminalcenterwhenchallenged
withanantigen,andthedeepercortexmainlyconsistingoftheT
cells.ThereisazoneknownasthesubcorticalzonewhereT
cells(orcellsthataremainlyred)mainlyinteractwithdendritic
cells,andwherethereticularnetworkisdense.Thepredominant
sitewithinthelymphnodeswhichcontainTcells&accessory
cellsisalsoknownasparacortex(reticularnetwork).[7]

Diagramofalymphnode

Medulla
Themedullacontainslargebloodvessels,sinusesandmedullarycordsthatcontainantibodysecreting
plasmacells.
Themedullarycordsarecordsoflymphatictissue,andincludeplasmacells,macrophages,andBcells.
Themedullarysinuses(orsinusoids)arevessellikespacesseparatingthemedullarycords.Lymph
flowsintothemedullarysinusesfromcorticalsinuses,andintoefferentlymphaticvessels.Medullary
sinusescontainhistiocytes(immobilemacrophages)andreticularcells.

Function
Thelymphfluidinsidethelymphnodescontains
lymphocytes,atypeofwhitebloodcell,whichcontinuously
recirculatesthroughthelymphnodesandthebloodstream.
Moleculesfoundonbacteriacellwallsorchemicalsubstances
secretedfrombacteria,calledantigens,maybetakenupby
dedicatedantigenpresentingcellssuchasdendriticcellsinto
thelymphsystemandthenintolymphnodes.Inresponseto
theantigens,thelymphocytesinthelymphnodemake
antibodieswhichwillgooutofthelymphnodeinto
circulation,seek,andtargetthepathogensproducingthe
antigensbytargetingthemfordestructionbyothercellsand
complement.Otherimmunesystemcellswillbemadetofight
theinfectionand"sent"tothelymphnodes.Theincreased
numbersofimmunesystemcellsfightingtheinfectionwill
makethenodeexpandandbecome"swollen."
Lymphcirculatestothelymphnodeviaafferentlymphatic
Thereareclustersofnodesunderthe
vesselsanddrainsintothenodejustbeneaththecapsuleina
arms,inthegroin,neckandabdomen
spacecalledthesubcapsularsinus.Thesubcapsularsinus
drainsintotrabecularsinusesandfinallyintomedullary
sinuses.Thesinusspaceiscrisscrossedbythepseudopodsofmacrophages,whichacttotrapforeign
particlesandfilterthelymph.Themedullarysinusesconvergeatthehilumandlymphthenleavesthe
lymphnodeviatheefferentlymphaticvesseltowardseitheramorecentrallymphnodeorultimatelyfor
drainageintoacentralvenoussubclavianbloodvessel.
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TheBcellsmigratetothenodularcortexandmedulla.
TheTcellsmigratetothedeepcortex.Thisisaregionofthelymphnodecalledtheparacortex
thatimmediatelysurroundsthemedulla.Unlikethecortex,whichhasmostlyimmatureTcells,or
thymocytes,theparacortexhasamixtureofimmatureandmatureTcells.Lymphocytesenterthe
lymphnodesthroughspecializedhighendothelialvenulesfoundintheparacortex.
Whenalymphocyterecognizesanantigen,Bcellsbecomeactivatedandmigratetogerminalcenters(by
definition,a"secondarynodule"hasagerminalcenter,whilea"primarynodule"doesnot).When
antibodyproducingplasmacellsareformed,theymigratetothemedullarycords.Stimulationofthe
lymphocytesbyantigenscanacceleratethemigrationprocesstoabout10timesnormal,resultingin
characteristicswellingofthelymphnodes.
Thespleenandtonsilsarelargelymphoidorgansthatservesimilarfunctionstolymphnodes,thoughthe
spleenfiltersbloodcellsratherthanlymph.

Clinicalsignificance
Lymphnodesmaybecomeenlargedduetoaninfection,tumouror
inflamedduetoleukemia.Thisincreaseinsizeisprimarilydueto
anelevatedrateoftraffickingoflymphocytesintothenodefromthe
blood,exceedingtherateofoutflowfromthenode.Theymayalso
beenlargedsecondarilyasaresultoftheactivationandproliferation
ofantigenspecificTandBcells(clonalexpansion).Insomecases,
wherethereisnoinfectiontheymaystillfeelenlargedduetoa
previousinfection.
Lymphadenopathyisatermmeaning"diseaseofthelymph
nodes."Itis,however,almostsynonymouslyusedwith"swollenor
enlargedlymphnodes."Inthiscase,thelymphnodesaredetectable
bytouch(palpable)thisisasignofvariousinfectionsanddiseases.

Micrographofamesenteric
lymphnodewithadenocarcinoma

Lymphedemaisafairlywidespreadconditionofthelymphaticsystemresultinginlocalisedfluid
retentionandtissueswelling.Affectedtissuesareatriskofinfection.Primarylymphedemagenerally
resultsfrompoorlydevelopedormissinglymphnodes.Secondarylymphedemaresultsmostlyfromthe
dissectionoflymphnodesduringbreastcancersurgeryandalsofromothertreatmentsusuallyinvolving
radiation.

Seealso
Peyer'spatch
Cervicallymphnodes
Tracheobronchiallymphnodes
Listoflymphnodesofthehumanbody

Additionalimages

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Lymphaticsystem

Sectionofsmalllymph
nodeofrabbit.

Lymphaticsofthearm

Lymphaticsofthe
axillaryregion

References
1."Whatarelymphnodes".SiamakN.Nabili,MD,MPH.20150205.
2."LymphNodesDirectory".www.webmd.com.
3."SwollenGlandsandOtherLumpsUndertheSkinTopicOverview".Children.webmd.com.20110414.
Retrieved20140228.
4.Warwick,RogerPeterL.Williams(1973)[1858]."Angiology(Chapter6)".Gray'sanatomy.illustratedby
RichardE.M.Moore(Thirtyfifthed.).London:Longman.pp.588785.
5.Kaldjian,EricP.J.ElizabethGretz,ArthurO.Anderson,YinghuiShiandStephenShaw(October2001).
"SpatialandmolecularorganizationoflymphnodeTcellcortex:alabyrinthinecavityboundedbyan
epitheliumlikemonolayeroffibroblasticreticularcellsanchoredtobasementmembranelikeextracellular
matrix".InternationalImmunology(OxfordJournals)13(10):12431253.doi:10.1093/intimm/13.10.1243.
PMID11581169.Retrieved20080711.Citeusesdeprecatedparameter|coauthors=(help)
6."Definition:cortexoflymphnodefromOnlineMedicalDictionary".Retrieved20081019.
7.Katakai,TomoyaTakahiroHara,HiroyukiGonda1,ManabuSugaiandAkiraShimizu(5July2004)."A
novelreticularstromalstructureinlymphnodecortex:animmunoplatformforinteractionsamongdendritic
cells,TcellsandBcells".InternationalImmunology16(8):11331142.doi:10.1093/intimm/dxh113.
PMID15237106.Retrieved20080711.Citeusesdeprecatedparameter|coauthors=(help)

Externallinks
Histologyimage:07101loa
(http://www.bu.edu/histology/p/07101loa.htm)Histology
LearningSystematBostonUniversity
LymphNodes(http://www.thelymphnodes.com)

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