Lymph Node

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I. OUTER CORTEX consists of the following:

A. B cells (see Chapter 9 V E), which are organized into lymphatic follicles that may contain germinal centers (these are evidence of an immune response whereby B cells are transformed into plasma cells)

B. Helper T cells

C. Follicular dendritic cells, which have an antigen-presenting function

D. Macrophages

E. Fibroblasts (reticular cells), which secrete type III collagen (reticular fibers) that form a stromal meshwork

II. INNER CORTEX (paracortex; thymic-dependent zone) consists of the following:

A. T cells

B. Dendritic cells, which have an antigen-presenting function

C. Macrophages

D. Fibroblasts (reticular cells), which sccrctc type III collagen (reticular fibers) that form a stromal meshwork

III. MEDULLA consists of the following:

A. Lymphocytes

B. Plasma cells

C. Macrophages, which are very numerous in the medulla (therefore, phagocytosis is extremely active)

D. Fibroblasts (reticular cells), which sccrctc type III collagen (reticular fibers) that form a stromal meshwork

IV. FLOW OF LYMPH occurs through afferent lymphatics, subcapsular (marginal) sinus, cortical sinuses, medullary sinuses, and finally through efferent lymphatics. Sinuses contain sinus macrophages, veiled cells, and reticular fibers that crisscross the lumen in a haphazard fashion.

V. FLOW OF BLOOD occurs through arteries that enter at the hilum, a capillary network within the outer and inner cortex, postcapillary (high endothelial) venules within the inner cortex, and veins that leave at the hilum. Postcapillary (high endothelial) venules have lymphocyte homing receptors and are the site where lymphocytes exit the bloodstream to repopulate the lymph node.

VI. CLINICAL CONSIDERATION (Figure 11-1). The population of lymphocytes within lymph nodes changes in certain clinical states, such as agammaglobulinemia, DiGeorge syndrome, and severe combined immunodeficiency (SC1D) or adenosine deaminase deficiency (ADA; "bubble boy" disease).

Figure 11-1. Diagram of lymph nodes in various clinical states. (A) Normal lymph node with B cells (outer cortex) and T cells (inner cortex) that impart a humoral immune response and cell-mediated immune response to the individual, respectively. (B) Lymph node in X-linked infantile (Bruton's) agammaglobulinemia with B cells absent but T cells present, so that humoral immune response is absent but cell-mediated immune response is present. (C) Lymph node in DiGeorge syndrome with B cells present but T cells absent, so that humoral immune response is present but cell-mediated immune response is absent. (D) Lymph node in severe combined immunodeficiency disease (SCID) or adenosine deaminase deficiency (ADA; "bubble boy" disease) with B cells and T cells absent, so that both humoral immune response and cell-mediated immune response are absent.

Figure 11-1. Diagram of lymph nodes in various clinical states. (A) Normal lymph node with B cells (outer cortex) and T cells (inner cortex) that impart a humoral immune response and cell-mediated immune response to the individual, respectively. (B) Lymph node in X-linked infantile (Bruton's) agammaglobulinemia with B cells absent but T cells present, so that humoral immune response is absent but cell-mediated immune response is present. (C) Lymph node in DiGeorge syndrome with B cells present but T cells absent, so that humoral immune response is present but cell-mediated immune response is absent. (D) Lymph node in severe combined immunodeficiency disease (SCID) or adenosine deaminase deficiency (ADA; "bubble boy" disease) with B cells and T cells absent, so that both humoral immune response and cell-mediated immune response are absent.

VII. SELECTED PHOTOMICROGRAPHS. Normal lymph node, lymph node in patient with late-stage AIDS, and lymph node in patient with breast cancer metastasis (Figure 11-2).

Figure 11-2. (A) Light micrograph of a normal lymph node showing the subcapsular sinus (s), outer cortex (OC), inner cortex (JC), and germinal center (GC) of a lymphatic follicle. (B) Lymph node in late-stage AIDS showing a marked reduction in lymphocytes, especially in the inner cortex. (C) Lymph node with breast cancer metastasis showing lymphoid tissue (lym) crowded to the periphery by the invasion of breast cancer cells (brca). (B,C: Reprinted with permission from East Carolina University, School of Medicine, Department of Pathology slide collection.)

Figure 11-2. (A) Light micrograph of a normal lymph node showing the subcapsular sinus (s), outer cortex (OC), inner cortex (JC), and germinal center (GC) of a lymphatic follicle. (B) Lymph node in late-stage AIDS showing a marked reduction in lymphocytes, especially in the inner cortex. (C) Lymph node with breast cancer metastasis showing lymphoid tissue (lym) crowded to the periphery by the invasion of breast cancer cells (brca). (B,C: Reprinted with permission from East Carolina University, School of Medicine, Department of Pathology slide collection.)

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