Understanding the lymphatic system

The lymphatic system consists of organs, ducts, and nodes. It transports a watery clear
fluid called lymph.
This fluid distributes immune cells and other factors throughout the body. It also
interacts with the blood circulatory system to drain fluid from cells and tissues.
The lymphatic system contains immune cells called lymphocytes, which protect the
body against antigens (viruses, bacteria, etc.) that invade the body. See more on
lymphocytes below. It is abnormal cells of this type that cause lymphoma.
Main functions of the lymphatic system
"to collect and return interstitial fluid, including plasma protein to the blood,
and thus help maintain fluid balance,
to defend the body against disease by producing lymphocytes,
to absorb lipids from the intestine and transport them to the blood."
Lymph organs
Include the bone marrow, lymph nodes, spleen, and thymus. Precursor cells in the bone
marrow produce lymphocytes. !lymphocytes (!cells) mature in the bone marrow. T!
lymphocytes (T!cells) mature in the thymus gland.
esides providing a home for lymphocytes (!cells and T!cells), the ducts of the
lymphatic system provide transportation for proteins, fats, and other substances in a
medium called lymph.
Lymph nodes" "#uman lymph nodes are bean!shaped and range in si$e from a few
millimeters to about 1-2 cm in their normal state.
They may become enlarged due to a tumor or infection. %hite blood cells are located
within honeycomb structures of the lymph nodes. &ymph nodes are enlarged when the
body is infected due to enhanced production of some cells and division of activated T and
cells.
In some cases they may feel enlarged due to past infections' although one may be
healthy, one may still feel them residually enlarged." %i(ipedia.org
"Shotty lymph nodes" refers to clusters of small swollen nodes. Shotty nodes may
occur when the immune system is reacting to an infection !! it doesn)t necessarily point
toward any particular disease.
"Bulky disease" generally describes a lymph node or e*tranodal tumor that measures
greater than ten centimeters in any dimension.
calcified nodes are not really rare, and typically are the result of some past, healed
infection. T is well!(nown to cause them,
for e*ample. +ancer is not."
medhelp.orgs
Cervical lymph nodes are lymph nodes located in and around the nec(.
Lymph
",eans clear water and it is basically the fluid and protein that has been s-uee$ed out of
the blood (i.e. blood plasma). The lymph is drained from the tissue in microscopic blind!
ended vessels called lymph capillaries.
These lymph capillaries are very permeable, and because they are not pressuri$ed the
lymph fluid can drain easily from the tissue into the lymph capillaries.
.s with the blood networ( the lymph vessels form a networ( throughout the body, unli(e
the blood the lymph system is a one!way street draining lymph from the tissue and
returning it to the blood." Source bbc.co.uk
"/nli(e the cardiovascular system, the lymphatic system is not closed and has no
central pump." wi(ipedia.org "&ymph movement occurs despite low pressure due to
peristalsis ! smooth muscle and s(eletal activity (everyday activity and motion of the
body).
"Secondary lymphatic tissues control the -uality of immune responses. 0ifferences
among the various lymphatic tissues significantly affect the form of immunity and relate
to how antigens (bacteria, virus, fungus, etc.) are ac-uired by these organs.
- Lymph nodes are filters of lymph
! the spleen is a filter of blood
! mucosal associated lymphatic tissues ac-uire antigens by transcytosis to lymphoid
tissue from the "e*ternal" environment across speciali$ed follicle!associated epithelial
cells." Source geocities.com
"&ymphatics are found in every part of the body except the central nervous system. The
ma1or parts of the system are the bone marrow, spleen, thymus gland, lymph nodes, and
the tonsils. 2ther organs, including the heart, lungs, intestines, liver, and s(in also
contain lymphatic tissue." gorhams.d(
Lymphoma
Is a disease in which malignant lymphocytes grow too fast or live too long. These cells
may then accumulate in the lymph nodes or other areas of the lymphatic system to form
tumors. %hen these cells accumulate in lymph nodes it)s often called adenopathy ! the
enlargement of the lymph nodes' but adenopathy can have other causes.
There are many benign reasons for enlarged lymph nodes:
Diagnostic Problems in the Evaluation of Lymphadenopathy, Weinstock, Straus
Cancernetworkcom
Lymphadenopathy! Differential Diagnosis and Evaluation, "obert #errer, $D,
$P% &merican #amily Physician
eactive Lymph nodes
"&3,P# nodes are a combination of burglar alarm and %est Point. &i(e a burglar alarm
they are on guard against intrusive antigen. &i(e %est Point, the nodes are in the
business of training a militant elite"" pleiad.umdn1.edu
!hat"s the deal #ith !a$ing% !aning% and &ersistently
'nlarged Lymph (odes)
&ymph nodes can increase or decrease in si$e for many reasons, including response to
treatment, progression of lymphoma, spontaneous regression of lymphoma, immune
activation against lymphoma, infection or the resolving of infection (reactive, see above),
and so on.
Therefore, imaging of lymphoma is only an estimate of treatment response and disease
direction.
Collapsing of necrotic areas in lymph nodes may e*plain a sudden decrease in a
large lymph node.
esidual lymphoid masses)
4ollowing treatment "a residual mass persisting on +T after treatment poses a common
clinical dilemma" it may indicate the presence of viable lymphoma, which re-uires
further treatment, or it can be benign, consisting of only fi*rotic and necrotic tissues."
P,I0" 5678899:
4or this reason P;T or <allium scans may be used after treatment to help differentiate
active disease from scar tissue.
&ymphoid tumors are made up of the accumulated abnormal lymphocytes but also
supportive tissue of different cell types" =epithelial cells and also there is supporting
tissue, called connective tissue which is there to support the epithelial cells>. These cells
are sometimes referred to in shorthand as tumor =stromal> cells.
2ur understanding is that the macrophages (immune cells) will eventually gobble up
this necrotic material after successful therapy, which e*plains why the treated =tumor>
continues to shrin( well after therapy is done.
?2T;" The delayed shrin(ing of lymphoid tumor can lead to -uestionable conclusions of
the causal effect of subse-uent therapy @ standard, investigational, and alternative,
because the tumor in some cases would have resolved with more time.
P;T scans are used to help distinguish between necrotic and viable tumor following
treatment, but this test is not perfect A can produce false positives due to inflammation.
eactive lymph nodes ! &ymph nodes may enlarge when immune cells react to
pathogen such as virus or bacteria. Swollen glands, common to many illnesses is an
e*ample of nodes enlarging in response to a pathogen. This might also be called a
flare.
Lymphocytes
Lymphocytes
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&ymphocytes, also called white blood cells, are described below. These are small cells,
:!B Cm in diameter in blood smears ...
These cells are the second most common white blood cell type, comprising about DE F
of the leu(ocyte population in peripheral blood....
&ymphocytes travel in the blood, but they routinely leave capillaries and wander
through connective tissue. Therefore, lymphocytes may be normally encountered at
any time in any location. They even enter epithelial tissue, crawling between the
epithelial cells. They reenter circulation via lymphatic system channels (hence their
name)."
Source: Blood Cells www.siumed.edu
Life cycle of lymphocytes
0evelop in the thymus gland or bone marrow.
!cells grow (differentiate) and mature in the bone marrow.
T!cells also start out in the bone marrow. They differentiate and mature in the thymus
gland (beneath breastbone).
!cell and T!cell lymphocytes are distributed through the blood stream, which
eventually branches into tiny blood vessels called capillaries.
Some lymphocytes migrate to capillaries into surrounding tissues. Some enter
lymphatic vessels!tiny, blind!ended tubes!and lead to larger lymphatic ducts and
branches.
.long the way, the fluid passes through lymph nodes, oval structures composed of
lymph vessels, connective tissue, and white blood cells. #ere, the lymphocytes either
are filtered out or are added to the contents of the node.
Lymph (odes
+lic( to enlarge
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Lymph nodes" "#uman lymph nodes are bean!shaped and range in si$e from a few
millimeters to about 1-2 cm (5E to 6E mm) in their normal state.
They may become enlarged due to a tumor or infection. %hite blood cells are located
within honeycomb structures of the lymph nodes. &ymph nodes are enlarged when the
body is infected due to enhanced production of some cells and division of activated T
and cells.
In some cases they may feel enlarged due to past infections' although one may be
healthy, one may still feel them residually enlarged." %i(ipedia.org
The lymph node provides an environment where lymphocytes can receive initial
e*posure to foreign antigens (viruses, bacteria, fungi, etc.), which activates the
lymphocytes to perform immune functions.
,ost lymph nodes form in clusters throughout the system, such as in the nec(, armpit,
and groin.
+ther 'lements in Lymphatic System
+lic( to enlarge spleen
illustration
,erc( ,anual
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The spleen is another important lymphatic organ. It processes lymphocytes from
incoming blood. The tonsils and adenoids are secondary lymphatic organs.
The spleen is a spongy, soft organ about as big as a person)s fist, is located in the
upper left part of the abdomen, 1ust under the rib cage. mer(.com
esources
Spleen disorders Merck Manual