Where are the major lymph nodes located in the human body. How does the lymphatic system contribute to overall health. What are the main components of the lymphatic system. How do lymphocytes and other immune cells function within the lymphatic system. Can lifestyle factors impact lymphatic system health.

The Anatomy and Structure of the Lymphatic System

The lymphatic system is a complex network of vessels, tissues, and organs that plays a crucial role in maintaining our body’s health and immunity. At its core, this system consists of lymph vessels, lymph nodes, and specialized organs like the spleen and thymus.

Lymph nodes are small, bean-shaped structures distributed throughout the body. They act as filters, trapping harmful substances and producing immune cells to combat infections. But where exactly are these important structures located?

• Neck (cervical lymph nodes)
• Armpits (axillary lymph nodes)
• Chest (mediastinal lymph nodes)
• Abdomen (mesenteric lymph nodes)
• Groin (inguinal lymph nodes)

These strategic locations allow the lymphatic system to effectively monitor and protect various regions of the body. Understanding the anatomy of the lymphatic system is crucial for healthcare professionals and researchers in diagnosing and treating various conditions, including infections and certain types of cancer.

The Role of Lymph in Body Function

Lymph is a clear, colorless fluid that circulates through the lymphatic vessels. It plays several vital roles in maintaining our body’s health and function. But what exactly does lymph do?

• Fluid balance: Lymph helps maintain proper fluid levels in body tissues
• Immune function: It transports white blood cells and antibodies throughout the body
• Nutrient absorption: Lymph aids in the absorption of fats and fat-soluble vitamins from the digestive system
• Waste removal: It helps remove cellular waste and toxins from tissues

The movement of lymph through the body is facilitated by muscle contractions and the presence of one-way valves in lymphatic vessels. This ensures that lymph flows in the correct direction, ultimately returning to the bloodstream via large veins near the heart.

Immune Cells and Their Functions in the Lymphatic System

The lymphatic system is home to various types of immune cells, each playing a specific role in defending the body against pathogens and other threats. These cells work together to create a robust immune response.

Types of Lymphocytes

Lymphocytes are a crucial component of the adaptive immune system. They come in several varieties, each with unique functions:

• B cells: Produce antibodies to neutralize specific pathogens
• T cells: Coordinate immune responses and directly attack infected or abnormal cells
• Natural Killer (NK) cells: Target and destroy virus-infected cells and certain types of cancer cells

These lymphocytes are produced in bone marrow and mature in either the bone marrow (B cells) or the thymus (T cells). They then circulate through the lymphatic system, ready to respond to potential threats.

Other Important Immune Cells

While lymphocytes are central to the adaptive immune response, other types of immune cells also play crucial roles within the lymphatic system:

• Macrophages: Engulf and destroy pathogens and cellular debris
• Dendritic cells: Present antigens to T cells, initiating specific immune responses
• Neutrophils: Rapidly respond to infections and inflammation

The coordinated action of these various immune cells allows the lymphatic system to effectively protect the body from a wide range of threats, from bacteria and viruses to cancer cells.

The Lymphatic System’s Role in Disease Prevention and Health Maintenance

The lymphatic system serves as a critical line of defense against various diseases and plays a significant role in maintaining overall health. Its functions extend beyond just fighting infections; it also helps in preventing chronic conditions and supporting the body’s natural healing processes.

Disease Prevention

How does the lymphatic system contribute to preventing diseases?

• Pathogen detection and elimination: Lymph nodes trap and destroy harmful microorganisms before they can spread throughout the body
• Cancer surveillance: The immune cells within the lymphatic system can recognize and eliminate some cancer cells before they develop into tumors
• Autoimmune regulation: A properly functioning lymphatic system helps prevent the immune system from attacking the body’s own tissues

Health Maintenance

Beyond disease prevention, the lymphatic system supports overall health in several ways:

• Detoxification: It helps remove waste products and toxins from body tissues
• Fluid balance: By draining excess fluid from tissues, it prevents swelling and promotes proper circulation
• Nutrient distribution: The lymphatic system aids in the transport of nutrients, particularly fats, throughout the body

Understanding the multifaceted role of the lymphatic system in health maintenance can help individuals make lifestyle choices that support its optimal function.

Common Disorders of the Lymphatic System

While the lymphatic system is crucial for maintaining health, it can also be subject to various disorders. Recognizing these conditions is important for early diagnosis and treatment.

Lymphedema

Lymphedema is a condition characterized by swelling in one or more extremities due to a blockage in the lymphatic system. It can be primary (inherited) or secondary (caused by damage to lymph nodes, often due to cancer treatments).

Symptoms of lymphedema include:

• Swelling in arms or legs
• A feeling of heaviness or tightness in the affected limb
• Restricted range of motion
• Recurring infections in the affected area

Lymphoma

Lymphoma is a type of cancer that originates in the lymphatic system. It occurs when lymphocytes grow and multiply uncontrollably. There are two main types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma.

Common symptoms of lymphoma include:

• Swollen lymph nodes in the neck, armpits, or groin
• Unexplained weight loss
• Fever and night sweats
• Persistent fatigue

Lymphadenitis

Lymphadenitis is the inflammation of lymph nodes, usually due to infection. It can be acute or chronic and may affect a single node or a group of nodes.

Symptoms of lymphadenitis may include:

• Swollen, tender lymph nodes
• Redness and warmth in the skin over the affected nodes
• Fever and general malaise

Early recognition and proper treatment of these disorders are crucial for maintaining the health and function of the lymphatic system.

The Interplay Between the Lymphatic System and Other Body Systems

The lymphatic system does not operate in isolation; it interacts closely with other body systems to maintain overall health and homeostasis. Understanding these interactions can provide valuable insights into how the body functions as a whole.

Lymphatic System and Cardiovascular System

The lymphatic and cardiovascular systems work in tandem to maintain fluid balance and circulation:

• The lymphatic system collects excess fluid from tissues and returns it to the bloodstream
• Lymphatic vessels run parallel to blood vessels, complementing their function
• Both systems play crucial roles in immune function and the distribution of nutrients

Lymphatic System and Digestive System

The lymphatic system plays a vital role in the digestive process:

• Specialized lymphatic vessels called lacteals absorb fats and fat-soluble vitamins from the small intestine
• Gut-associated lymphoid tissue (GALT) in the digestive tract helps protect against ingested pathogens
• The largest lymphatic vessel, the thoracic duct, empties lymph containing absorbed fats into the bloodstream

Lymphatic System and Respiratory System

The lymphatic system supports respiratory health in several ways:

• Lymphoid tissue in the respiratory tract helps trap and eliminate inhaled pathogens
• Lymphatic vessels in the lungs help remove excess fluid, preventing pulmonary edema
• The lymphatic system aids in the immune response to respiratory infections

These interactions highlight the interconnected nature of body systems and underscore the importance of a holistic approach to health and wellness.

Promoting Lymphatic Health: Lifestyle and Dietary Factors

Maintaining a healthy lymphatic system is crucial for overall well-being. While the lymphatic system works tirelessly to protect our bodies, there are several lifestyle and dietary factors that can support its function.

Exercise and Movement

Regular physical activity is one of the most effective ways to promote lymphatic health. How does exercise benefit the lymphatic system?

• Muscle contractions during exercise help pump lymph through the body
• Deep breathing during exercise increases the flow of lymph through the thoracic duct
• Specific exercises like rebounding (jumping on a mini-trampoline) can be particularly beneficial for lymphatic circulation

Hydration

Proper hydration is essential for optimal lymphatic function. Adequate fluid intake helps:

• Maintain the proper consistency of lymph
• Support the transport of nutrients and waste products
• Facilitate the removal of toxins from the body

Diet and Nutrition

A balanced diet rich in certain nutrients can support lymphatic health:

• Antioxidant-rich foods (berries, leafy greens, nuts) help reduce oxidative stress
• Omega-3 fatty acids (found in fish, flaxseeds, chia seeds) have anti-inflammatory properties
• Herbs like calendula, echinacea, and astragalus may support lymphatic function

Stress Management

Chronic stress can negatively impact the immune system and, by extension, the lymphatic system. Incorporating stress-reduction techniques such as meditation, yoga, or deep breathing exercises can help maintain lymphatic health.

Lymphatic Massage

Gentle massage techniques designed to stimulate lymph flow can be beneficial, especially for individuals with lymphedema or other lymphatic issues. However, it’s important to consult with a healthcare professional before attempting lymphatic massage.

By incorporating these lifestyle and dietary factors, individuals can support their lymphatic system’s function and contribute to their overall health and well-being.

Future Directions in Lymphatic System Research

As our understanding of the lymphatic system continues to grow, researchers are exploring new avenues for leveraging this crucial system to improve human health. Several exciting areas of research are currently underway, with potential implications for treating a wide range of conditions.

Immunotherapy and the Lymphatic System

Researchers are investigating ways to harness the power of the lymphatic system to enhance cancer immunotherapy:

• Developing methods to deliver immunotherapeutic agents directly to lymph nodes
• Exploring how to modify lymph node structure to improve immune responses
• Investigating the role of the lymphatic system in the efficacy of cancer vaccines

Lymphatic System and Neurological Disorders

Recent discoveries have revealed connections between the lymphatic system and the brain, opening up new areas of research:

• Studying the newly discovered lymphatic vessels in the central nervous system
• Investigating the role of the lymphatic system in conditions like Alzheimer’s disease and multiple sclerosis
• Exploring potential lymphatic-based therapies for neurological disorders

Bioengineering and Lymphatic Regeneration

Advances in bioengineering are paving the way for new approaches to treating lymphatic disorders:

• Developing artificial lymphatic vessels for transplantation
• Creating lymph node-on-a-chip models for drug testing and disease research
• Exploring stem cell therapies to regenerate damaged lymphatic tissue

Lymphatic System and Metabolic Disorders

Emerging research suggests that the lymphatic system may play a role in metabolic health:

• Investigating the connection between lymphatic function and obesity
• Exploring the role of the lymphatic system in lipid metabolism and cardiovascular health
• Studying how lymphatic dysfunction may contribute to insulin resistance and diabetes

These research directions hold promise for developing new treatments and interventions that could significantly impact human health. As our understanding of the lymphatic system deepens, we may uncover even more ways in which this crucial system influences our overall well-being.

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Lymph nodes: Histology | Kenhub

Author:
Lorenzo Crumbie MBBS, BSc
•
Reviewer:
Jerome Goffin

Last reviewed: July 13, 2023

Reading time: 22 minutes

Lymph node (histological slide)

The presence of foreign organisms within the blood stream can trigger a massive cascade of events that will disrupt many homeostatic microenvironments within the body. Therefore, the immune system carries out detailed surveillance of the blood in order to detect these pathogens. One method of screening takes place at the level of the lymph nodes. These are secondary lymphoid organs that are widely distributed throughout the body. Apart from its role in immune regulation, the lymphatic system is also important for immune regulation and fat absorption.

Between 400 and 450 lymph nodes are scattered throughout the average human body. They are found along the lymphatic vessels, which carry fluid from the interstitial space into the main circulation. They are particularly abundant in the cervical, axillary, inguinal, perihilar, and intra-abdominal areas. These locations are vulnerable points of entry of pathogens into the host’s intrinsic environment. As a result, it is important that surveillance is maximized in these areas. This article will review the embryology and gross anatomy of lymph nodes. However, the primary focus will be on the histological composition of these structures as well as clinically relevant points regarding lymph node function.

Contents

1. Gross anatomy
2. Histological architecture
   1. Outer cortex
   2. Paracortex
   3. Medulla
3. Blood Supply
4. Embryology
5. Clinical notes
   1. Lymphadenopathy
   2. Lymphadenectomy
   3. Lymphedema
6. Sources

+ Show all

Gross anatomy

At approximately 0.1 by 2.5 cm, the lymph node is a relatively small glandular structure that resembles a kidney-bean. It has a convexed surface that is penetrated by afferent lymph vessels. On the opposing side, there is a concavity that is penetrated by the supplying artery, vein and nerve and also allows exit of efferent lymphatic vessels. This concavity is known as the hilum of the lymph node. They are suspended in loose connective tissue that follows the large vasculature.

[Active lymph node. Stain: hematoxylin and eosin. Medium magnification. ]

Histological architecture

Lymph nodes are encapsulated by dense connective tissue comprised of elastin and collagen fibres along with interspersed fibroblasts. The convexed surface of the lymph node is pierced by numerous afferent lymph vessels. They extend to the deeper areas of the lymph node by way of the trabecular extensions of the cortex. As the trabeculae penetrate the lymph node, they continue as reticulin fibrils (type III collagen) that offer additional structural support to the gland.

Trabeculae (histological slide)

Cross sectional analysis of a lymph node reveals that it is subdivided into three regions:

Outer cortex

The outermost layer is the cortex. It is made up of a subcapsular sinus, cortical sinus and lymphoid nodules. The subcapsular sinus is the first space that lymph fluid from the afferent channels enters within the node. The fluid then travels from here to the cortical sinuses; which are branches of the subcapsular sinus. The cortical sinuses are also known as trabecular sinuses because they travel along the trabecular network within the lymph node.

Cortex (histological slide)

The endothelium of the trabecular sinuses are perforated by dendritic processes as well as reticulin fibres. Antigen presenting cells (APCs), circulating antigen, and lymphocytes flowing within the lymph can access the lymphatic tissue within the nodes through the disrupted endothelium. The cortical layer also has relatively large aggregates of helper T – lymphocytes and rapidly dividing B – lymphocytes in the peripheral part of the lymph nodes. Although both T cells and B cells are present in the cortex, B cells are more abundant than T cells are in this region. These lymphoid nodules are situated around the branched, interlacing extensions of the follicular dendritic cells (FDCs). The nodules may or may not have a germinal centre depending on if it is a primary or secondary follicle.

Primary follicle (histological slide)

Histological staining of lymph node samples are strongly influenced by the amount of antigen the cells of the lymph node are exposed to. Additionally, the number of cells within the node as well as the distinct separation of the cords is also influenced by antigenic exposure. As a result, the primary follicle is comprised of small dormant lymphocytes throughout, while the secondary follicle has a heterogeneous collection of large B lymphocytes that have already been activated by inciting antigens. Primary follicles absorb less histological stains then secondary follicles. This is likely due to fewer cells in the primary follicle when compared to the secondary follicle.

Secondary follicle (histological slide)

The germinal centre can be further subdivided into a dark zone, light zone and a mantle zone. Each zone facilitates different aspects of B cell affinity maturation. In the peripherally aspect of the germinal centre, quiescent B cells are found in the mantle zone. These cells are characterized by intense basophilic staining, small cytoplasmic volume and a heterochromatic nucleus. Other cells in the mantle zone include follicular dendritic cells as well as the occasional helper T lymphocyte and macrophages. The fate of B cells in the mantle zone can go one of two ways. These cells either remain in the lymph node and mature into antibody secreting plasma cells and remain in the lymph node, or they transform into memory B cells that re-enter the systemic circulation.

Germinal center (histological slide)

The other two zones of the germinal centre are the light zone and dark zone. The light zone contains centrocytes that interact with follicular dendritic cells that express intact antigen on their surface. Centrocytes with high affinity binding to the follicular dendritic cell antigen will persist, while those with weak binding undergoes apoptosis. While resident macrophages help to clean up apoptotic B cells, helper T cells support the remaining B cells and foster the class switching phase of the cellular maturity.

Centrocytes (histological slide)

In the dark zone of the germinal centre, the centroblasts are highly mitotic and have a strong likelihood of producing mutated antibodies. These are the source cells for the light zone.

Centroblasts (histological slide)

Paracortex

Deep to the cortical layer is the paracortex. Its margins blend with the superficial cortex and deep medulla. The principal distinguishing features are the absence of lymphoid nodules and the large number of T lymphocytes (both cluster of differentiation 4 and 8 positive T cells [CD4+ and CD8+]) within the stroma of the paracortex.

Paracortex (histological slide)

The paracortex also has unique venules known as high endothelial venules (HEVs). Most of the lymphocytes that enter the lymph node do so via these channels. They are made up of cuboidal endothelium that is fitted apically with integrins and glycoproteins. Both these surface markers allow unimpeded passage of lymphocytes (i.e. diapedesis) from the percolating blood into the lymph node. These specialized vessels are also present in the mucosa associated lymphatic tissue distributed throughout the gastrointestinal tract. However, they are at their highest level of development within the lymph nodes.

Medulla

The deepest layer of the lymph node is the medulla. It is subdivided functionally and histologically into two other regions; which are the medullary cords and sinuses. The cords are populated by plasma cells, as well as B – cells and T – cells. The cells are arranged in cord-like projections extending centrally from the paracortex.

Medulla (histological slide)

Interlacing between the cords are distended areas lined by discontinuous endothelium. The luminal surface of the sinuses also contains a vast network of reticular cell processes. They act as the final point of filtration of circulating lymph. The medullary sinuses are the terminal continuations of the peripherally located cortical sinuses. They eventually culminate at the hilum of the lymph node to form efferent lymphatic vessels.

Medullary sinuses (histological slide)

Lymph vessels are lined by a single layer of squamous endothelium. They are fitted with valves that promotes unidirectional flow of lymph from the afferent lymph vessels to the lymph node and then to the efferent lymph vessels. The afferent lymph channels bring lymph with either free floating or complement bound antigen into the subcapsular space. Of note, the subcapsular space extends around the entire lymph node except at the hilum. The lymph then flows through the cortical sinuses.

Efferent lymphatic vessels (histological slide)

Blood Supply

The arterial supply of the lymph nodes is derived from the vessels they encircle within their respective regions. For example, the axillary lymph nodes are perfused by arterial branches of the axillary artery. Each lymphatic artery gains access to the node by way of the hilum. As the vessel penetrates this area, it gives off a myriad of straight branches within the medulla that also arborize to supply areas that are distal to the vessels.

Hilum of the lymph node (histological slide)

In the cortex, the straight arteries branch off into arterioles that form tightly packed anastomosing networks. The capillaries are more commonly seen around the germinal centres, where there are usually less arterioles. Capillaries also become more numerous when there is antigenic stimulation of the lymph node. The arterioles and capillaries then return to similarly numerous anastomosing networks of venules and veins. They tend to follow the course of the arteries and arterioles in the opposite direction. Eventually the veins leave the node via the same point of entrance of the arteries (the hilum).

Embryology

A few weeks after the initiation of cardiovascular development (third week of gestation), the lymphatic system begins to take shape (sixth week of gestation). Numerous studies dating from 1995 to 2002 identified vascular endothelial growth factor receptor 3 (VEGFR 3), vascular endothelial growth factor C (VEGF C) and prospero homebox 1 (PROX1) as integral components in the development of lymphatic vessels. While VEGFR 3 and VEGF C are essential for vascular differentiation from mesenchyme, the presence of PROX1 is imperative for lymphatic endothelial cell differentiation. Definitive confirmation of the venous derivative theory postulated in 1902 was recently confirmed in 2007.

One theory proposed that outpouchings of the venous endothelium (i.e. diverticulae) result in the formation of lymphatic sacs. Another school of thought proposes that the lymphatic system, like the rest of the vascular network, originates from cells arising from the mesenchymal layer and develops separately from the veins. The former theory, proposed in 1909, is the most widely accepted concept.

The lymph sacs develop adjacent to the primitive venous network. The lymph sacs identified at the early stage of development are paired (jugular and posterior lymph sacs) and unpaired lymph sacs (retroperitoneal and cisterna chyli). Jugular lymphatic sacs form around the superior cardinal veins (precursors to the jugular veins). There are axillary lymphatic sacs that develop around the right subclavian vein. On the left side, the thoracic duct forms on either side of the left brachiocephalic vein. There are also lumbar and iliac sacs forming caudally. The lumbo-iliac, jugular and axillary sacs are bilateral structures.

Cisterna chyli

The deep cervical nodes are the first to develop from its lymphatic sac. It is followed by the axillary, parasternal, and mediastinal lymph nodes; which also arise from their respective lymphatic sacs. The retroperitoneal, lumbo-iliac and inguinal nodes are derived from the lumbo-iliac lymphatic sacs. The differentiation from sac to nodes occurs when the sacs are invaded and segmented by adjacent mesenchymal cells.

Axillary lymph nodes

The mesenchyme also forms the lymph node capsule and connective tissue stroma. More specifically, it gives rise to the fibroblastic reticular cells that produce the connective tissue stroma as well as its extracellular matrix. Eventually lymphoid tissue inducer cells that promote the development of lymphoid tissue within the lymph node are formed. There is subsequent invasion of the lymph nodes by thymic lymphocytes either shortly before, or during the antenatal period,. These T lymphocytes tend to migrate into the deeper cortex while the B lymphocytes migrate to the outer cortex of the lymphatic nodules.

Now that you’ve learned about the structure of a lymph node, test your knowledge with the following quiz.

Clinical notes

Lymphadenopathy

Certain groups of lymph nodes are responsible for draining lymph from particular regions of the body. For example, lymphatic fluid from the lower limbs and perineal area will drain to the inguinal lymph nodes. Keep in mind that this lymph may contain pathogenic antigen from potential invaders. This antigenic stimulation can result in local enlargement of lymph nodes draining that particular region. The antigenic stimulation may also lead to changes not only in the size of the nodes, but also their consistency. This process is known as lymphadenopathy; it is also applicable to any disease process that affects the reticuloendothelial system. Lymph node enlargement is considered significant based on how large the nodes get. A general rule of thumb states that any enlargement greater than 1 cm of more than one lymph node is considered lymphadenopathy. However, some clinicians say that enlargement should be related to the region the nodes are located in. In other words:

• Cervical lymph nodes greater than 2 cm are considered significant
• Axillary lymph nodes greater than 1 cm are considered significant
• Inguinal lymph nodes greater than 1.5 cm are considered significant

Lymphadenopathy can be further classified as local or generalized. If swollen nodes are only seen in one region (i.e. cervical or axillary) then it is local. But if swollen nodes are found in more than one areas (i.e. epitrochlear and cervical) then it is generalized. Typically, swollen lymph nodes are reflective of self-limiting viral or bacterial infections in children. However, there are other non-benign conditions that may also result in lymphadenopathy. Furthermore, in adults, it is unlikely for lymph nodes to be found in a quiescent state as past exposure may incite long standing morphological changes within the nodes. Therefore it is important to differentiate between an ongoing disease process and a past exposure. Nevertheless, the swollen glands should not be ignored.

Lymphadenopathy should not be confused with lymphadenitis. The latter refers to an acute inflammatory process within the lymph node. While this condition also presents with lymph node enlargement, it is characterized by painful, indurated lymph nodes. This is in contrast to lymphadenopathy where the lymph nodes are painless on palpation and are not erythematous.

Clinicians can use clues from lymph node enlargement to determine where the underlying insult is occurring. Palpating lymph nodes is a clinical skill that is relatively easy to master and should not be neglected. Palpation of lymph nodes is particularly important during the general examination of a patient, as well as during examination of specific systems such as the respiratory system and abdominal exam. Common areas to palpate include the epitrochlear, axillary, cervical, pre and postauricular, occipital, submandibular and submental nodes. Inguinal nodes may also be palpated but the popliteal nodes are difficult to appreciate. In addition to the size and location of the nodes, the clinician should also note whether or not these nodes are tender, indurated and febrile as this points to a clinical diagnosis of lymphadenitis. Lymph nodes that are immobile, clumped together, and firm are more than likely (but not exclusively) a sign of malignancy than those that were described earlier.

The list of aetiological factors leading to lymphadenopathy is quite eclectic. The can be generally classified based on whether or not the lymphadenopathy is generalized (systemic) or regional (localized). Below is a truncated list of the causes of lymphadenopathy:

• 
  Generalized
  
  • Infections
    • Viral
    • Bacterial
    • Parasitic

  • Autoimmune & Hypersensitivity disorders
    • Systemic lupus erythematosus
    • Drug reactions

  • Storage disorders
    • Gaucher disease

  • Neoplasms
    • Leukaemias
    • Lymphomas

• 
  Regional (specifically those that are palpable)
  • Cervical
    • Upper respiratory tract infections
    • Infectious mononucleosis
    • Leukaemias
    • Lymphomas

  • Submaxillary and Submental
    • Oral infection

  • Occipital
    • Tinea capitis
    • Rubella
    • Roseola

  • Pre-auricular
    • Cutaneous infection
    • Catscratch disease

  • Supraclavicular
    • Tuberculosis
    • Lymphoma

  • Axillary
    • Immunization reaction
    • Non-neoplastic lesions of the breast
    • Mastitis
    • Brucellosis
    • Lymphoma

  • Inguinal
    • Insect bites
    • Sexually transmitted infections

Lymphadenectomy

In cases where lymphadenopathy is believed to be a result of a non-benign process, then surgical excision of the node may be warranted. Lymphadenectomy is a diagnostic and therapeutic approach to managing patients with malignancies. It is often done in addition to removing a primary tumor. Recall that a hallmark feature of cancers is their ability to metastasize. If these malignant cells gain access to the circulating lymph then they can spread throughout the body and become lodged in the lymph nodes. This will result in the formation of a secondary site from which these nodes can spread. Therefore, clinicians use this information as a part of staging the malignancy. The stage of the malignancy also influences the mode of treatment that would be best for the patient.

Lymphedema

Lymphedema is a disorder of the lymphatic system characterized by swelling of the limbs as a result of disrupted lymphatic pathways. The etiology of lymphedema can be primary due to lymphatic hypoplasia which is inherited, or secondary due to obstruction or disruption of lymphatic vessels. Symptoms and signs of this condition are brawny, fibrous, nonpitting edema in one or more limbs diagnosed by physical examination.

Primary lymphedema is uncommon and occurs as a result of hypoplastic lymphatic channels. The clinical presentation can vary in phenotype and patient age. There are also associations with lymphedema and other genetic disorders such as Turner syndrome.

The causes of secondary lymphedema are more common and very often misdiagnosed. They are multicausal and can occur after surgery including lymph node dissection (typically breast cancer), radiation therapy, after trauma, lymphatic obstruction by a tumor, venous insufficiency, or infectious diseases such as lymphatic filariasis. Other than swelling, these patients may develop skin changes that include hyperkeratosis or hyperpigmentation. Further complications may lead to the development of elephantiasis (extreme hyperkeratosis that looks like elephant skin) or lymphangitis (acute bacterial infection of lymphatic vessels).

Lymphedema is diagnosed by a good physical examination and additional tests with CT and MRI. The treatment of primary lymphedema is surgical including reconstruction while the treatment of secondary lymphedema means management of the cause. To mobilize fluid in lymphedema, physicians/patients may employ complex decongestive physiotherapy (CDPT). This involves a specific massage technique, skincare, and carefully fitted elastic compression garments. When applied correctly, CDPT dramatically increases lymphatic transport, delays the development of interstitial fibrosis, and improves symptoms.

Sources

All content published on Kenhub is reviewed by medical and anatomy experts. The information we provide is grounded on academic literature and peer-reviewed research. Kenhub does not provide medical advice. You can learn more about our content creation and review standards by reading our content quality guidelines.

References:

• 
  Bailey, R. and Weiss, L. (1975). Light and electron microscopic studies of postcapillary venules in developing human fetal lymph nodes. American Journal of Anatomy, 143(1), pp.43-57.
• 
  Butler, M., Isogai, S. and Weinstein, B. (2009). Lymphatic development. Birth Defects Research Part C: Embryo Today: Reviews, 87(3), pp.222-231.
• 
  Dhar, A. (2017). Lymphadenitis – Dermatologic Disorders – MSD Manual Professional Edition. [online] MSD Manual Professional Edition. Available at: http://www.msdmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/lymphadenitis [Accessed 12 Sep. 2017].
• 
  Douketis, J. (2017). Lymphadenopathy – Cardiovascular Disorders – MSD Manual Professional Edition. [online] MSD Manual Professional Edition. Available at: http://www.msdmanuals.com/professional/cardiovascular-disorders/lymphatic-disorders/lymphadenopathy [Accessed 12 Sep. 2017].
• 
  Gray, H. and Standring, S. (2009). Gray’s anatomy. 40th ed. [Edinburgh u.a.]: Churchill Livingstone Elsevier.
• 
  Kanwar, V. and Sills, R. (2017). Lymphadenopathy: Background, Pathophysiology, Epidemiology. [online] Emedicine.medscape.com. Available at: http://emedicine.medscape.com/article/956340-overview#a4 [Accessed 12 Sep. 2017].
• 
  Kumar, V., Abbas, A. and Aster, J. (2015). Robbins and Cotran pathologic basis of disease. 9th ed. Philadelphia, PA: Elsevier Saunders.
• 
  Mescher, A. and Junqueira, L. (2013). Junqueira’s Basic Histology. 13th ed. McGaw-Hill.
• 
  James D. Douketis, MD (2017). Lymphedema – Cardiovascular Disorders – MSD Manual Professional Edition. [online] Available at: http://www.msdmanuals.com/professional/cardiovascular-disorders/lymphatic-disorders/lymphedema [Accessed 12 Sep. 2017].
• 
  Pansky, B. (1982). Review of medical embryology. New York: Macmillan.
• 
  Vondenhoff, M., van de Pavert, S., Dillard, M., Greuter, M., Goverse, G., Oliver, G. and Mebius, R. (2008). Lymph sacs are not required for the initiation of lymph node formation. Development, 136(1), pp.29-34.

Author, review and layout:

• Lorenzo Crumbie
• Uruj Zehra
• Adrian Rad

Illustrators:

• Lymph node (histological slide) – Smart In Media
• Cisterna chyli – Begoña Rodriguez
• Axillary lymph nodes – Begoña Rodriguez
• Trabeculae (histological slide) – Smart In Media
• Cortex (histological slide) – Smart In Media
• Primary follicle (histological slide) – Smart In Media
• Secondary follicle (histological slide) – Smart In Media
• Germinal center (histological slide) – Smart In Media
• Centrocytes (histological slide) – Smart In Media
• Centroblasts (histological slide) – Smart In Media
• Paracortex (histological slide) – Smart In Media
• Medulla (histological slide) – Smart In Media
• Medullary sinuses (histological slide) – Smart In Media
• Efferent lymphatic vessels (histological slide) – Smart In Media
• Hilum of the lymph node (histological slide) – Smart In Media

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Lymphatic System Anatomy–Lymphosurgery Center

The lymphatic system is an important part of the human cardiovascular system and complements it.

Unlike the circulatory system, the lymphatic system does not have its own pump and is open. The lymph circulating in it moves slowly and under little pressure. Lymph is a fluid that is constantly formed by drainage of interstitial fluid into the lymphatic capillaries.

The structure of the lymphatic system includes:

• lymphatic capillaries
• lymphatic vessels
• lymph nodes
• lymphatic trunks and ducts

subclavian trunks; on the right into the right lymphatic duct, right jugular and right subclavian trunks. The ducts and trunks flow into the large veins of the neck, and then into the superior vena cava. In this way, lymph is transferred from the interstitial spaces back into the blood.

Lymphatic vessels pass through the lymph nodes. They are combined into several groups and are located along the vessels. Many afferent vessels carry lymph to the node, and it flows out from there only through one or two efferent vessels. Lymph nodes are small formations of a round, oval, bean-shaped, less often ribbon-shaped form up to 2 cm long. Here, lymph is filtered, foreign matter is separated and destroyed, and lymphocytes are produced here to fight infection. Lymph nodes that perform a barrier and immune role.

Main functions of the lymphatic system:

• Transport function – carrying lymph, metabolic products from tissues to the venous bed.

• Drainage function – the return of proteins, water, salts, toxins and metabolites from tissues to the blood. Removal of fluid, pus, effusion from the wound, cavities. Stability of the “capillary lymphatic pump”

• Lymphocytopoiesis, hematopoietic function – formation, maturation, differentiation of lymphocytes involved in immune reactions.

• Immune, protective functions – formation of the body’s immune defense, neutralization of foreign particles, bacteria, viruses, fungi, protozoa that enter the body. filtration from impurities, tumor particles and cells.

Any failure or blockage of the lymphatic vessels or nodes entails swelling or swelling of the tissues, lymphadenitis, erysipelas, lymphostasis occur. Experts, not without reason, believe that the lymph could tell about what the blood is “silent about”, because many of the waste products of the cells first enter the lymph, and then into the blood.

If most doctors can help us in the fight against many diseases, then only individual doctors – lymphologists – can diagnose and treat disorders in the lymphatic system.

According to the statistics of doctors themselves, in the CIS there are only a few lymphologists – specialists in the lymphatic system.

Lymphologists say: Your health is the purity of your lymphatic system!

Be healthy and happy!

where they are located, what functions they perform, in which diseases 9 increase0001

Inflammation and enlargement of the lymph nodes usually causes discomfort and pain. As a rule, this indicates that an inflammatory process is underway in the body.

What are lymph nodes

Lymph nodes are the most important organs that perform a barrier-filtration function ¹ . Their main function is the biological filter of lymph – a colorless liquid that washes all the tissues and cells of the body. It consists of plasma and formed elements. Interestingly, lymph plasma has an almost similar chemical structure to blood plasma, but contains fewer proteins ² .

Useful information about lymph nodes

Where are the lymph nodes

Lymph nodes are found almost everywhere. They are arranged in such a way as to become an obstacle in the way of various “garbage”: toxins, viruses, bacteria, parasites, fungi, cancer cells.

Most lymph nodes are located deep under the skin and even near internal organs where they cannot be felt. But some lymph nodes – under the jaw, in the armpits, in the groin – can be palpated even in a healthy, non-inflamed state.

Photo: Shutterstock

Functions of the lymph nodes

As mentioned earlier, the main function of the lymph nodes is barrier-protective function. In these organs of the lymphatic system, protective cells of the body are formed, such as lymphocytes, antibodies, phagocytes. Lymph nodes protect against the penetration of infections, and also prevent the reproduction of malignant tumor cells and play a role in the immune response to substances foreign to the body.

The lymph nodes also perform the following functions:

• hematopoietic – after the lymph nodes, lymph enriched with lymphocytes gets into the blood;
• drainage – promote the outflow of excess fluid;
• depository (reserve) – lymph node is a temporary storage of lymphocytes and lymph. The latter lingers in the lymph node in order to ensure the unloading of the bloodstream in “emergency” situations, for example, during venous congestion;
• metabolic – lymph nodes are involved in the metabolism of fats, proteins, carbohydrates and other substances.

Causes of swollen lymph nodes

Lymph nodes have their own diseases, and most often their inflammation is a reaction to some other disease or condition. Completely different reasons can lead to an increase in lymph nodes (lymphadenopathy). Consider the most common of them.

Local infections

Infection is one of the most common causes of swollen lymph nodes.

— For example, it can be acute respiratory diseases, leading to an increase in regional lymph nodes associated with the area in which inflammation occurs, says general practitioner Oksana Khamitseva.

As a rule, the focus of the disease is located near enlarged lymph nodes. So, with infections of the upper respiratory tract, the lymph nodes in the neck become inflamed, with a sexual infection – in the groin.

Generalized viral and bacterial infections

If only one category of lymph nodes is affected, then they speak of local inflammation. If the nodes that are not adjacent to each other increase, then we are talking about a generalized inflammation of the lymph nodes.

This widespread inflammation can be caused by infections – bacterial, viral, fungal, which affect the entire body. It can be tuberculosis, some infectious skin diseases, rubella, chickenpox, cytomegalovirus, mononucleosis, HIV and others.

Autoimmune diseases

Autoimmune connective tissue diseases such as arthritis and systemic lupus erythematosus can also lead to swollen lymph nodes. In such diseases, the body begins to attack its own cells. Due to the increasing load on the lymph nodes, their inflammation occurs.

Tumor processes

Swollen lymph nodes can also signal tumor processes in the body. As we wrote above, lymph nodes prevent the reproduction of cancer cells, but in some cases, tumor cells can get stuck in them and multiply. Tumor processes can lead to the development of leukemia, lymphogranulomatosis, lymphoma.

Hypersensitivity of the body

Allergic reactions can also provoke inflammation of the lymph nodes. In addition, their increase may be associated with hypersensitivity to certain drugs.

How lymph nodes are treated

The treatment of lymphadenopathy is varied and always depends on its cause. An increase in lymph nodes is a signal of inflammation, so you need to look for its source.

Most often, inflammation of the lymph nodes occurs as a secondary process, that is, a reaction to another disease:

• if this is associated with acute respiratory infections, then it is necessary to treat the respiratory tract infection itself, be it a bacterium or a virus;
• if it is associated with a generalized infection (mononucleosis, HIV), then long-term specific therapy is selected here;
• cat-scratch disease (felinosis) is treated with special antibiotics;
• Sepsis is controlled only in the hospital by intravenous administration of various drugs, including antibiotics, and ionic solutions.
• autoimmune diseases (systemic lupus erythematosus, Kawasaki disease, etc.) are treated by a rheumatologist, prescribing hormones or cytostatics for long courses under constant supervision.

Lymphadenopathy can also be caused by cancer. Conventionally, they can be divided into 3 sections:

1. leukemia, when the primary malignant focus is in the bone marrow;
2. lymphomas, when the foci are located directly in the lymph nodes;
3. metastases, when the focus is located in the internal organ, and cancer cells affect the lymph nodes in the path of lymph outflow.

— In the case of leukemia, a bone marrow transplant is possible. With lymphoma, it is useless to do this, you can only use various options for radiation, chemotherapy, genetic engineering methods. And if lymphadenopathy is caused by metastases, then, as a rule, the tumor of the corresponding organ is removed, entering healthy tissues and capturing the “package” of affected lymph nodes, says our expert Oksana Khamitseva.

How to maintain the health of the lymphatic system at home

According to physician Oksana Khamitseva, the health of the lymphatic system primarily depends on two components: good lymphatic drainage and normal functioning of the immune system. This is not difficult to achieve:

• regular physical activity;
• avoid tight, constricting clothing;
• smoking and alcohol cessation;
• courses of multivitamins 2 times a year;
• food high in protein and fiber in the diet;
• adequate fluid intake.

Popular questions and answers

General practitioner Oksana Khamitseva answers popular questions about lymph nodes.

Which lymph node is responsible for what?

– Each internal organ is supplied with lymph nodes, arteries and veins. If we talk about those lymph nodes that we can feel:

• Submandibular: increase with rhinitis, pharyngitis, tonsillitis, inflammation of the teeth and gums.
• Cervical: inflamed with acute respiratory infections, conjunctivitis, otitis media.
• Parotid: react to otitis media, acute respiratory infections.
• Occipital: increased with head and neck infections, acute tonsillitis, infectious mononucleosis.
• Axillary: may also be associated with mononucleosis, mastitis, breast cancer, HIV, cat scratch disease.
• Elbows: felinosis, HIV.
• Inguinal: mumps, generalized infections, inflammation of the urogenital organs.

What to do if the lymph nodes are inflamed?

— If you have lymphadenitis, you need to see a doctor, because you don’t know what it can be connected with. If you notice an increase in lymph nodes in the head and neck, there are signs of acute respiratory infections (runny nose, sore throat, cough, fever), then you can independently start taking vitamins, antiviral drugs, NSAIDs, symptomatic treatments for colds.

If you notice an increase in lymph nodes, which is objectively not related to the infectious process, then doing something without a doctor’s recommendation can be dangerous. Even taking vitamins, if the process is autoimmune, will spur the immune system to even more aggressive inflammation.

Why is inflammation of the lymph nodes dangerous?

— Complications of lymphadenitis include:

• transfer of infection to nearby tissues: bones, subcutaneous fat, skin;
• blockage by blood clots of veins adjacent to inflamed lymph nodes;
• violation of lymphatic drainage, edema, “elephantiasis” of the limbs.

What can not be done with enlarged lymph nodes?

– If you notice an increase in lymph nodes, then it is strongly not recommended to ignore it, heat or apply ice, make lotions without the permission of a doctor. Also, do not smear with anti-inflammatory ointments (you will reduce one lymph node and decide that you are cured, and if it is an oncology?), squeeze and massage the lymph node.

The patient does not know in which direction the lymph flows from this or that lymph node, and if you make the wrong movements, stagnation can be provoked.

Which doctor treats lymph nodes?

— All roads lead to a therapist. After examination and examination, a specialist can identify what lymphadenitis is associated with, treat acute respiratory infections or refer to an ENT doctor, an infectious disease specialist if an infectious process is detected. If an autoimmune disease is detected, your doctor is a rheumatologist, and in case of suspicion of leukemia or lymphoma, an oncologist.

Sources:

1. Semioshko N.V. Lymph nodes adjacent to the celiac trunk // BBC 28.706 Ya431 V 38. – 2014. – P. 111. http://sno.grsmu.by/conference/mk47.pdf#page=111
2. Pogrelchuk O.E., Danko E.S. Blood and lymph. Hematopoiesis // In the world of scientific discoveries. – 2018. – S. 219-221. https://www.elibrary.ru/download/elibrary_36443065_39723184.pdf
3. Dvoretsky L.I. Differential diagnosis in lymphadenopathy // Handbook of a polyclinic doctor. – 2005. – no. 2.