A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that include B and T cells. Lymph nodes are important for the proper functioning of the immune system, acting as filters for foreign particles including cancer cells, but have no detoxification function. In the lymphatic system, a lymph node is a secondary lymphoid organ. A lymph node is enclosed in a fibrous capsule and is made up of an outer cortex and an inner medulla. Lymph nodes become inflamed or enlarged in various diseases, which may range from mild throat infections to life-threatening cancers. The condition of lymph nodes is very important in cancer staging, which decides the treatment to be used and determines the prognosis. Lymphadenopathy refers to glands that are enlarged or swollen. When inflamed or enlarged, lymph nodes can be firm or tender.
Structure
Lymph nodes are kidney or oval shaped and range in size from 2 mm to 25 mm on their long axis, with an average of 15 mm. Each lymph node is surrounded by a fibrous capsule (made of collagenous connective tissue), which extends inside the lymph node to form trabeculae. The substance of a lymph node is divided into the outer cortex and the inner medulla. These are rich with cells. The hilum is an indent on the concave surface of the lymph node where lymphatic vessels leave and blood vessels enter and leave. Lymph enters the convex side of a lymph node through multiple afferent lymphatic vessels, and from there, it flows into a series of sinuses. Upon entering the lymph node, lymph first passes into a space beneath the capsule known as the subcapsular sinus, then moves into the cortical sinuses. After traversing the cortex, lymph collects in the medullary sinuses. Finally, all of these sinuses drain into the efferent lymphatic vessels, which carry the lymph away from the node, exiting at the hilum on the concave side.
Location
Lymph nodes are present throughout the body, are more concentrated near and within the trunk, and are divided into groups. There are about 450 lymph nodes in the adult. Some lymph nodes can be felt when enlarged (and occasionally when not), such as the axillary lymph nodes under the arm, the cervical lymph nodes of the head and neck and the inguinal lymph nodes near the groin crease. Most lymph nodes lie within the trunk adjacent to other major structures in the body - such as the paraaortic lymph nodes and the tracheobronchial lymph nodes. The lymphatic drainage patterns are different from person to person and even asymmetrical on each side of the same body. There are no lymph nodes in the central nervous system, which is separated from the body by the blood–brain barrier. Lymph from the meningeal lymphatic vessels in the CNS drains to the deep cervical lymph nodes. However, the CNS does innervate lymph node by sympathetic nerves. These regulate lymphocyte proliferation and migration, antibody secretion, blood perfusion, and inflammatory cytokine production.
Size
Subdivisions
A lymph node is divided into compartments called nodules (or lobules), each consisting of a region of cortex with combined follicle B cells, a paracortex of T cells, and a part of the nodule in the medulla. The substance of a lymph node is divided into the outer cortex and the inner medulla. The cortex of a lymph node is the outer portion of the node, underneath the capsule and the subcapsular sinus. It has an outer part and a deeper part known as the paracortex. The outer cortex consists of groups of mainly inactivated B cells called follicles. When activated, these may develop into what is called a germinal center. The deeper paracortex mainly consists of the T cells. Here the T-cells mainly interact with dendritic cells, and the reticular network is dense. The medulla contains large blood vessels, sinuses and medullary cords that contain antibody-secreting plasma cells. There are fewer cells in the medulla. The medullary cords are cords of lymphatic tissue, and include plasma cells, macrophages, and B cells.
Cells In the lymphatic system a lymph node is a secondary lymphoid organ. Lymph nodes contain lymphocytes, a type of white blood cell, and are primarily made up of B cells and T cells. B cells are mainly found in the outer cortex where they are clustered together as follicular B cells in lymphoid follicles, and T cells and dendritic cells are mainly found in the paracortex. There are fewer cells in the medulla than the cortex. The medulla contains plasma cells, as well as macrophages which are present within the medullary sinuses. In case of diseases like cancer, macrophages within the lymph nodes may play pro-cancerous role by deleting anticancer T cells e.g., PD-L1+ macrophages in lymph nodes, facilitated by anticancer vaccines, can directly delete CD8+ T cells via extrinsinc apoptotic signalling. As part of the reticular network, there are follicular dendritic cells in the B cell follicle and fibroblastic reticular cells in the T cell cortex. The reticular network provides structural support and a surface for adhesion of the dendritic cells, macrophages and lymphocytes. It also allows exchange of material with blood through the high endothelial venules and provides the growth and regulatory factors necessary for activation and maturation of immune cells.
Lymph flow
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