HAEMATOLOGY & LYMPHATIC

SYSTEM
By Fentahun A. (MSc.)
 Outlines
Outlines of the presentation
Introduction
The Immune System & Lymphoid Organs
The lymphoid organs and main paths of lymphatic vessels
Antigens
Antibodies
Cytokines
Cells of the Immune System
Lymphocytes
Types of Immune Responses
Lymphoid Tissue
 INTRODUCTION

The body has a system of cells the immune

system.
The immune system has the ability to distinguish
"self" (the organism's own molecules) from "non-
self" (foreign substances).
 INTRODUCTION
This system has the ability to neutralize or
inactivate foreign molecules (such as soluble
molecules as well as those present in viruses,
bacteria, and parasites) and to destroy
microorganisms or other cells (such as virus-
infected cells, cells of transplanted organs, and
cancer cells)

On occasion, the immune system of an individual

reacts against its own normal body tissues or
molecules, causing autoimmune diseases.
 INTRODUCTION

The cells of the immune system are:-

Distributed throughout the body in the blood,
lymph, and epithelial and connective tissues.

Arranged in small spherical nodules called

lymphoid nodules found in connective tissues and
inside several organs; and

Organized in larger lymphoid organsthe lymph

nodes, the spleen, the thymus, and the bone marrow.
 INTRODUCTION

Lymphoid nodules are isolated cells of the

immune system found in the mucosa of the:-

Digestive system (including the tonsils, Peyer's

patches, and appendix), respiratory system,
reproductive system, and urinary system are
collectively known as mucosa-associated
lymphoid tissue (MALT) and may be considered a
lymphoid organ.
 INTRODUCTION

The wide distribution of immune system cells and

the constant traffic of lymphocytes through the
blood, lymph, connective tissues, and lymphoid
organs provide the body with an elaborate and
efficient system of surveillance and defense.
THE IMMUNE SYSTEM & LYMPHOID ORGANS
 Lymph
Has a fluid plasma that could clot, but looser and softer than
the blood clot.
Has various composition that include:
1) Cells that appear as it passes through the lymph nodes. These
includes:
Lymphocytes making about 99% for recirculation into blood.
A few erythrocytes.
Occasional eosinophils.
2) Macromolecules
Lipid as chyle from the intestine.
Proteins mainly from liver.
 The lymphoid organs and main paths of
lymphatic vessels
The lymphatic system is comprised of:-
Lymphatic vessels, which transport interstitial fluid
(lymph) back to the blood circulation, and the lymphoid
organs which house lymphocytes and other cells of the
body's immune defense system.

Lymphoid organs are divided in to two:-

Primary lymphoid organs are the bone marrow and
thymus, where B and T lymphocytes are formed
respectively.
The secondary lymphoid organs include the lymph nodes,
mucosa-associated lymphoid tissue (MALT), and spleen.
 Antigens
Definition:-
A molecule that is recognized by cells of the immune
system is called an antigen and may elicit a response from
these cells and it may consist of;
soluble molecules (such as proteins, polysaccharides, and
nucleoproteins) or
molecules belonging to whole cells (bacteria, protozoa,
tumor cells, or virus-infected cells).

The cells of the immune system do not recognize and react

to the whole antigen molecule but instead react to small
molecular domains of the antigen known as antigenic
determinants or epitopes.
 Antigens Continued.
The response of the organism to antigens may be
cellular (in which lymphocytes are primarily in
charge of eliminating the antigen) or humoral (in
which antibodies secreted by plasma cells are
primarily responsible for the response).

Some epitopes (e.g. polysaccharides of bacterial

walls or lipids) usually elicit a humoral response
whereas proteins elicit both a cellular and humoral
response.
 Antibodies
Definition:-
An antibody is a glycoprotein that interacts specifically
with an antigenic determinant.

Antibodies belong to the immunoglobulin protein

family. Free molecules of antibodies are secreted by
plasma cells that arise by proliferation and terminal
differentiation of clones of B lymphocytes whose
receptors recognize and bind specific epitopes.
 Antibodies Continued.
These secreted antibodies either circulate in the
plasma and may leave the blood vessels reaching the
tissues or are present in the secretion of some epithelia
(eg, of the mammary gland and salivary glands).

Other antibodies are not free molecules, but are integral

membrane proteins of the surface of lymphocytes.

In any case, each antibody combines with the epitope that it

specifically recognizes.
 Antibodies Continued.
There are several classes of antibody molecules but all have
a common design: they consist of two identical light chains
and two identical heavy chains bound by disulfide bonds and
noncovalent forces.

The isolated carboxyl-terminal portion of the heavy chain

molecules is called the Fc region.

The Fc regions of some immunoglobulins are recognized by

receptors on the membranes of several cell types and for this
reason antibodies bind to the surface of these cells.
 Antibodies Continued.
The first 110 amino acids near the amino-terminal part of the
light and heavy chains vary widely among different antibody
molecules and this region is called the variable region.

The antigen-binding site of an antibody consists of the

variable regions of one heavy and one light chain.

Thus, each antibody has two antigen-binding sites, both for

the same antigen. The molecules in some immunoglobulin
classes may form dimers, trimers, or pentamers.
The antigen-binding site of an antibody
 Classes of Antibodies

Classes of Antibodies include:-

1. IgG
It is the most abundant class representing 7580% of
serum immunoglobulins. It is produced in large amounts
during immune responses.

It is the only immunoglobulin that crosses the placental

barrier and is transported to the circulatory system of the
fetus, protecting the newborn against infections for a
certain period of time.
 Classes of Antibodies Continued.

2. IgA
It is the main immunoglobulin found in secretions, such as
nasal, bronchial, intestinal, and prostatic, as well as in
tears, colostrum, saliva, and vaginal fluid.

It is present in secretions as a dimer or trimer called

secretory IgA, composed of two or three molecules of
monomeric IgA united by a polypeptide chain called
protein J and combined with another protein, the secretory
component.
 Classes of Antibodies Continued.
Because it is resistant to several enzymes, secretory IgA
persists in the secretions where it provides protection against
the proliferation of microorganisms.

IgA monomers and protein J are secreted by plasma cells in

the lamina propria of the epithelium of the digestive,
respiratory, and urinary passages; the secretory component is
synthesized by the mucosal epithelial cells and is added to
the IgA polymer as it is transported through the epithelial
cells.
 Classes of Antibodies Continued.

3. IgM
It constitutes about 10% of blood immunoglobulins and
usually exits as a pentamer.
Together with IgD, it is the major immunoglobulin found on
the surface of B lymphocytes. These two classes of
immunoglobulins have both membrane-bound and circulating
forms.
IgM bound to the membrane of a B lymphocyte functions as its
specific receptor for antigens.
The result of this interaction is the proliferation of B
lymphocytes into antibody-secreting plasma cells.
Secreted IgM, when bound to antigen, is very effective in
activating the complement system.
 Classes of Antibodies Continued.

4. IgE
It is much less abundant than the other classes and
usually exists as a monomer.
As its Fc region has a great affinity for receptors
present on the surfaces of mast cells and basophils,
it attaches to these cells after being secreted by
plasma cells and only small amounts are found in
the blood.
Classes of Antibodies Continued.
When IgE molecules present on the surface of mast
cells or basophils encounter the antigen that elicited
the production of this specific IgE, the antigen
antibody complex triggers the liberation of several
biologically active substances, such as histamine,
heparin, leukotrienes, and eosinophil-chemotactic
factor of anaphylaxis.

This characterizes an allergic reaction, which is

thus mediated by the binding of cell-bound IgE with
the antigens (allergens) that stimulated its
production.
 Classes of Antibodies Continued.

5. IgD
The properties and activities of IgD are not
completely understood.

It is monomeric and is even less abundant than IgE,

constituting only 0.001% of the immunoglobulin in
plasma.

IgD is found on the cell membrane of B

lymphocytes.
 Cytokines

Definition:-
The functions of cells in the immune system are regulated
by a large number of molecules, mainly cytokines, which
are peptides or glycoproteins usually with low molecular
masses (between 8 and 80 kDa).

They influence both the cellular and humoral immune

responses.
they act on many cells that have receptors for themnot
only cells of the immune system, but also cells of other
systems, such as the nervous system and endocrine
system.
 Cytokines Continued..
They are primarily produced by cells of the immune
system, mainly lymphocytes, macrophages, and
other leukocytes, but may also be synthesized by
other cell types, such as endothelial cells and
fibroblasts.

Chemotaxins, or chemokines, are cytokines that

induce diapedesis of leukocytes and migration to
sites of inflammation.
 Cells of the Immune System
The primary cells that participate in the immune
response are lymphocytes, plasma cells, mast cells,
neutrophils, eosinophils, and cells of the
mononuclear phagocyte system.

Antigen-presenting cells, a group of diverse cell

types, assist other cells in the immune response.

This group includes, among other cells,

lymphocytes, macrophages, and dendritic cells.
 Lymphocytes

Lymphocytes are classified as

B cells.
T cells.
natural killer (NK) cells.
The B and T cells are the only cells that have the
ability to selectively recognize a specific epitope
among a vast number of different epitopes (on the
order of 1018).
 Lymphocytes Continued..
B and T cells differ based on their life history,
surface receptors, and behaviour during an immune
response.

Although B and T cells are morphologically

indistinguishable in either the light or electron
microscope, different surface proteins (markers)
allow them to be distinguished by
immunocytochemical methods.
 Lymphocytes Continued..
The precursors of all lymphocyte types originate in
the bone marrow.

some lymphocytes mature and become functional in

the bone marrow, and after leaving the bone marrow
enter the blood circulation to colonize connective
tissues, epithelia, lymphoid nodules, and lymphoid
organsThese are the B lymphocytes.
 Lymphocytes Continued..
T lymphocyte precursors, on the other hand, leave the bone
marrow, and through the blood circulation reach the thymus
where they undergo intense proliferation and differentiation
or die by apoptosis.

After their final maturation, T cells leave the thymus and are
distributed throughout the body in connective tissues and
lymphoid organs.

The other lymphoid structures are all secondary or peripheral

lymphoid organs (spleen, lymph nodes, solitary lymphoid
nodules, tonsils, appendix, and Peyer's patches of the ileum).
 Lymphocytes Continued..
B and T cells are not anchored in the lymphoid
organs; instead, they continuously move from one
location to another, a process known as lymphocyte
recirculation so that the cellular composition and
microscopic anatomy of lymphoid tissues differ
from one day to the next.

B and T cells are not distributed uniformly

throughout the lymphoid organs but occupy specific
organs preferentially.
 Lymphocytes Continued..
Approximate percentages of B and T cells in lymphoid
organs.

Lymphoid Organ T lymphocytes (%) B lymphocytes (%)

Thymus 100 0

Bone marrow 10 90

Spleen 45 55

Lymph nodes 60 40

Blood 70 30
 Cont
Three important subpopulations of T cells
are the following:
1. Helper cells
Which produce cytokines that promote
differentiation of B cells into plasma cells, activate
macrophages to become phagocytic, activate
cytotoxic T lymphocytes, and induce many parts
of an inflammatory reaction.
Helper cells have a marker called CD4 on their
surfaces and are, hence, called CD4+ T cells.
 Cont
2. Cytotoxic T cells
Are CD8+ and act directly against foreign cells or
virus-infected cells by two main mechanisms.
In one, they attach to the cells to be killed and
release proteins called perforins that create holes
in the cell membrane of the target cell, with
consequent cell lysis.
In the other, they attach to a cell and kill it by
triggering mechanisms that induce programmed
cell death, or apoptosis
 Cont

3. Regulatory T cells
Are CD4+CD25+ and play crucial roles in
allowing immune tolerance, maintaining
unresponsiveness to self-antigens and
suppressing excessive immune responses.
These cells produce peripheral tolerance, which
backs up the central tolerance emerging in the
thymus.
 Types of Immune Responses
The two basic types of immune responses are
The innate response and the adaptive response.
The innate response
Which can include the action of the complement system,
defensins, and cells such as neutrophils, macrophages, mast cells,
and natural killer cells.
is fast, nonspecific, and older from an evolutionary point of view.
It does not produce memory cells.
The adaptive response,
Which depends on the initial recognition of antigens by B and T
cells.
is more complex, is slower and specific, produces memory cells,
and is a more recent evolutionary development.
 Lymphoid Tissue
Definition:-
Lymphoid tissue is connective tissue characterized by a rich supply
of lymphocytes.
It exists free within the regular connective tissue or is surrounded by
capsules, forming the lymphoid organs.
Because lymphocytes have very little cytoplasm, lymphoid tissue
filled densely with such cells stains dark blue in H&E-stained
sections.
Lymphoid tissues are basically made up of free cells, typically with a
rich network of reticular fibers of type III collagen supporting the
cells.
In most lymphoid organs, the reticular fibers are produced by a
fibroblastic cell called a reticular cell, whose many processes rest on
the fibers.
 Cont
The thymus is an exception in that its cells are
supported by a reticulum of unusual epithelial
cells.
The network of reticular fibers of the lymphoid
tissue may be relatively dense and thus able to hold
many free lymphocytes, macrophages, and plasma
cells.
Areas of more loosely organized lymphoid tissue,
with fewer and larger spaces, allow easy movement
of these cells.
 Thymus
The thymus is a bilateral
bilateralorgan
organlocated
locatedininthe
the
mediastinum; it attains its peak
peak development
development during
during
youth.
 Thymus
Like bone marrow and B cells, the thymus is
considered a central or primary lymphoid organ
because T lymphocytes form there.
Whereas all other lymphoid organs originate
exclusively from mesenchyme (mesoderm), the
thymus has a dual embryonic origin.
Its precursor lymphoblasts originate in the bone
marrow, but then move to invade a unique
epithelium that developed from the endoderm of
the embryo's third and fourth pharyngeal
pouches.
 Cont
The thymus has a connective tissue capsule that
penetrates the parenchyma and divides it into
incomplete lobules, with continuity between the
cortex and medulla of adjoining lobules.
Each lobule has a peripheral darkly stained zone
known as the cortex and a central light zone called
the medulla.
The cortex is richer in small lymphocytes than the
medulla and therefore it is The thymic cortex.
 Cont
The thymic cortex is composed of an extensive
population of T lymphoblasts (also called thymocytes)
and macrophages in a stroma of epithelial reticular cells.
The epithelial reticular cells usually have large euchromatic
nuclei and are diverse morphologically, but generally either
squamous or stellate with long processes.
They are typically joined to similar adjacent cells by desmosomes
, forming an unusual cytoreticulum.
Cytoplasmic bundles of intermediate keratin filaments
(tonofilaments) give evidence of these cells' epithelial origin.
Occluding junctions between flattened epithelial reticular cells
at the boundary between cortex and medulla help to separate these
two regions.
 Cont
The thymic medulla also contains;
a cytoreticulum of epithelial reticular cells,
many less densely packed differentiated T lymphocytes, and
structures called thymic(Hassall's) corpuscles, which are
characteristic of this region.
Thymic corpuscles consist of epithelial reticular cells
arranged concentrically, filled with keratin filaments, and
sometimes calcified.


The thymus, an encapsulated, bilateral organ in the mediastinum, is subdivided by connective tissue (CT) septa into connected
lobes. Lobes of an active thymus shown have peripheral regions of cortex (C), where basophilic lymphocytes are fairly dense, and
more central medulla (M) regions with fewer lymphocytes. Besides the differences in location and cell density, the medulla region is
characterized by the scattered presence of distinct thymic corpuscles (arrow). X140. H&E.
The thymic medulla contains fewer
lymphocytes than the cortex and the
epithelial reticular cells (arrowheads)
have different morphology and
function. The most characteristic
feature of the medulla in humans is
the presence of thymic (Hassall's)
corpuscles (H). These are of variable
size and contain layers of epithelial
reticular cells undergoing
keratinization and degeneration.
X200. H&E.
 Cont
Arterioles and capillaries in the thymic cortex are
sheathed by flattened epithelial reticular cells with
tight junctions.
These features create a blood-thymus barrier and
prevent most circulating antigens from leaving the
microvasculature and entering the thymus cortex.
No such barrier is present in the medulla and
mature T lymphocytes exit the thymus via venules
in this zone.
The capillary endothelium has a thick basal
lamina.
 Cont
The thymus has no afferent lymphatic vessels and
does not constitute a lymph filter, as do lymph
nodes.
The few lymphatic vessels of the thymus are in the
connective tissue of the capsule, septa and blood
vessel walls and are all efferent.
Role of the Thymus in T Cell Maturation

The thymus is the site of;

T lymphocyte differentiation
removal of T lymphocytes reactive against self-antigens,
important part of central self-tolerance induction.
T lymphoblast surfaces do not yet exhibit the T cell receptor
(TCR) or the CD4 and CD8 markers.
Their progenitor cells arise in the fetal liver or bone marrow
and migrate to the thymus during both fetal and postnatal
life.
After entering the thymus, T lymphoblasts populate the
cortex where they proliferate extensively.
 Cont
As thymocytes mature and express T cell markers, they
undergo thymic selection, a stringent quality control
process, as they pass through a succession of
microenvironments created by different mixes of the stromal
epithelial reticular cells.
Differentiating thymocytes in the cortex are presented with
antigens bound to class I and class II MHC proteins on the
epithelial reticular cells, macrophages, and dendritic cells.
Thymocytes whose TCRs cannot bind MHC molecules at
all are non functional and have no future as T cells; these
cells (as many as 80% of the total) are induced to undergo
apoptosis.
 Cont
Similarly, those thymocytes that strongly bind MHCs
containing self-peptides are also deleted since such T cells
could cause a damaging autoimmune response.
Only 23% of the thymocytes pass both these positive and
negative selection tests and survive to migrate into the
thymic medulla.
The others die by apoptosis and are removed by the
numerous local macrophages.
Movement into the medulla depends on the action of
chemokines and on the interaction of thymocytes with the
ECM and cytoreticulum. Mature, functional T cells enter the
blood circulation by passing through the walls of venules in
the medulla and are distributed throughout the body.
 Cont
Besides their structural roles, the epithelial reticular
cells produce a number of paracrine factors
required for differentiation, selection and migration
of mature T lymphocytes, notably thymopoietin
and thymosins.
Other polypeptides secreted by these cells,
including thymulin and thymus humoral factor,
also affect target cells outside the thymus.
Mucosa-Associated Lymphoid tissue (MALT)

The digestive, respiratory, and genitourinary tracts

are common sites of invasion by pathogens because
their lumens are open to the external environment.
To protect the organism, the mucosal connective
tissue of these tracts contains large and diffuse
collections of dendritic cells, lymphocytes, IgA-
secreting plasma cells, APCs, and lymphoid
nodules.
Lymphocytes and dendritic cells are also present
within the epithelia lining the lumens. Most of the
lymphocytes are B cells; among T cells, CD4 helper
cells predominate.
 Cont
In some places, these aggregates form large, conspicuous
structures such as the tonsils and the Peyer patches in the
ileum.
Similar aggregates with lymphoid follicles are found in the
appendix. Collectively the mucosa-associated lymphoid
tissue (MALT) is one of the largest lymphoid organs,
containing up to 70% of all the body's immune cells.
Tonsils are partially encapsulated lymphoid tissue lying
beneath and in contact with the epithelium of the oral cavity
and pharynx.
According to their location they are called palatine,
pharyngeal, or lingual tonsils.
 Lymph Nodes
Lymph nodes are bean-shaped, encapsulated
structures, generally 210mm in diameter,
distributed throughout the body along the course of
the lymphatic vessels.
The nodes are found in the axillae (armpits) and
groin, along the great vessels of the neck, and in
large numbers in the thorax and abdomen,
especially in mesenteries.
Lymph nodes constitute a series of in-line filters
that are important in the body's defense against
microorganisms and the spread of tumor cells.
 Cont
All this lymph, derived from tissue fluid, is filtered
by at least one node before returning to the
circulation.
These kidney-shaped organs have a convex surface
that is the entrance site of lymphatic vessels and a
concave depression, the hilum, through which
arteries and nerves enter and veins and lymphatics
leave the organ.
A connective tissue capsule surrounds the lymph
node, sending trabeculae into its interior.
 Cont
The cortex, situated under the capsule, consists of
the following components:
Many reticular cells, macrophages, APCs, and
lymphocytes.
Lymphoid nodules, with or without germinal
centers, formed mainly of B-lymphocytes,
embedded within the diffuse population of other
cells.
Areas immediately beneath the capsule, called the
subcapsular sinuses, where the lymphoid tissue has
wide reticular fiber meshes.
 Cont
Lymph containing antigens, lymphocytes, and
APCs circulates around the wide spaces of these
sinuses after being delivered there by the afferent
lymphatic vessels.
Cortical sinuses, running between the lymphoid
nodules, which arise from and share the structural
features of the subcapsular sinuses.

They communicate with the subcapsular sinuses

through spaces similar to those present in the
medulla.
 Cont
The paracortex does not have precise boundaries
with the cortex and medulla.
It can be distinguished from the outer cortex by its
lack of B cell lymphoid nodules and its
accumulation of T cells.
Venules in the paracortex comprise an important
entry point for lymphocytes moving from blood
into lymph nodes.
 Cont
The lymph node medulla has two major
components:
Medullary cords are branched cordlike
extensions of lymphoid tissue arising from the
paracortex.
They contain primarily B lymphocytes and often
plasma cells and macrophages.
Medullary cords are separated by dilated spaces,
frequently bridged by reticular cells and fibers,
called medullary sinuses.
 C- cortex
P-paracortex
M- medulla
MC- medullary cords
MS- medullary sinus
T- terabucullae
lN- lymph node
CT- connective tissue
 The Spleen
The spleen is the
largest ductless
gland.
is a soft vascular
organ.
weighs from 50 to
250g.
is related to the 9th,
10th & 11th ribs on
the side.

65
 The Spleen
Spleen is found In left
hypochondria thus,
cant be palpated.

surface projection of
the longitudinal axis
of the spleen is the
tenth rib.

It is concealed
anteriorly by the
greater curvature of
stomach & left colic
(splenic) flexure.

66
 Spleen
The spleen has: 2 ends medial
and lateral
2 borders upper and lower
2 surfaces parietal
(diaphragmatic) in relation to
diaphragm & visceral surface in
relation to stomach, left kidney,
left colic flexure and tail of
pancreas.

Diaphragm separates spleen from

the 9th, 10th & 11th ribs.

Visceral surface has:

Gastric, renal & colic areas and
Superior extremity & Inferior-
extremity
67
 Spleen
Visceral surface:
Gastric area - greater curvature of stomach
Renal area - faces medially and caudally.
Related to upper ventral surface of left kidney.
Colic area - left colic (splenic) flexure

Superior extremity:
directed toward the vertebral column
Inferior extremity:
rests on the left colic flexure and phrenicocolic ligament
Associated ligaments of the spleen (double layers of
peritoneum):
phrenicocolic ligament (from Lt Colic Flexure to Diaphragm)
gastrolienal ligament: from stomach to spleen
lienorenal ligament: from spleen to Lt kidney 68
 Spleen
The spleen is the largest single accumulation of
lymphoid tissue in the body and the only one involved
in filtration of blood, making it an important organ in
defense against blood-borne antigens.
It is also the main site of destruction of aged
erythrocytes.
As is true of other secondary lymphoid organs, the
spleen is a production site of antibodies and activated
lymphocytes, which are delivered to the blood.
Any inert particles in blood are actively phagocytosed
by spleen macrophages.
 Cont
The spleen is surrounded by a capsule of dense connective
tissue from which emerge trabeculae, which partially
subdivide the parenchyma or splenic pulp.
Large trabeculae originate at the hilum, on the medial
surface of the spleen;
these trabeculae carry nerves and arteries into the splenic
pulp as well as veins that bring blood back into the
circulation.
Lymphatic vessels that arise in the splenic pulp also leave
through the hilum via the trabeculae.
 Spleen
Clinical Considerations:

Surgical removal of the spleen may be carried out in

healthy patients whose spleen has been ruptured by
trauma. In the long run, splenectomy has no dire
effects.

There is an increased risk of infection after

splenectomy, especially in very young children.

In hypertrophic spleen due to overactivity of its

macrophage system, it can be removed without
apparent ill effects. 74
 Tonsils
Tonsils belong to the MALT, but because they are
incompletely encapsulated, they are considered
organs and will be studied apart from the MALT.
The tonsils constitute a lymphoid tissue that lies
beneath, and in contact with, the epithelium of the
initial portion of the digestive tract.
Depending on their location, tonsils in the mouth and
pharynx are called palatine, pharyngeal, or lingual.
 Palatine Tonsils

The two palatine tonsils are located in the

lateral walls of the oral part of the pharynx.
They are lined with a squamous stratified
epithelium that often becomes so densely
infiltrated by lymphocytes that it may be
difficult to recognize.
The lymphoid tissue in these tonsils forms a
band that contains;
free lymphocytes,
lymphoid nodules, generally with germinal centers .
 Cont
Each tonsil has 1020 epithelial invaginations that
penetrate the tonsil deeply, forming crypts, whose
lumens contain;
desquamated epithelial cells, live and dead
lymphocytes, and bacteria.
Crypts may appear as purulent spots in tonsillitis.
Separating the lymphoid tissue from subjacent
structures is a band of dense connective tissue, This
capsule usually acts as a barrier against spreading
tonsillar infections.
 Pharyngeal Tonsil

The pharyngeal tonsil is a single tonsil situated in the superior

posterior portion of the pharynx.
It is covered by ciliated pseudostratified columnar
epithelium typical of the respiratory tract, although areas of
stratified epithelium can also be observed.
The pharyngeal tonsil is composed of pleats of mucosa and
contains diffuse lymphoid tissue and lymphoid nodules.
It has no crypts, and its capsule is thinner than the capsule of
the palatine tonsils.
Hypertrophied pharyngeal tonsils resulting from chronic
inflammation are called adenoids.
 Lingual Tonsils
The lingual tonsils are smaller and more numerous
than the palatine and pharyngeal tonsils.
They are situated at the base of the tongue and are
covered by stratified squamous epithelium.
Each lingual tonsil has a single crypt.