HISTOLOGY OF TONSILS AND SPLENIC CIRCULATION

BY

DR. MUDASSAR ALI ROOMI (MBBS, M.

PHIL)

SPLENIC CIRCULATION
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Splenic artery : its 4-5 rami enter the Hilum. Along trabeculae Finest arterioles pass Adventitia of the arteries is replaced by periartereolar Lymphoid sheath (PALS) Lymphatic aggregations is enlarged at certain places to form splenic lymphatic nodule (Malpighian bodies 0.25 1 mm) Splenic arteriole is eccentrically placed in lymphatic nodule
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Blood Circulation in Spleen

Splenic Artery
3 5 or 4 branches

Enter trabelulae Small arteriole branches (Periart Lymphatic sheath surrounds it) Central Arterioles in Splenic Nodule Eccentric position Branches to Splenic Nodule Arterioles lose thin Lymph Sheath divide in Red Pulp

Straight Vs (Penicilli)
Thick wall due to condensation of Ret. Lymphocytes) Lumen of B.Vs. Narrow ellipsoid One or more Capillaries
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Theories of blood flow in spleen

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1. Closed Theory

It states that the terminal arterial capillaries open directly into the venous sinuses.

2. Open Theory

It states that terminal arterial capillaries release their blood into pulp reticulum, from where the blood gradually filters into the venous sinuses.

3. Compromise Theory

both open and closed

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Lymphoid organs and MALT

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Mucosa-Associated Lymphoid tissue (MALT)

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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.

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. April 30, 2012

Collectively the mucosa-associated

tonsils
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Definition: 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 .
Waldyers ring
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Palatine tonsils
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Palatine tonsils is located in the posterior parts of the soft palate.

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Palatine tonsils
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These are covered by stratified squamous epithelium.

Each has 1020 epithelial invaginations that penetrate the tonsil deeply, forming crypts .
The lymphoid tissue in these tonsils forms a band that contains free lymphocytes and lymphoid nodules, generally with germinal centers. The epithelium is densely infiltrated by dendritic cells and lymphocytes Separating the lymphoid tissue from subjacent structures is a band of dense connective tissue that acts as a capsule or barrier against spreading tonsil infections.
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Palatine tonsils
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The pharyngeal tonsil

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The pharyngeal tonsil is situated in the posterior wall of the nasopharynx usually covered by ciliated pseudostratified columnar epithelium. The pharyngeal tonsil is composed of pleated mucosa containing diffuse lymphoid tissue and lymphoid nodules and a capsule thinner than that of the palatine tonsils.
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lingual tonsils
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The lingual tonsils are situated along the posterior surface of the tongue and are covered by stratified squamous epithelium with crypts. The lymphoid tissue of these tonsils has many of the same basic features as that of palatine tonsils. All these epithelia contain intraepithelial lymphocytes and dendritic cells.

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COMPARISO N

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Adenoid hypertrophy
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Adenoid hypertrophy (or enlarged adenoids) is the unusual growth ("hypertrophy") of the adenoid tonsil. Treatment: Surgical removal of the adenoids is a procedure called adenoidectomy

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Tonsillitis
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Tonsillitis is inflammation of the tonsils most commonly caused by a viral or bacterial infection. Symptoms of tonsillitis include sore throat and fever.

Tonsillitis

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Gut-Associated Lymphoid Tissue (GALT)

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The appendix and Peyer patches in the ileum of the digestive system are main components of GALT.

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Gut-Associated Lymphoid Tissue (GALT)

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MALT extends along the entire gastrointestinal tract, but in the wall of the ileum are particularly large aggregates of lymphoid follicles called Peyer patches, each consisting of 10200 nodules and bulging into the gut lumen with no connective tissue capsule. The simple follicle-associated epithelium (FAE) covering these nodules contains specialized M cells with apical microfolds rather than the brush border and glycocalyx typical of enterocytes. M cells continuously sample antigens and microorganisms in the intestinal lumen. Each is characterized by a large basal intraepithelial pocket open to the underlying lymphoid tissue through a porous basement membrane. Antigenic material bound to the apical surface of M cells is rapidly translocated via transcytosis from the intestinal lumen to APCs and lymphocytes located in the pocket. T helper cells and B cells derived from these lymphocytes move away from the FAE and initiate adaptive responses to the antigens. These B cells give rise to plasma cells secreting IgA, which is transported by enterocytes into the intestinal lumen to bind and neutralize potentially

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Clinical problem
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Appendicitis is a common disease, which may be triggered by bacterial and viral infections resulting in hyperplasia of lymphatic nodules and obstruction of the lumen of the appendix. Clinical features? Complications? Treatment?
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Identification points: palatine tonsil

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Tonsillar crypts lined by Stratified squamous nonkeratinized epithelium No lymph sinuses No cortex and medulla Lymph nodules are arranged in

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COMPARISO N

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