1
Department of Applied
& Medical Sciences,
Coleg Cambria, Grove
Park, Wrexham, UK
Correspondence to Joshua
John-Scott Rogers
22095246@cambria.ac.uk
Accepted 6 February
2022
SUMMARY abnormally, allowing them to gather within the lymph
A 69 year old white female has been referred to an nodes and other areas of the lymphatic system.
oncologist by the individual's GP for demonstrating Affected lymphocytes no longer have their
symptoms of swelling in the lymph node, found in the infection-fighting abilities, leaving the patient more
neck region, excessive bleeding, fatigue, a constant vulnerable to infection(7). Healthy lymphatic systems
cough and night sweats. Patient has endured operate by maintaining fluid balance, this is
occasional nose bleeds and abdominal discomfort accomplished through collecting excess fluids from the
around 12 months before the initial diagnosis. Patient tissues and disspositing them into the bloodstream.
has suffered frequent heart burns(1). Patient received
a biopsy on the neck region to confirm diagnosis(2).
Lymph tissue sample was extracted from the neck
using a biopsy needle and further examined under a
microscope by a pathologist to locate abnormal
cells(1).Physical examination took place resulting in an
excess of colour in the tongue and large bruises on the
surface of the skin being located(3). After further
results the patient underwent a PET scan to examine
the extent of the cancer. A small quantity of
radioactive glucose was injected into the vein, the
scanner located where the glucose has been used by
the patient's brain and created a picture for further
examination.(4.). Treatment was decided upon the
severity of the patient's cancer. Investigations showed
The lymphatic system produces disease-fighting
an increase in lymphocytes within the lymph nodes in
lymphocytes to defend against infection. Blood plasma
the neck area forming the present tumour whilst the
creates lymph, found within lymph nodes scattered
PET scan indicated cancer in the lymph nodes above
around the human body(8). Lymph fluid formation
and below the diaphragm, these areas revealed a high
occurs at the arterial end of the capillary bed.
metabolic rate within the tissues, revealing the
Ultrafiltration materialises due to hydrostatic pressure
patient's diagnosis of stage 3 Hodgkin's lymphoma due
forcing the fluid through the selectively permeable
to the severity of the spread(5). Patient was treated
capillary wall, leaving behind proteins within the blood
through the use of 6-8 cycles of chemotherapy which
plasma(9). The
continued over a course of several months with the
lymphatic system
combination of the steroid medicine, prednisone to
maintains fluid balance
reduce inflammation(6.) Treatment proved to decrease
by depositing fluids that
the lymphocyte levels within the patient as well as a
leak out of the blood
significant decrease in the size of the tumours in both
vessels. Lymph nodes
regions of the neck and spleen. Certain symptoms
composed of lymphatic
including the swelling were relieved.
tissue have the role of
filtering substances
BACKGROUND
through the lymphatic
In order to provide the correct treatment for the
fluid, allowing the body
patient a thorough investigation involving delicate
to build immunity and
attention will be carried out accurately. Hodgkin’s
fight off disease. There are five different variants of
lymphoma is a variant of blood cancer affecting the
lymph nodes these include: Axillary, cervical, inguinal,
lymphatic system. This causes B-lymphocytes mediastinal ,pelvic and retroperitoneal lymph nodes.
originating from the bone marrow, to multiply Thymus glands within the lymphatic system facilitate
Phillips-Jenkins P, BMJ Clinical Case Report 2022 1
, T-cells that specialise in white blood cells which results create large lymphatic trunks to allow better
in the killing of cells as well as the activation of other transportation of a milky fluid, chyle, where it deposits
immune cells. The thymus gland is located beneath the into the bloodstream. This process allows the
breastbone in level with the heart and is composed of transportation of larger substances and permits the
lymphocytes absorption of fat soluble vitamins and fats(12). Valves
and reticular within the lymphatic system function by flowing lymph
cells. This back towards the heart. Lymphatic vessels emerge into
part of the larger tubes called collecting ducts in order to keep
lymphatic fluid moving one way. These series of valves empty
system lymph in either the left or right lymphatic duct (13).
contains a The spleen, a secondary component of the lymphatic
system situated in the upper left quadrant of the
abdomen cavity, beneath the diaphragm. It is the
rich-lymphatic cortex in addition to an medulla, inner largest of the lymphatic organs and is enclosed by
zone and an outer zone. The cortex is the site of connective tissue capsules. The spleen filters blood as
lymphocyte growth, especially T cells(10). Within the well as eradicating pathogens. By removing old and or
thymus positive selection occurs resulting in a small damaged cells it allows for better blood
percentage of thymocytes, an immature T cell circulation(14).
containing the ability to recognise MHC-peptide
complexes to develop and mature further. They react FORMATION AND DRAINAGE OF TISSUE FLUID
with the MHC immune receptors. The remainder of Tissue fluid surrounds the body’s cells with its
thymocytes unable to recognise the complex water-esque liquid form. Its responsibilities include
MHC-peptide are left to die through apoptosis(11). T bathing the tissue to allow tissue fluid to excrete into
cells then migrate to the medulla, where they build the intercellular spaces. Its role also involves
tolerance induction and differentiate further before facilitating the exchange of materials to provide a
they then enter the bloodstream through medullary route of contact between the cells and blood(15).
veins or are sent to peripheral tissue. Negative Tissue fluid is greatly composed of plasma however its
selection can occur after the T cells differentiate which composition differs from that of plasma. There is a low
causes the T cells to attack the body’s own tissue. The presence of proteins such as enzymes and albumins,
inner zone of the medullary cavity stores red and its configuration contains low quantities of proteins
yellow bone marrow. Bone marrow is soft and due to the inability of larger proteins to pass through
gelatinous and can be found in the centre of most the selectively permeable capillary wall(16). As
bones. The function of bone marrows involves the mentioned previously tissue fluid forms towards the
process of hematopoiesis which is the formation of arterial end of the capillary due to ultrafiltration. The
blood cells as well as the production of specialised residence of proteins in the fluid utilises osmotic
stem cell connective tissues. Certain lymphocytes pressure (low water potential) causing water to move
began their life cycle within bone marrow. Leukocytes from the tissue fluid back into the blood plasma, but
are a type of B-lymphocyte also produced by the bone the hydrostatic pressure is greater than the osmotic
marrow in the lymphatic system and their function in gradient generating a greater flow from the plasma to
the immune system is to fight diseases, the production the tissue fluid. The drainage of tissue fluid mostly
of leukocytes increases when a disease is located. drains back into the venous end of the capillary bed.
Small masses of lymphatic tissue can be located in the This is a result of low hydrostatic pressure compared to
rear end of the the arterial end of the capillary, lower water potential
throat in the due to the presence of protein. The tissue fluid will
pharynx called re-enter the capillaries whilst carrying molecules and
tonsils. Their role the remaining fluid is drained through the one ended
within the lymphatic vessels for transport, travelling back into the
lymphatic system is bloodstream as lymphs(9).
to prevent disease
in the respiratory CASE PRESENTATION
and digestive A 69 year old woman, suffering from a history of
regions of the body, rheumatoid arthritis, long time smoker as well as
this is done by arrhythmia and high blood pressure. The patient was
producing antibodies. The tonsils however are prone referred to an oncologist for presenting the following
to infection themselves leading to further symptoms; swelling of the lymph node in the neck,
complications such as tonsillitis. The lacteal is a fatigue, persistent cough, night sweats and occasional
secondary component of the lymphatic system located abdominal discomfort. For the previous diagnosis the
within the intestinal villi(10). Lymph capillaries have patient has received medication such as amlodipine in
the role of expediting excess fluid, returning them to order to treat the high blood pressure, levothyroxine
the venous blood. Small lymphatic vessels combine to and the OPPA combination for chemotherapy aspect of
Phillips-Jenkins P, BMJ Clinical Case Report 2022 2
