Thymus histology

Overview

The thymus is an encapsulated primary lymphoid organ. Histologically, it is divided into subcapsular cortical, cortical and medullary regions within each lobule, created by the intervening connective tissue septae extending from the capsule.

Gross cross sectional dissection of the thymus reveals a darker cortical region that is more peripheral to the lighter medullary compartment. The variation in colour intensity is attributed to the density of the thymocytes in each respective area. Therefore, the darker cortex has more T – lymphocytes when compared to the lighter medulla.

There are two major categories of cells within the thymus. These are the thymic epithelial cells and thymocytes. The thymic epithelial cells are endodermal derivatives of the third pharyngeal pouch that further differentiates into specialized epithelium within the cortex and medulla. Overall, these cells are characterized by an eosinophilic cytoplasm containing intermediate filament bundles with pale, ovoid nuclei.

Cortex and cell types

The superficial subcapsular cells are arranged as a continuous squamous sheath that follows the visceral contours of the capsule; even extending within the septae into the lobules and surrounding the vascular beds within it. The cell membranes are tightly held together by desmosomes and occluding junctions. The squamous thymic epithelial cells, along with pericytes and vascular epithelium, form the blood thymus barrier. With this barrier in place, the likelihood of exposing thymocytes to improper antigens is greatly reduced.

Deep to this layer of cells, within the cortex, are stellate thymic epithelial cells that are filled with keratinized tonofilament anchored together by desmosomes. This architectural arrangement gives rise to the cytoreticulum of the cortex. The cytoreticulum is analogous the collagenous reticular network observed in other lymphoid tissue. They both facilitate attachment of maturing lymphocytes and surrounding macrophages.

Cytoreticular cells are antigen presenting cells (APC) that express both class I and class II major histocompatibility complex (MHC I and MHC II) proteins that participate in the thymic education program. They also release cytokines that help to create the microenvironment necessary for thymic education.

An inner layer of squamous cortical thymic epithelial cells that are MHC I positive extends into the lobules of the thymus and forms the corticomedullary barrier. This functional partition separates the outer cortex from the inner medulla.

Medulla and cell types

Within the medulla, there is a second layer of squamous thymic epithelial cells that reinforces the corticomedullary barrier. The medulla also has a cytoreticulum that provides a similar microenvironment for resident dendritic cells, macrophages and more mature thymocytes.

Unique to the thymic medulla is a concentric congregation of thymic epithelial cells known as Hassall corpuscles. They are responsible for the release of cytokines that regulate dendritic activity. Other theories propose that they also remove apoptotic thymocytes. This is supported by the presence of cellular debris at the centre of the whorls that are particularly eosinophilic and partially keratinized. Furthermore, they program a special subset of thymocytes – the regulatory T-cells – that facilitate peripheral tolerance. Throughout the parenchyma of the thymus, as many as 50 thymocytes may be associated with large epithelial cells known as thymic nurse cells.

Other cell types

There are other non-thymic and non-lymphocytic cell lines that are located at different parts of the thymus based on their role within the gland. The myelogenous cell line includes dendritic cells, macrophages and monocytes. Fibroblasts are found mostly around the vessels as well as in the capsule and medulla. They are responsible for the production of collagenous material and other connective tissues that provide structural support of the gland. The monocytes are predominantly seen at the corticomedullary junction. They will differentiate into mature macrophages that are seen in both the cortex and medulla. However, they are more abundant in the cortex where they remove cellular debris.

The dendritic cells are also found at the corticomedullary junction as well as in the medulla. They are the antigen presenting cells that help with the thymocytes’ maturation. Large, circular cells with a centrally located nucleus and haphazardly arranged myofilament are found mostly in the medulla. These myoid cells are rarely seen, however.

Thymocytes are also referred to as T-lymphocytes or T-cells for short. They enter the thymus during intrauterine life. Premature T-cells or small thymocytes are primarily found in the cortex and are tightly packed between the cytoreticulum. In addition to the squamous thymic epithelial cells that occupy the subcapsular zone, there are also mitotic lymphoblasts and thymic stem cells residing in this area as well. Lymphoblasts are mononuclear, large and agranular. They differentiate into prolymphoblasts, which eventually form lymphocytes.

Review

Let’s review the general histology of the thymus:

• There are three subtypes of epithelial cells in the cortex:
  • Squamous thymic epithelial cells are important in the formation of the thymus blood barrier.
  • Stellate thymic epithelial cells that form the cytoreticulum.
  • Other squamous thymic epithelial cells that form the corticomedullary barrier.
• There are three subtypes of epithelial cells in the medulla:
  • The squamous thymic and stellate thymic cells of the medulla have similar functions to their counterparts in the cortex.
  • Hassall corpuscles.
• Other non-thymic, nonlymphoid  cells include:
  • Myeloid cells include monocytes, macrophages, and dendritic cells,
  • Fibroblasts facilitate the production of collagenous material,
  • The rarely observed myoid cells are believed to facilitate migration of lymphoid tissues across the thymus.

Characteristics and location

The bi-lobar thymus is a primary lymphatic endocrine gland found in the anterior mediastinum. It is enclosed by a capsular membrane that also fuses with the connective tissue that joins the left and right lobes. The organ is soft, and its shape is influenced by the surrounding structures. In relation to the size of the body, it is largest at birth, measuring up to 6 cm x 5 cm by 1 cm in length, width and thickness, and weighing approximately 10 to 15 grams.

The left lobe has been noted to be thicker than the right (11 mm to 9 mm, respectively). However, with advancing age, the thickness decreases to about 5.5 mm. Elongation of the organ is also seen throughout childhood. As the patient ages, the thymic composition changes and the lymphoid parenchyma is replaced by adipocytes. This is a characteristic feature of the thymus known as thymic involution or atrophy, and usually begins at the start of puberty.

Anatomical relations

The mediastinum is an intrathoracic space that is divided into superior and inferior portions. The inferior segment is further subdivided into anterior, middle and posterior compartments. The thymus gland extends across the superior as well as the anterior part of the inferior mediastinum. There are several key structures that are in close proximity to the thymus that can prove problematic if injured during a thymectomy.

The most superior poles of the thymus project above the suprasternal notch, with the left lobe being higher than the right lobe. In cases where the left lobe extends towards the inferior pole of the thyroid gland, it becomes attached to the lower pole of the thyroid gland via the thyrothymic ligament. The most caudal part of the organ extends as far as the fourth costochondral joint. At this level, the right lobe can be located to the right of the right lung and ascending aorta, with the superior vena cava seen posteriorly.

The structures anterior to the thymus in the superior mediastinum include the:

• investing neck fascia
• manubrium sterni
• the three most superior costochondral joints
• sternohyoid muscle
• sternothyroid muscle
• the internal thoracic arteries and veins

The phrenic nerves course along the anterolateral surface of the thymus and continue caudally toward the diaphragm. The parietal pleurae of the lungs constitute the lateral borders for the thymus. The anterior cardiac surface along with its great vessels, as well as the proximal trachea, is posteriorly related to the thymus.

Arterial supply

Arterial supply to the thymus is provided by derivatives of the inferior thyroid and internal thoracic vessels. The superior thyroid artery provides a branch to the thymus as well. The vessels will enter each lobe of the thymus through their respective interlobular septa. Subsequently, they will enter the thymic parenchyma via the corticomedullary junction. In other cases, the branches may directly pierce the thymus to enter the parenchyma.

Venous drainage

Venous tributaries leave the medial surface of each lobe and coalesce into common trunks. These trunks will eventually drain directly into the superior vena cava. More commonly, the trunks drain to the internal thoracic, inferior thyroid and left brachiocephalic veins.

Lymphatics

The thymus is unique in that it does not have afferent lymphatic vessels entering it. The efferent lymphatics emerge from the corticomedullary junction, as well as the medulla itself. The vessels traverse the extravascular compartment with the thymic vasculature. They then terminate in parasternal, tracheobronchial and brachiocephalic lymph nodes.

Innervation

The prenatal thymus is innervated by the vagus nerve prior to its descent into the mediastinum. Subsequently, after descending into the mediastinum, sympathetic branches of the stellate (cervicothoracic) ganglion enter the gland by way of the interlobular septa, alongside the vascular structures. Each lobe of the thymus is therefore pierced medially, laterally and dorsally. The derivatives of the sympathetic and vagus nerves ramify in the corticomedullary junction.

For more details about the anatomy, location and neurovasculature of the thymus, take a look below: