UST FACULTY OF MEDICINE AND SURGERY
Class of 2016
Histology
Second Shifting Reviewer
BLOOD
Consist of a variety of cells suspended in plasma
Plasma is composed of:
o 90% water
o 8% protein
Includes blood coagulation
proteins, albumin, globulin
Nearly all derived from
synthesis in the liver except
for immunoglobulins from
plasma cells
Exert colloidal osmotic
pressure within the
circulation
o 1% inorganic salts
o 0.5% lipids
o 0.1% sugar
Histological Methods
Romanowsky-type Staining Technique: gemsa,
wright, leishman
Staining characteristics:
o Basophilia: affinity for basc dye
methylene blue; for DNA nuclei and
RNA in the cytoplasm
o Azurophilia: affinity for purple azure
dyes; for lysosomes
o Eosinophilia: affinity for acidic dye
eosin; for haemoglobin
o Neutrophila: affinity for salmon
pink/lilac dye (not necessarily with
neutral pH); for neutrophil granules
Erythrocytes
Function in O2 and CO2 transport
Lifespan: 120 days
Fully differentiated form: outer plasma
membrane enclosing haemoglobin and some
enzymes
Staining:
o Stains pink due to haemoglobin, a
basic protein
o Pale staining at the center is
attributable to its biconcave shape
Biconcave disc shape
o 7.2 micrometers in diameter
o Provides 20-30% more surface area,
enhancing gas exchange
o Allows deformability, thus RBCs can
pass through small capillaries (3-4
micrometers in diameter)
o Determined by cytoskeleton and water
content
o Main determinant of lifespan
Plasma Membrane
o Lipid bi-layer
o Blood group substances on the surface
o Spectrin: main skeletal protein
Metabolism
o Energy derived from anaerobic
metabolism of glucose because of the
absence of mitochondria
o Energy needed to maintain electrolyte
gradients
o Energy also needed to maintain iron in
divalent form and sulfhydryl groups in
reduced, active form
Reticulocytes
o Immature RBCs that still retain residual
nuclear material
o Released into the circulation from the
bone marrow
o Final maturation into erythrocytes
occur 24-48 hours after release
o Supravital staining is used for
detection which forms a blue-stained
reticular precipitate
o Reticulocyte percentage is a useful
indicator of erythropoiesis; high levels
are present when there is increased
RBC production
Granulocytes
With prominent cytoplasmic granules
All have single multi-lobed nucleus, and thus
assumes many morphological shapes
Also called polymorphonuclear leukocytes, with
neutrophils as the ones exhibiting the greatest
polymorphism
Myeloid cells, with exclusive origin in the bone
marrow
Neutrophils
40-75% of circulating leukocytes
Principal function for the inflammatory
response; degenerates after engulfing bacteria
and do not re-enter the circulation
Highly motile through pseudopodia and exhibit
crawling movement
Highly lobulated: usually 5 lobes
Highly condense chromatin indicating latency
Anaerobic mode of metabolism
Neutrophilia: increased neutrophil count in
acute inflammation, bacterial infection
Drumstick Chromosome D
o Small drumstick appendage in the
neutrophils of females
By: Sachi Estreller |Section B 1
UST FACULTY OF MEDICINE AND SURGERY
Class of 2016
o Condensed, quiescent X chromosome
o Also called the Barr Body
Granules
o Primary Azurophilic Granules
Stain purple, spherical
First to appear during
differentiation
Contain microbicidal
myeloperoxidase and
neutrophil defensins
Contribute to killing and
degradation of MOs
o Secondary Granules
Most numerous, rod-like
Contain laysozyme,
gelatinase, collagenase,
lactoferrin, cathelicidins,
transcobalamin-1
o Gelatinase/ Tertiary Granules
Secrete enzymes for tissue
degradation
Contain gelatinase which
breaks down ECM and insert
adhesion molecules into cell
membrane
o Secretory Granules
Reservoir for membrane-
associated receptors needed
for neutrophil function
Also contain alkaline
phosphatase and albumin
Neutrophil Functon
o Chemotaxins
Attract neutrophils when
released by damaged tssue
or during antibody response
Stimulate fusion of secretory
granules to cell surface
o Opsonization
Coating of organisms with
antibodies
Enhances phagocytic activity
o Phagosome Formation
First step in phagocytosis
Organism surrounded by
pseudopodia which then fuse
and form a phagosome
Phagosome fuses with
primary granules
o Degranulation
Secretion of granule contents
into extracellular
environment
Occurs first in secondary
gelatinase specific
granules
Eosinophils
1-6% of circulating leukocytes
With bilobed nucleus, often obscured by
cytoplasmic granules
Exhibit diurnal variation, being greatest in the
morning and least in the afternoon
Circulate for 8-12h then emigrate from
capillaries to tissues
Chemotaxis
o Release of eotaxin, IL-5 and eosinophil
chemotactic factor of anaphylaxis
o Responsible for recruitment of
eosinophils to tissues, especially the
spleen, lymph nodes, and GI tract
Granules
o With large ovoid eosinophilic specific
granules, containing an elongated
crystalloid
o Crystalloid consists of major basic
protein, hydrolytic lysosomal enzymes,
and eosinophil peroxidise
o Smaller granules contain aryl
sulphatase and acid phosphatase
Eosinophil Function
o Central role in induction and
maintenance of nflammatory
responses due to allergy
o Also important in defense against
parasites
o Modulate local immune responses by
producing tumor necrosis factor,
transforming growth factor, GM-CSF,
and IL-4,5,8
o All have receptors forIgE; IgG and
complement receptors are also
present
o Minor role as antigen-presenting cells
Basophils
Least common leukocyte, <1% of circulating
WBCs
With bilobed nucleus, obscured by cytoplasmic
granules
Many structural and functional similarities with
mast cells
Formed in the bone marrow, stimulated by IL-3
Granules
o With large basophilic specific granules
o Exhibits metachromasia: binds toluene
blue and stains red
o Membrane-bound, oval/round, flled
with packed electron dense material
o Granules contain proteoglycans
consisting of sulphated GAGs (heparin
and chondroitin sulphate), which
accounts for metachromasia
By: Sachi Estreller |Section B 2
UST FACULTY OF MEDICINE AND SURGERY
Class of 2016

o Also contain histamine, tryptase, slow
reacting substance and eosinophil
chemotactic factor of anaphylaxis
Basophilic Function
o Effector cells in allergic disorders
mediated by IgE and T helper cells; also
in the immune response to parasites
o High affinity membrane receptors
specific for IgE
o Immediate Hypersensitivity
(Anaphylactoid) Reaction
Release of histamine and
other vasoactive mediators
during degranulation
Allergic rhinitis, asthma,
urticaria, anaphylactic shock
o Cutaneous Basophil Hypersensitivity
Cell-mediated
hypersensitivity
Degranulation is slow
Basophils serve as infiltrating
cells in allergic dermatitis
and skin allograft rejection
Agranulocytes
Lymphocytes
Smallest cells among WBCs
Second most common leukocyte; 20-50% of
circulating WBCs
With round nucleus and small amount of pale,
basophilic, non-granular cytoplasm
o Large lymphocyte: cytoplasm visible,
activated form (B and T lymphocytes)
o Small lymphocyte: cytoplasm sparse,
inactivated form
Plasma membrane exhibits small cytoplasmic
projections which appear as short microvilli in
EM
Monocytes
Largest among WBCs
2-10% of circulating leukocytes
Circulate in blood 3-4 days before emigrating to
tissues
Motile phagocytic cells that are precursors of
macrophages
With large, eccentrically-placed nucleus; often
with a deep indentation giving it a horse-shoe
appearance
With numerous lysosomal granules and
cytoplasmic vacuoles
May produce energy using aerobic or anaerobic
means
Granules
o Contain myeloperoxidase, acid
phosphatase, elastase, cathepsin-G,
tumor necrosis factor, plasma proteins,
membrane adhesion proteins
Monocyte-Macrophage System
o Monocytes migrate to peripheral
tissues where they assume the role of
macrophages
o Includes kupffer cells of the liver,
microglia of CNS, langerhans cells of
skin, alveolar macrophages in lung, and
osteoclasts of bone
Monocyte Function
o Has capacity for phagocytosis
o Monocytes that migrate to tissue
proliferate as macrophages when
stimulated by growth factors
o Macrophages become active when
exposed to interferon-gamma
produced by T lymphocytes
o Macrophages process and present
antigen to the immune system and
secrete cytokines for tissue repair
Platelets
Small, non-nucleated; round/oval biconcave
discs
Function for platelet plug formation and clot
formation, coagulation, and vascular repair
Granules
o With purple-stained and granular
cytoplasm
o 20% of platelet volume are granules
o Alpha Granules
Contain membrane adhesion
molecules and coagulation
factors
o Dense Granules
Contain serotonin and ADP
Cytoskeleton
o Well-developed
o Dense Tubular System
Intracellular store of calcium
released into cytosol of
platelet
o Marginal band of microtubules
Depolymerise during platelet
aggregation
Rich in actin and myosin
involved in clot retraction
Surface-connected Canalicular System
o Interconnected membrane channels in
continuity with external environment
o Alpha granules fuse with this for
secretion of contents

By: Sachi Estreller |Section B 3

UST FACULTY OF MEDICINE AND SURGERY
Class of 2016
HEMOPOIESIS
Process by which mature blood cells develop
from their precursors
All blood cell types are derived from
Multipotential/ Pluripotential Stem Cell (divide
slowly) that differentiate into 5 types of
Unipotential Stem Cells (divide rapidly) which
are committed to a different developmental
lineage
Rate of division is modulated by hormones:
poietins, colony stimulating factors, interleukins
Development
Early Embryo
Primitive blood cells arise from the yolk sac, and
later in the lver
3-7 months
Spleen is the major site of hemopoiesis
By 7 months, erythropoiesis established in the
bone marrow
4-5 months
Granulocyte and platelet formation begins in the
bone marrow
Birth
Hemopoiesis almost exclusive to the bone
marrow although liver and spleen may still
participate in production as needed
Adult
Hemopoiesis in the bone marrow of the skull,
ribs, sternum, vertebral column, pelvs, and
femur
Bone Marrow
Consists of vascular sinuses and highly branched
fibroblasts with interstices packed with
hematopoietic cells
Major site of removal of aged and defective RBCs
Site of B lymphocyte differentiation, and contain
antibody-secreting plasma cells
Structure
Sinuses are of the continuous endothelium type
with an underlying discontinuous basement
membrane
Sinus endothelial cells
o Control passage of materials in and out
of the compartment
o Active in endocytosis
Stromal cells
o Synthesize reticulin for a supporting
meshwork for the bone marrow cells
o Also give rise to fat cells
Macrophages
o Involved n phagocytosis of cell debris
and cells that underwent programmed
cell death and apoptosis
Collagen Fibers, Laminin and Fibronectin
o Bind hemopoietic cells to the marrow
stroma
Ground Substance Proteoglycans
o Bind growth factors and other
modulators of hemopoiesis
Red Marrow
Active site for hemopoiesis
Color due to the predominance of maturing RBCs
Two main components:
o Marrow Stromal Cells in a reticulin
framework
o Interconnected blood sinusoids
Yellow Marrow
May be reactivated if the need arises for
increased hemopoiesis
RBC Production
Main features during differentiation:
o Decreased cell size and nuclear
extrusion
o Loss of organelles
o Increase in cytoplasmic Hgb
Process takes about 1 week, from stem cell to
erythrocyte
Rate of production is controlled by
erythropoietin (from kidney), and availability to
ron, folic acid, vitamin B12, and protein
precursors
Erythroblastic Island
Unit of erythropoiesis within the bone marrow
Consists of one or two macrophages surrounded
by erythrocyte progenitors
Proerythroblast
First recognizable erythrocyte precursor
Contain numerous cytoplasmic organelles but no
haemoglobin
Has granular nucleus containing one or more
nucleoli
Strongly basophilic due to high RNA content and
lack of Hgb
Early Normoblast
Basophilic erythroblast
Hgb synthesis and organelle degeneration begins
Cell division ceases, nucleus condenses
By: Sachi Estreller |Section B 4
UST FACULTY OF MEDICINE AND SURGERY
Class of 2016

There is a transition from basophilia o Mature megakaryocytes pass to

polychromasia (exhbit both baso-and pulmonary vascular bed where they
eosinophilia) eosinophilia/orthochromasia fragment
Platelet release depends on activation of
Late Normoblast proteases called caspases
Orthochromatic erythroblast
Nucleus is highly condensed and is extruded Megakaryoblast
Undergoes as many as 7 reduplications of
Reticulocyte Erythrocyte nuclear and cytoplasmic contents without cell
division
Granulocyte Production Reduplications accompanies by increasing
Myeloblast nuclear lobulation and cell size
Earliest recognizable stage in granulopoiesis
Megakaryocytes
Promyelocytes The largest cells in the bone marrow
Have developed azurophilic (primary) granules Responsible for platelet production
which later develop to specific granules Cytoplasm is filled with basophilic granules
Have pseudopodia or cytoplasmic extensions
Myelocyte Metamyelocyte Mature Granulocyte from which platelets will form
Have developed specific granules Polyploid and undergoes endomtosis
Nucleus becomes increasingly segmented as the o Process or nuclear replication without
cell progresses from this stage to later stages of cytokinesis
metamyelocyte and mature granulocyte o Result in a large, irregular, multilobar
Immediate precursors of mature granulocytes nucleus containing dispersed
have irregular horseshoe or ring-shaped nucles chromatin with no nucleoli
called stab cells or band forms Three Cytoplasmic Zones
o Perinuclear Zone
Lymphocyte Production Contains golgi apparatus,
RER and SER, developing
Main characteristic feature is the decrease in cell
granules, centrioles and
size
spindle tubules
May occur outside the bone marrow in response
Remain attached to nucleus
to specific immunologic stimulation
o Intermediate Zone
Undergo lymphoblast and prolymphocyte stages
Contain the Demarcation
Membrane System, an
Monocyte Production extensive system of
Main characteristic feature is decrease in cell interconnected tubules
size and progressive indentation of the nucleus This system acts as a
Undergo monoblast and promonocyte stages reservoir of membrane to
Three cell divisions occur before mature allow extension of
monocyte stage is reached pseudopodia
There is no reserve pool for monocytes o Outer Marginal Zone
Spend an average of 3-4 days in the circulation Contain cytoskeletal
before migrating to tissues, after which they filaments traversed by
cannot re-enter the circulation membranes connecting with
the DMS
Platelet Production
Platelets form from the fragmentation of the
megakaryocyte pseudopodia
Platelets are released by:
o Pseudopodia of megakaryocytes,
called proplatelets, located in the
sinusoidal lumens fragement and enter
circulation

By: Sachi Estreller |Section B 5

UST FACULTY OF MEDICINE AND SURGERY
Class of 2016

MUSCLE o Muscle fibers that result after

Generate motile forces through contraction regeneration have their nuclei a the
Motile forces brought about by interaction of center rather than at the periphery
actin and myosin Structure
Composed of extremely elongated,
multinucleate contractile cells, termed as muscle
Single-Cell Contractile Units
fibers
Myoepithelial Cells
Appears as unbranched cylindrical cells with
Important component of secretory glands
flattened nuclei at the periphery
Function to expel secretions from glandular acini
Muscle Fibers
o Bound together by collagenous
Pericytes
supporting tissue called endomysium,
Smooth muscle-like cells surrounding blood
which is continuous with the
vessels
perimysium
o Capillaries are found in the
Myofibroblasts
endomysium
Have contractile role in addition to secreting
Fasciculi
collagen
o Grouped muscle fibers surrounded by
Dominant cell type when tissues undergo repair
loose collagenous tissue called
after damage
perimysium
o Arteries may traverse the perimysium
Multi-Cellular Contractile Units o Muscles responsible for fine
Skeletal Muscle movements have small fasciculi and a
Responsible for movement of the skeleton and greater proportion of perimysial tissue
organs o Muscles responsible for gross
Voluntary, striated movements have large fasciculi and
lesser proportion of perimysial tissue
Smooth Muscle Whole Muscle Mass
Forms the muscular component of viscera o Surrounded by a dense collagenous
structures such as blood vessels, GI tract, uterus, sheath called epimysium
and urinary bladder o Large blood vessels and nerves enter
Involuntary, unstriated the epimysium before branching

Cardiac Muscle Bands and Striations

Characteristics intermediate between skeletal Striations are brought about by the regular
and smooth muscle alternation of contractile proteins
Provides continuous, rhythmic contractility of Sliding Filament Theory
the heart o Using energy from ATP, thick and thin
Involuntary, striated filaments slide over one another,
causing shortening of the sarcomere
Skeletal Muscle o A band remains constant in width
Embryogenesis during contraction
Myoblasts o I and H bands narrow during
o Mesenchymal cells in each myotome contraction
differentiate into these mononuclear Actin Filament
skeletal muscle precursors o Thin filaments, attached to a disc-like
o Proliferate by mitosis zone represented by the Z line
Myotubes Myosin Filament
o Elongated multi-nuclear cells formed o Thick filaments, attached to a disc-like
from fused myoblasts zone represented by the M line
Satellite Cells I Bands
o Stem cells that remain in the adult o Light, isotropic in polarised light
o Enter mtosis after muscle damage and A Bands
fuse to form differentiated muscle o Dark, anisotropic bands
fibers

By: Sachi Estreller |Section B 6

UST FACULTY OF MEDICINE AND SURGERY
Class of 2016
o Bisected by a lighter H band, which is
further bisected by a more dense M
band
Z Bands
o Fine dark lines that bisect the light I
bands
o Most electron dense and divides each
myofibril into contractile units called
sarcomeres
Innervation and the Conducting System for Contractile
Stimuli
Contraction is controlled by large motor nerves
that branch to supply a group of muscles,
termed as a motor unit
Neuromuscular Spindles
o Specialized stretch receptors
The T System
o System of tubular extensions of the
sarcolemma that extends transversely
into the muscle cell to surround each
myofibril at the region of the junction
of the A and I bands
o Lumen is continuous with extracellular
space
Sarcoplasmic Reticulum
o Derived from SER
o On each side of a T tubule, the SR
exhibits a flattened cisternal
arrangement called the terminal
cisternae
Tubular Triad
o The triad formed by the T tubule and
the terminal cisternae are located near
the junction of the I and A bands on
each sarcomere
o Enables rapid dissemination of the
depolarisation of the sarcolemma of
muscle fibers
o Promotes release of calcium from
sarcoplasmic reticulum to sarcoplasm,
which activates sliding filament
mechanism
o Conducting system of slow twitch
fibers are more regular than fast twitch
fibers
Types of Muscle Fibers
Type of metabolism of each fiber is determined
by the frequency of its motor nerve supply
Type I Muscle Fibers
o Small, slow twitch
o Contain abundant mitochondria, rely
on aerobic metabolism
o Large content of myoglobin, which
accounts for its red color
Type I Muscle Fibers
o Large, fast twitch
o Contain few mitochondria and
myoglobin
o Rich in glycogen and glycolytic
enzymes, rely on anaerobic
metabolism
o Glycogen content account for its white
color
Smooth Muscle
Specialized for continuous contractions of
relatively low force, producing diffuse
movements resulting in contraction of whole
muscle mass rather than individual motor units
Influenced by ANS, hormones, and local
metabolites
Structure
Cells are relatively small with a single elongated
and centrally-located nucleus
Fibers are elongated, spindle-shaped cells with
tapered ends that are occasionally bifurcated
Fibers are bound together in irregular branching
fasciculi, which are the functional contractile
units
Arrangement is typically with the outer
longitudinal smooth muscle layer applied to an
inner circular smooth muscle layer
Bundles of contractile proteins criss-cross the
cell
Caveolae
o Flask-shaped invaginations of the
plasma membrane, which are
analogous to sarcoplasmic reticulum of
skeletal muscle
Focal Adhesion Densities
o Attachment junctions for myosin and
actin filaments at the cell membrane
Focal Densities
o Attachment for myosin and actin
filaments in the cytoplasm
Contraction
Mechanism of Contraction
o Myosin only binds to actin if one chain
is phosphorylated
o On membrane excitation, calcium ions
are released into cytoplasm and bind
to calmodulin
o The calcium-calmodulin complex
activates myosin light-chain kinase,
which phosphorylates myosin, hence
permitting binding
o Smooth muscle is able to maintain high
force of contraction for very little ATP
By: Sachi Estreller |Section B 7
UST FACULTY OF MEDICINE AND SURGERY
Class of 2016

Unitary/ Tonic Smooth Muscles Purkinje System

o Cells tend to generate their own low o System of highly modified cardiac
level of rhythmic contraction, which muscle cells constitutes the pacemaker
may also be stimulated by stretch and regions of the heart, coordinating
transmitted from cell to cell via gap contraction of the myocardium
junctions
o Richly innervated by ANS, which is Contraction
modulatory rather than stimulatory Strong and utilize high energy; continuous and
o Characterized by slow contraction, no initiated by inherent mechanisms and
APs and low content of fast myosin modulated by external autonomic and hormonal
o Found in gut, ureter, fallopian tube stimuli
Phasic Smooth Muscles Conduction of stimuli is similar to skeletal muscle
o Characterized by rapid contracton but T tubules ramify throughout the cardiac
associated with AP muscle cytoplasm at the Z lines
o Innervated by ANS, which precisely There is a slow leak of calcium ions into the
controls contraction cytoplasm after recovery from preceding
o Found in the iris of the eye, vas contraction, which causes a succession of
deferens, some large arteries automatic contractions independent of external
stimuli
Cardiac Muscle
Structure
Long cylindrical cells with one or two centrally-
located nuclei
Ends of the fibers branch out and connect with
other branches, thus being described as a
syncytium
Sarcomeres are arranged into a branching
myofibrillar network continuous in three
dimensions throughout the cytoplasm
Intercalated Discs
o Specialized intercellular junctions
o Provide points of anchorage for
myofibrils and permit rapid spread of
contractile stimuli
o Always conincide with the Z lines
o Three types of contact:
Fascia Adherens
Resembles zonula
adherens but more
extensive and less
regular
Actin filaments at
the ends of the
terminal
sarcomeres insert
into this and
transmit
contractile forces
Desmosomes
Provide anchorage
for intermediate
filaments
Gap Junctions
Sites of low
electrical
resistance

By: Sachi Estreller |Section B 8

UST FACULTY OF MEDICINE AND SURGERY
Class of 2016
NERVOUS TISSUES
Merely consist of variations in the arrangements
of neurons and their supporting tissues
The Neuron
Basic Structure
Cell Body
o Contains nucleus
o In general, located n the CNS except
for the cell bodies of most prmary
sensory neurons and terminal effector
neurons of the ANS
o Cytoplasm is called the perikaryon
Axon
o Also called nerve fibers
o Each neuron has a sngle axon arsing
from a the axon hillock of the cell body
o Terminates to other neurons or
effector organs through small branches
which end in terminal boutons
o Convey impulses away from cell body
Dendrites
o Convey impulses towards the cell body
Basic Neuron Types
Multipolar Neuron
o Numerous dendrites project from the
cell body
o Intermediate, integratory, and motor
neurons
Bipolar Neurons
o Single dendrite
o Receptor neurons for smell, sight, and
balance
Pseudo-Unipolar Neurons
o Single dendrite and axon arise from a
common stem of the cell body
Ultrastructure
SER is not a prominent feature; prominent
features include tubules, cisternae, and vesicles
Perikaryon
o Site of neurotransmitter synthesis,
after which neurotransmitters are
transported along the axon
Nucleus
o Round or ovoid and usually centrally-
located within the perikaryon
o Chromatin is completely dispersed and
the nucleolus is conspicuous
Nissl Bodies
o Aggregations of RER
o RER extends into the dendrites but not
into the axon
Mitochondria
o Numerous and rod-like in the
perikaryon
o Slender and elongated in the axon
Neurofilaments
o Intermediate filaments arranged in
parallel bundles with microtubules
throughout the perikaryon and along
the axon and dendrites
Myelinated and Non-Myelinated Nerve Fibers
The rate of conduction of APs is proportional to
the diameter of the axon
Myelination increases axon conduction velocity
Schwann Cells
Provide structural and metabolic support to the
neuron
Responsible for producing myelin sheath for
neurons in the PNS
CNS counterpart are called oligodendrocytes
o In the CNS, the oligodendrocytes form
multiple myelin internodes and
contribute to the ensheathment of as
many as 50 axons
Mesaxon
o Zone of apposition of the Schwann cell
Internode
o Single segment of myelin produced by
each Schwann cell
Non-Myelinated Nerve Fibers
Small diameter axons that are simply enveloped
by the cytoplasm of Schwann cells
More than one axon may occupy a single
channel within the Schwann cell
Myelinated Nerve Fibers
Large diameter axons wrapped by concentric
layers of Schwann Cell plasma membrane that
forms a myelin sheath
A single axon is enveloped in concentric layers of
Schwann cell cytoplasm and plasma membrane
Later on, the cytoplasm is excluded and the
remaining inner leaflets of plasma membrane
form the myelin sheath
Myelin
o Substantial lipid content insulate the
axon, prevention ion fluxes across the
axonal membrane except at the nodes
of ranvier
o 2 parts:
Major dense lines: from
fuson of cytoplasmic leaflets
Intraperiod lines: closely
apposed external membrane
leaflets
By: Sachi Estreller |Section B 9
UST FACULTY OF MEDICINE AND SURGERY
Class of 2016
o Nodes of Ranvier
Short intervals in the axon
that are not enclosed by
myelin
Sites for salutatory
conduction
o Schmidt-Lanterman Incisures
Synapses and Neuromuscular Junctions
Synapses
Specialized intercellular junctions which allow
communication by linking neurons
For a given synapse, conduction of an impulse is
unidirectional but response may be excitatory or
inhibitory
Types
o Axo-dendritic
o Axo-somatic
o Axo-axonic
Structure
o Terminal Bouton
Termination of an axon
Not myelinated
Contain mitochondria and
synaptic vesicles with
neurotransmitters
Vesicles are manufactured in
the cell body or n the bouton
Protein synthesis may also
occur in the bouton
o Synaptic Cleft
Intercellular gap that
separates terminal bouton
from the plasma membrane
of other neuron or effector
cell
o Presynaptic Membrane
Site where synaptic vesicles
aggregate and dock upon the
arrival of an AP
Contents of vesicles are
released into the synaptic
cleft through exocytosis
o Postsynaptic Membrane
Contain receptors for
neurotransmitters
Neuromuscular Junctions
Also called motor end plates
Intercellular junctions that link neurons and
muscle fibers
Have similar structure with synapses with a few
additions:
o One motor neuron may innervate
numerous motor fibers, forming a
motor unit
o External lamina of the Schwann cell
merges with the muscle fiber and the
endoneurium becomes continuous
with the endomysium
o Secondary Synaptic Cleft
Formed by deep folding of
the postsynaptic membrane
o Sole plate
Recess in the muscle cell
surface occupied by the
motor end plate
Covered by an extension of
the cytoplasm of a Schwann
cell
Contains mitochondria and
an aggregation of muscle cell
nuclei
Peripheral Nervous Tissues
Peripheral Nerve
Nerve fibers are ensheathed by loose vascular
supporting tissue called endoneurium
Nerve fascicles are surrounded by collagenous
tissue invested by a layer of flat epithelial cells
called perimysium
Bundles of fasciles are further ensheathed by
epineurium
Ganglia
Ganglia are discrete aggregations of neuron cell
bodies outside the CNS
Spinal Ganglion
o Lie on the posterior roots of the spinal
cord as they pass through
intervertebral foramina
o Contain cell bodies of primary sensory
neurons which are pseudo-unipolar
o Nerve cell bodies are surrounded by
numerous satellite cells
Sympathetic Ganglion
o Multipolar ganglion cells, more widely
spaced
o Eccentrically located nuclei with
lpofuscin in the cytoplasm
o Satellite cells smaller in number and
more irregularly placed
Parasympathetic Ganglion
o Cell bodies located near or at the
effector organs
By: Sachi Estreller |Section B 10
UST FACULTY OF MEDICINE AND SURGERY
Class of 2016
Central Nervous Tissues
Neuroglia
Mass of support cells in which CNS neurons and
their processes are embedded
Comprise all non-neural cells of the CNS
Highly branched cells that occupy spaces
between neurons; provide structural and
metabolic support
Oligodendrocytes
o CNS equivalent of Schwann cells
o Responsible for formation of myelin
o Can contribute to myelination of up to
50 axons
o Myelin sheath formation in the
embryo occurs at 4 months
Astrocytes
o Most numerous glial cells in gray
matter
o Highly branched cells that pack the
interstices between neurons and their
processes
o Glial Fibrillary Acidic Protein: protein of
intermediate filaments characteristic
of astrocytes
o Functions
Mediate exchange of
metabolites between
neurons and the vascular
system
Play a role in repair of CNS
tissue after injury
o Types
Fibrous Astrocytes: in white
matter; few straight
cytoplasmic processes
Protoplasmic Astrocytes: in
gray matter; numerous short
branched cytoplasmic
processes
o Perivascular Feet
Processes of astrocytes that
terminate in the basement
membrane of capillaries
Form part of the BBB
o Glia Limitans
Invest in the layer between
CNS and the pia mater
forming the Glia Limitans
Microglia
o CNS representatives of the monocyte-
macrophage system
o With elongated nuclei and fine, highly
branched processes
o Function for defence and immunologic
mechanisms
In response to tissue
damage, microglia transform
into large amoeboid
phagocytic cells
Stained by CD68,which also
stains macrophages
Ependymal Cells
o Specialized epithelium which lines the
ventricles and spinal canal
o Cuboidal or low columnar in shape
o Do not rest on a basement membrane,
but the bases instead taper and form
fine branches which ramify into an
underlying layer of processes derived
from astrocytes
o Microvilli and cilia may be present at
the luminal surface
Gray Matter
Contains neuron cell bodies
Oligodendrocytes tend to aggregate around
neuron cell bodies
Neuropil
o Feltwork of axons and dendrites arising
from and converging upon the neurons
that surround the nuclei of both
neurons and neuroglia
o Most devoid of myelin, exhibits
eosinophilia
White Matter
Consist of tracts of nerve fibers
Lipids in the myelin sheaths of axons accounts
for its white appearance
Choroid Plexus
Vascular structure arising from the wall of each
of the four ventricles and responsible for the
production of CSF
Consists of blood vessels that run in fronds
composed of collagenous tissue covered by
cuboidal or columnar epithelium
Capillaries and vessels are large, thin-walled,
sometimes fenestrated
Long, bulbous microvill project from the luminal
surfaces of the epithelial cells
Cytoplasm contains numerous mitochondria
CSF
o produced at constant rate and
reabsorbed from subarachnoid space
into superior sagittal venous sinus via
arachnoid villi
o Serves as shock absorber
o Involves active secretion of sodium
ions by choroid epithelial cells into the
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CSF, followed by passive movement of
water from local vessels
Meninges
Three layers of supporting tissue that invest the
brain and spinal cord: Pia, Arachnoid, and Dura
Mater
Pia Mater
o Covers the surface of nervous tissue
o Contain collagen fibers, fine elastin
fibers, and fibroblasts
o Separated from underlying astrocytes
by a basement membrane
Arachnoid Mater
o Thicker, fibrous layer
o Structurally continuous with the pia
mater (collectively called
leptomeninges)
Subarachnoid Space
o Space between the pia mater and the
arachnoid mater that forms large
cisterns
o Connected to the ventricular system
and contains CSF
o Lined by flattened arachnoidal cells
o Arteries and veins pass through this
space, invested by subarachnoid
mesothelium
Perivascular Space
o Separated from subarachnoid space by
the epithelium of the pa that blends
with the adventitia of vessels
o Located between the penetrating
vessels and the pia
Dura Mater
o Dense fibroelastic layer external to the
arachnoid mater
o Merges with the periosteum of the
skull
o Suspended from the periosteum of the
spinal canal by denticulate ligaments
Subdural Space
o Space between the arachnoid and the
dura mater
Epidural Space
o Intervening space in the outer surface
of dura mater
o Filled with loose adipose tissue and
extensive venous plexus
The Blood Brain Barrier
CNS capillaries are impermeable to certain
plasma constituents
Junctions between endothelial cells exhibit little
or no pinocytosis; not fenestrated and are bound
together by zonula occludens
Maintenance of barrier-type endothelium is
under the control of astrocyte foot processes
Capillaries of the choroid plexus, pituitary and
pineal gland, and vomiting center of the
hypothalamus are devoid of this barrier
Sensory Receptors
Nerve endings or specialized cells that convert
stimuli into afferent nerve impulses
Functional Classification
Exteroceptors
o Respond to stimuli from outside the
body
o Receptors for touch, light pressure,
deep pressure, cutaneous pain,
temperature, smell, taste, sight, and
hearing
Proprioceptors
o Provide conscious and unconscious
information about orientation, skeletal
position, tension and movement
o Vestibular apparatus of the ear,
tendon stretch receptors, and
neuromuscular spindles
Interoceptors
o Respond to stimuli from viscera
o Chemoreceptors of blood, vascular
baroreceptors, receptors for visceral
pain, hunger, thirst, etc.
Morphological Classification
Simple Receptors
o Merely free, branched or unbranched
nerve endings
o Rarely visible under light microscope
Compound Receptors
o Involve organization of non-neural
tissues to complement the function of
the neural receptors
Free Nerve Endings
Simplest form of sensory receptor
For unsophisticated sensory modalities such as
pain, temperature, and touch
Small diameter afferent fibers with slow rate of
conduction
Some myelinated, but the nerve endings are
unmyelinated
In the skin:
o Located n dermo-epidermal junction
o Some exhibit a terminal expansion
associated with Merkel cells which are
non-neuronal cells scattered in the
basal layers of the epidermis
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o Merkel cells contain vesicles similar to Nuclear Bag fibers

synapses; thought to be responsible Central nuclear
for touch sensations area dilated

Meissners Corpuscles Central Nervous System

Small, encapsulated, sensory receptors found in Terminologies
the dermis of the skin (dermal papillae) in the Cortex
fingertips, soles of feet, nipples, eyelids, lips, o Extensive, diffuse arrangement of
genitalia neurons over brain surface
Involved in reception of light discriminatory Nucleus
touch o Arrangement of neuronal cells as a
Degree of discrimination dependent on discrete unit
proximity of receptors to one another Column
o Arrangement of neuronal cells running
Pacinian Corpuscules along spinal cord
Large, encapsulated sensory receptors Tract or Fascicle
responsive to pressure or coarse touch, vibration o Bundle of axons running in white
and tension matter
Found in deeper layers of skin, ligaments and Gyri
joint capsules, mesenteries, some viscera o Crests of folds in the cerebral cortex
o Folia: counterpart in cerebellum
Other Simple Mechanoreceptors Sulci
Ruffini Corpuscles o Clefts between gyri
o Robust, spindle-shaped structures
found in soles of feet Spinal Cord
Krause End Bulbs Gray Matter
o Delicate receptors in the lining of the o More extensive in cervcal and lumbar
oropharynx and conjunctiva of the eye regions corresponding to sensory and
motor innervations
Neuromuscular Spindle o Central Canal
Stretch receptor organs within skeletal muscles Lies in its central commissure
responsible for regulation of muscle tone via the and is line by ependymal
spinal stretch reflex cells and contains CSF
Lie parallel to muscle fibers embedded in o Ventral Horns
endomysium or perimysium Area of central gray matter
Contains up to 10 intrafusal fibers containing cell bodies of
Intrafusal Fibers large lower motor neurons
o Have central non-striated area in o Dorsal Horns
which their nuclei are concentrated Area of central gray matter
o Two types of sensory fibers: containing cell bodies of
Annulospiral endings: small second order sensory
branched nonmyelinated neurons that relay sensory
endings of large myelinated information from primary
sensory fibers located in afferent neurons for
nonstriated areas of temperature and pain whose
intrafusal fibers cell bodies lie in the dorsal
Flower-spray endings: root ganglia
smaller myelinated sensory o Lateral Horns
fibers located in striated Area of central gray matter
portions of intrafusal fibers, containing cell bodies of
o Two types of intrafusal fibers preganglionic, sympathetic
Nuclear Chain Fibers efferent neurons
No dilation of Found in the thoracic and
nuclear area and upper lumbar regions
nuclei arranged in
a single row

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White Matter
o Ascending tracts of sensory fibers
and descending motor tracts
o Volume increases progressively
from sacral to cervical regions
o Dorsal Columns
Triangular area of white
matter between the
dorsal horns
Convey fibers for senses
of vibration, Pons
proprioception, and
discriminatory touch
where they synapse
with gracile and cuneate
nuclei
In the cervical region,
each column is divided
into fasciculus gracilis
(lower limbs) and
fasciculus cuneatus
(upper limbs)
o Ventrolateral White Matter
Lateral spinothalamic
tract, ventral
spinothalamic tract,
spinocerebellar tracts,
corticospinal tracts
Medulla Oblongata
Closed Medulla
o Lower half of the medulla where
narrow central canal that
continues to the spinal cord is
present
o Pyramids
Formed by axons
originating in the motor
cortex descending Cerebellum
through the inner
capsule
Deccussation of the
pyramids
Open Medulla
o Upper half of the medulla where
the fourth ventricle is present
o Inferior Olivary Nucleus
most prominent feature
Peculiar convoluted
appearance
Together with medial
and dorsal accessory
olivary nuclei form the
inferior olivary complex
Inferior olivary complex
relays central and spinal
afferent stimuli to
cerebellar cortex
Nuclei Present
o Hypoglossal Nucleus
o Spinal Nucleus of the Trigeminal Tract
o Nucleus Gracilis and Cuneatus
Pass upwards to the
thalamus via the medial
lemniscus
Basal Pons
o Bulky ventral region
o Consists of criss-crossed bundles of
longitudinal and transverse fibers
between which lie collections of
neuron cell bodies known as pontine
nuclei
o Two types of descending fibers
Axons from motor cortex
that descend and form the
pyramids
Axons that synapse in the
pontine nuclei then pass in
the transverse bundles and
enter the cerebellum
through the middle
peduncles
Tegmental Pons
o Smaller dorsal region
o Contains the ascending spinothalamic
tracts and nuclei of CN 5, 6, 7
o Contains the medial lemniscus, which
is the upwards continuaton of the
proprioceptive, vibration, and fine
touch pathways of the gracile and
cuneate nuclei
Coordinates muscle activity and maintains
posture and equilibrium
Consist of cortex of gray matter with central core
of white matter containing four pairs of nuclei
Afferent and efferent fibers pass through the
inferior, middle, and superior peduncles
Cerebellar Cortex
o Has deeply convoluted folds called
folia, and consists of three layers:
o Molecular Layer
Contain few neurons and
large numbers of
unmyelinated nerve fibers
Contain stellate cells and
basket cells
o Granular Cell Layer
Extremely cellular
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Contain golgi cells in the o Fusiform Cells

superficial part Spindle-shaped cells oriented
o Purkinje Cells at right angles to the surface
Single layer of huge neurons of the cortex
whose axons extend down to Axon arises from side of the
the granular layer and cell body
dendrites branch into o Horizontal Cells of Cajal
molecular layer Small and spindle-shaped but
oriented parallel to the
Substantia Nigra surface of the cortex
Large mass of gray matter extending throughout Least common
the midbrain Layers of the Neocortex
Divides the cerebral peduncles into dorsal and o Plexiform (Molecular) Layer
ventral parts Most superficial
Play a role in fine control of motor function Contains manly dendrites
Neurons are multipolar and axons of cortical neurons
Cytoplasm contains numerous granules of Sparse nuclei of neuroglia
neuromelanin pigment in adults and horizontal cells of cajal
Pigmented neurons contain dopamine which is o Outer Granular Layer
an inhibitory neurotransmitter that act on Dense population of small
neurons of the corpus striatum pyramidal and stellate cells
o Pyramidal Cell Layer
Thalamus Pyramidal cells of moderate
Large masses of gray matter lying on each side of size predominate, with cells
the third ventricle increasing in size in deeper
Complex relay and integration center for layers
information from almost all parts of the CNS Martinotti cells also present
Contain reticular, motor, specific sensory nuclei o Inner Granular Layer
Densely packed stellate cells
Cerebral Cortex o Ganglionic Layer
Consist of convoluted cortex of gray matter Large pyramidal cell (Betz
overlying central medullary mass of white cells) and small numbers of
matter stellate cells and cells of
martinotti
Neuron Types
o Multiform Cell Layer
o Pyramidal Cells
Contains small pyramidal
Pyramid-shaped cell bodies
cells, cells of Martinotti,
Slender axon arises from
stellate cells (superficial),
base and passes into
fusiform cells (deep)
underlying white matter
Thick branching dendrite
arises from apex
Betz Cells: largest pyramidal
cells in the cortex which are
upper motor neurons
o Stellate (Granule Cells)
Star-shaped cell body
Small neurons with short
vertical axon and short
branching dendrites
o Cells of Martinotti
Small polygonal cells with
few short dendrites
Axon extends towards
surface and bifurcates

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CIRCULATORY SYSTEM
Mediates the continuous movement of all body
fluids
o Transport of nutrients and wastes
o Temperature regulation
Two divisions:
o Blood vascular system
Arterial system: distribution
network to tiny peripheral
microcirculation
Venous system: from
capillary system to the heart
The heart is the central
pump
o Lymph vascular system
Drainage vessels for
returning excess
extravascular fluid to the
blood vascular system
Transport lymph to lymph
nodes for immunological
screening
No central pump, but had an
intrinsic pumping system
from contractile smooth
muscles in the lymph vessel
wall together with valve
system that prevents
backflow
Common basic structure of the circulatory
system
o Tunica Intima
Inner lining comprising of a
single layer of extremely
flattened epithelial cells
supported by a basement
membrane and dense
collagenous tissue
o Tunica Media
Intermediate muscular layer
Muscular content exhibits
the greatest variation from
one part of the system to
another
o Tunica Adventitia
Outer supporting tissue layer
o Vasa Vasorum
Present in tissues of the thick
walls of large vessels
Small arteries that run in the
tunica adventitia and sends
arterioles and capillaries into
the tunica media
The Heart
Epicardium
Equivalent of the tunica adventitia
Constant layer consists of dense sheet of
fibrocollagenous tissue with elastic fibers
Has an outer surface of mesothelial cells
responsible for secreting lubricating fluid
Contains adipose tissue in some areas, especially
in areas containing artery branches
Myocardium
Equivalent of the tunica media
Cardiac-type muscle connected through
intercalated discs
Papillary muscles are extensions of the
myocardium, which provide attachment points
for chordate tendinae
Has an extensive and intimate capillary network
Endocardium
Tunica intima equivalent
Surface layer of flattened endothelial cells
supported by a fibrous layer and contains
variable amounts of elastic tissue
Endocardium of atria is thicker and contains
more elastic fibers
Heart Valves
Consist of leaflets of fibroelastic tissue
Surface covered by thin endothelium continuous
with lining of the heart chambers and great
vessels
Fibroelastic layer of endocardium condenses and
forms the valve ring
Lamina fibrosa
o Central fibroelastic sheet of the valve
o Dense central plate of collagen
containing scattered elastic fibers
Conducting System
Recall conduction pathway
Nodal Fibers
o Small specialized myocardial fibers
o Electrochemical stimuli transmitted
through gap junctions
o Fibers embedded in collagenous
fibrous tissue containing many blood
vessels and autonomic nerve fibers
o SA node
RA wall near entry of SVC
Origin of the impulse;
impulse rate controlled by
ANS
o AV node
Medial wall of RA above the
tricuspid valve ring at the
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base of the interatrial smooth muscle cells known as

septum myointimal cells
Conducting Fibers o Myointimal cells
o Specialized cardiac muscle fibers that No basement membrane,
contain few myofibrils, with abundant thus are not epithelial
glycogen granules and mitochondria With aging, accumulates lipid
o AV bundle of his which causes the intima to
Divide into left and right thicken with possible
bundle branches and development of
become purkinje fibers that atherosclerosis
run immediately beneath Tunica Media
endocardium before o Extremely elastic
penetrating myocardium o With fenestrated sheets of elastin
Purkinje Fibers separated by collagenous tissue and
o Larger than cardaiac muscle fibers smooth muscle
o Pale staining center Tunica Adventitia
o No T tubule system o Contains vasa vasorum that also
o Connected through desmosomes and traverses the outer half of the tunica
gap junctions rather than intercalated media
discs
Muscular Arteries
Arterial System Main distributing branches of the arterial tree
Cyclical pumping action of the heart generates Radial, femoral, coronary, cerebral arteries
pulsatile flow in this system Elastic tissue largely concentrated as two well-
o Systole: contraction of ventricles defined elastic sheets
causing expansion of arterial walls o Internal elastic lamina
o Diastole: elastic recoil of arterial walls Between tunica intima and
o Expansion and recoil is a function of media
the elastic tissue within the walls of o External elastic lamina
the arteries Less prominent
o Flow of blood to organs and tissues Between tunica media and
regulated by smooth muscle cells that adventitia
vary the diameter of the vessels under Tunica intima
the control of the sympathetic NS and o Very thin and indistinct under low
the adrenal medullary hormones magnification
Walls of arterial vessels are characterized by Tunica media
presence of elastin and smooth muscle wall o Composed of concentrically arranged
layers that are thick relative to the diameter of smooth muscle with scanty elastic
the lumen fibers
General trend: amount of elastic tissue Tunica adventitia
decreases and amount of smooth muscle tissue o Collagen and elastic tissue
increases as vessels become smaller o May contain vasa vasorum in large
muscular arteries
Elastic Arteries Small muscular arteries
Major distribution vessels; blood flow highly o 0.5-2mm in diameter
pulsatile o With thin and distinct internal elastic
Aorta, brachiocephalic trunk, common carotid, lamina but no external elastic lamina
subclavian arteries, large pulmonary arterial o Tunica media has 3-10 concentric
vessels layers of smooth muscle and almost no
Tunica Intima elastic fibers
o Single layer of endothelial cells
supported by collagenous tissue rich in Arterioles
elastin Terminal branches of the arterial tree that
o Subendothelial tissue contains supply arterial beds
fibroblasts and other cells similar to o Transition from large to small
arterioles involve the loss of internal

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elastic lamina and progressive
reduction of muscle layers in the
tunica media
The Microcirculation
Concerned with exchange of gases, fluids,
nutrients, and metabolic waste products
Exchange occurs mainly in the capillaries
o Precapillary sphincters
Arterioles and muscular
sphincters at the arteriolar
capillary junctions
Controls blood flow together
with arterioles,
metarterioles, and AV shunts
Endothelial Cells
Flat and polygonal, connected by junctional
complexes
Have numerous pinocytotic vesicles
Wiebel-Palade Bodies
o Special membrane-bound organelles
which store von willebrand factor
Mainly functions in fine control of blood
coagulation and thrombosis, vessel wall
permeability, and local control of
vasoconstriction/dilatation
Capillaries
Consist of a single layer of endothelial cells and
basement membrane
Muscular and adventitial layers absent
Pericytes
o Occasional flattened cells that
surround and embrace capillary
endothelial cells
o May have contractile function
o Has own basement membrane
Continuous Capillary
o Endothelial cells bound together by
scattered tight junctions of the fascia
occludens type
o Marginal folds
Small cytoplasmic flaps that
extend across the
intercellular junctions at the
luminal surface
o Capillary Exchange Mechanism
Passive diffusion of gases,
small ions, LMW metabolites
Pinocytotic vesicles of
proteins and some lipids
Intercellular spaces
Fenestrated Capillary
o Found in tissues with extensive
molecular exchange such as small
intestine, endocrine glands, kidney
o Fenestrations permit the rapid
exchange of macromolecules smaller
than plasma proteins
o Pericytes are rarely found in
fenestrated capillaries
o Diaphragm
Structure that traverses the
fenestrations
Function not known
o Endothelium of sinusoids, bone
marrow, spleen, and liver has large
fenestrations without diaphragms and
an underlying discontinuous basement
membrane
Metarterioles
Larger diameter capillaries characterized by a
discontinuous outer layer of smooth muscle cells
Small capillaries likewise arise from these vessels
as with arterioles
May form shunts/ direct communications
between arterioles and venules
Venous System
Low-pressure component responsible for
carrying blood from capillary networks to the RA
of the heart
Driving forces
o Contraction of smooth muscles of the
vein wall
o External compression of veins by
skeletal muscle
Backflow prevented by valves derived from the
intima
Elastic and muscular components are less
prominent features
Post-capillary Venules
Formed by the confluence of several capillaries
Similar structure to large capillaries with
endothelium and pericytes but no smooth
muscle layer
Blood flow is sluggish
Main site of migration of WBCs into and out of
circulation
o Margination: migration of WBCs to
periphery of blood stream and
attachment to endothelial cell surface
prior to emigration to tissues
Collecting Venules
Larger than post-capillary venules but with more
pericytes
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Muscular Venules Lymphatic vessels found in all areas of the body

Addition of smooth muscle component 2-3 except CNS, cartilage, bone, bone marrow,
layers thick thymus, placenta, cornea, and teeth
Characterized by a clearly defined intimal layer Lymphatic capillaries have greater permeability
devoid of elastic fibers and a tunica media than blood capillaries
consisting of one or two layers of smooth muscle o Endothelial cell cytoplasm is very thin
and basement membrane is
Veins rudimentary or absent
Characterized by a thicker muscular wall and o There are no pericytes
poorly developed internal elastic lamina Valves
Tunica adventitia continuous with surrounding o Supporting tissue core consists merely
collagenous supporting tissue of reticulin fibers and ground
Valve substance
o Only occur in veins of more than 2mm
in diameter, particularly those draining
extremities
o Consists of delicate semilunar
projections of the tunica intima of the
vein wall
o Composed of fibroelastic tissue lined
by endothelium
Medium-sized vein
o Tunica intima consists of endothelial
cell layer supported by fibrous tissue
o Tunica media is thin compared with
equivalent sized artery, only 2-3 layers
of smooth muscle
o Tunica adventitia is thickest and
composed of collagenous fibrous
tissue
Large muscular vein
o Tunica intima very narrow
o Tunica media more substantial
o Tunica adventitia broad with collagen
and vasa vasorum
o Elastic fibers prominent between
media and adventitia but there are no
distinct elastic laminae
Superior and Inferior Vena Cava
o Largest veins in the body
o Have the thickest walls of all veins
o Distinct intima of fibroelastic tissue
o Narrow media of circular smooth
muscle cells
o Thick adventitia with collagen and
longitudinal smooth muscles

Lymph Vascular System

Drains excess fluid, the lymph, from extracellular
spaces and returns it to blood vascular system
General trend: as lymphatics get larger, there is
more smooth muscle cell in the walls
Along the course of vessels are aggregations of
lymph nodes where lymph is sampled for
antigens and are acted upon by the immune
system

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UST FACULTY OF MEDICINE AND SURGERY
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IMMUNE SYSTEM
Main Lines of Defense
Protective Surface Mechanisms
First line of defence
Skin as an impenetrable barrier
Mucuous surfaces of the body protected by
antibacterial substances (eg. lysozyme in tears
and saliva)
Surface mucus produced by goblet cells and
removed by ciliary action in the respiratory tract
Maintenance of acidic environment inhibiting
the growth of pathogens
Innate Immune System
Rapid reaction to infections
Produces same magnitude of response each time
the same pathogen is encountered
Cell components
o Neutrophils, eosinophils, basophils
macrophages, histiocytes, mast cells
Proteins and Peptides
o Complement, acute phase proteins,
and cytokines
Response is the release of molecules toxic to
pathogens, phagocytosis, intracellular killing of
pathogens, and action of natural killer cells
Produces inflammation
Adaptive Immune System
Characterized by ability to learn, producing
greater, more specific, and faster response
during the second and subsequent encounters
with the same pathogen
Dependent on cell division to produce large
number of lymphocytes with specificity for a
pathogen
Takes 3-5 days for a specific response
Amplifies some mechanisms of the innate
immune response
Lymphocytes
Constantly patrol the body and has a unique
ability of producing an equally huge range of
antigen receptors, examples:
o Surface Ig for B cells
o T cell receptor for T cells
T-Cells
Originate from bone marrow and migrate to
thymus for maturation:
o Proliferation, rearrangement of TCR
genes, acquisition of surface receptors
and accessory molecules
T Helper Cells
o Help other cells perform their
functions by secreting interleukins
o Provide help to B cells, cytotoxic T
cells, and macrophages
Cytotoxic T Cells
o Kill virus-infected and cancer cells
o Require interaction with helper cells to
activate and proliferate
Suppressor T Cells
o Suppress immune responsiveness to
self-antigens
Memory T Cells
o Provide rapid reaction force for
subsequent encounter with same
antigen
B-Cells
Originate and mature in bone marrow
Mature into plasma cells that synthesize large
amounts of antibody/ immunoglobulins
Primary immune response
o Antigen encountered for the first time
o Production of memory B cells
Secondary immune response
o Rapid response with greater
magnitude
o Produces IgG instead of IgM
Plasma cells
o Differentiated B cells capable of
producing large amounts of antibody
o Found in medullary cords of lymph
nodes, white pulp of spleen,
supporting tissues of mucosal surfaces,
bone marrow
o Ig chains are synthesized in the RER
and transported to surface via
secretory vesicles
Lymphocytes and the Antigen Presenting Cell
Antigen presenting cells (APCs) include
macrophages, dendritic cells, and B lymphocytes
APC function
o Antigen is taken up by APC into an
early endosome that fuses with
lysosoe containing major
histocompatibility complex (MHC)
o Antigen broken down to short peptides
and bound to MHC, then transported
to plasma membrane where it will
make contact with T cells that activate
adaptive immune response
Helper T cells recognize MHC
II
Cytotoxic T cells recognize
MHC I
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Lymphocyte Surface Markers
Act as receptors for antigen, as costimulatory
molecules for activation of lymphocytes, and
signal transmission from the surface to the
inside of the cell
Antigen Receptors
o Brought about by gene splicing, the
random rearrangement of segments of
genes coding for the Ag-binding part of
the receptor
o T Cell Receptors for T cells
o Surface Immunoglobulin for B cells
Accessory, Binding/Costimulatory Molecules
o Required for stimulaton of both T and
B cells
o Helper T cells recognizable by CD4
surface marker that binds to MHC class
II on the surface of APCs
o Cytotoxic T cells recognizable by CD8
surface marker that binds to MHC class
on the surface of APCs
Signal Transduction Molecules
o T cells: CD3 passes a message to the
inside of the cell that triggers cell
activation
o B cells: Ig-alpha and Ig-beta function in
the same way as CD3
Others
o Transmembrane proteins, complement
receptors, interleukin receptors, CD2
Basics of the Immune Response
Activation of the Immune System
Requires contact between antigen and surface
receptors on mature lymphocytes
Mechanisms:
o T cells dependent on antigen
presenting cells (APC)
Antigen taken up by APC and
broken down to short
peptides
Short peptides are then
bound to major
histocompatibility complex,
which is then incorporated in
cell membrane and exposed
to ECF where it makes
contact with a T cell
APCs bound to MHCII are
acted upon by T helper cells
o Antigen synthesized within a body cell
Presented on APC bound to
MHCI, which is recognized by
Cytotoxic T cells
o B lymphocytes interact directly with
antigens
Antigens recognized through
surface Ig
SIg must bind to a protein or
polysaccharide antigen with
a repeating chemical
structure
Generation of Effector Mechanisms
Production of antibodies by plasma cells
o Ab binds to viral surface antigens
o Ag-Ab complex actvate production of
Membrane Attack Complex, which
puntures outer membrane of attacking
organism
o Bound Ab opsonises organisms and
facilitates phagocytosis
o Ab bound to toxins inactivates them
Cell-mediated cytotoxicity
o Destruction via apoptosis of abnormal
cells by cytotoxic t cells, natural killer
cells, or antibody dependent cytotoxic
cells
Secretion of cytokines that activate
macrophages
o Mechanism of type IV hypersensitivity
Termination of Immune Response
Removal of antigen, short lifespan of plasma
cells, suppressor T cells
Immunological Memory
Memory T and B cells produced are able to
respond faster and more effective during a
second response to a smaller quantity of antigen
Thymus
Flattened lymphoid organ in upper anterior
mediastinum
Most active during childhood, undergoes
involution during mid-adulthood
o Involves fatty infiltration and
lymphocyte depletion
o Fatty infiltration of interlobular septa
occurs first spreading out into the
cortex and medulla
o Lymphocyte depletion results in
collapse of epithelial framework, but
the epithelial cells that persist
continue to produce thymic hormones
throughout life
o Acute Thymic Involution
Occur in response to severe
disease and metabolic stress
characterized by greatly
increased lymphocyte death
By: Sachi Estreller |Section B 21
UST FACULTY OF MEDICINE AND SURGERY
Class of 2016

Mediated by high levels of Nurse cells

corticosteroids o Cortical epithelial cells that envelope
multiple lymphocytes promoting T cell
Function differentiation and proliferation
Site of maturation of T lymphocytes to helper T o Other epithelial cells in the thymus
cells and cytotoxic T cells function to:
Proliferation of clones of mature nave T cells Provide a mechanical
Development of immunological self-tolerance supporting pramework,
Secretion of hormones and cytokines that Secrete hormones that
regulate T cell maturation, proliferation, and regulate T cell maturation
function and proliferation
Blood-thymus Barrier: serves
Structure as barrier to entry of
Highly cellular outer cortex and less cellular antigenic material into the
central medulla thymic parenchyma
Invested by loose collagenous capsule
Thymic Cortex Lymph Nodes
o Deeply basophilic Encapsulated aggregation of lymphocytes
o Packed with immature and maturing T interposed in the lymph vascular system
cells called thymocytes Site where dendritic cells present antigen to T
o Site where large lymphocytes divide by cells
mitosis Lymph nodes facilitate and maximize the
o Epithelial framework more delivate probability of lymphocytes meeting the right
and finely branched than the medulla antigen
o T cells undergo further maturation as
they go deeper into the cortex Capsule
TCR genes rearranged Collagenous
Cells acquire surface markers Have extended trabeculae into the substance of
the node
Thymic Medulla
o Eosinophilic Sinuses
o Dominant feature is the robust Sinuses (particularly the subcapsular sinus) are
epithelial component traversed by reticulin strands that provide
Hassals Corpuscles support for large eosinophilic sinus macrophages
Increase in number that filter antigen and other cell debris from
and size with age afferent lymph
Formed from Subcapsular Sinus
groups of o Encircles the node beneath the capsule
keratinized o Afferent lymphatic vessels divide
epithelial cells and outside, pierce the capsule, and drain
present a into this sinus
degenerative o Continuous with the trabecular sinuses
phenomenon o Acts as a strainer for antigen entering
o Thymic Interdigitating Cell the node
Type of APC Cortical Sinus
Express high levels of MHC I o Passes towards the medulla through
and MHC II the cortical cell mass
Present self-antigens to Medullary Sinus
maturing T cells o Dominant feature of the medulla
Clonal deletion/ Negative o Converge upon the hilum and
selection: any self-reactive T concavity of the node
cell is obliterated via o Lymph drains from hilum to efferent
apoptosis, prevents lymphatic vessels which then drain to
development of proximal nodes before joining the
autoimmunity thoracic duct/right lymphatic duct

By: Sachi Estreller |Section B 22

UST FACULTY OF MEDICINE AND SURGERY
Class of 2016
Lymph Node Cortex
Highly cellular outer region
Consist of densely-packed lymphocytes
Lymphoid Follicles
o In superficial cortex
o Site where B cells undergo expansion
and maturation; self-reactive cells are
deleted and memory cells regenerated
o Mantle Zone
Made up of small resting B
cells; with condensed nuclear
chromatin
Wider side towards capsule
o Germinal Center
Consist of actively dividing B
cells
Also contain Follicular
Dendritic Cells, the major
antigen presenting cells of
the follicles found in all areas
of the germinal center,
mantle zone, and primary
follicles
Also contain Tingible Body
Macrophages that contain
numerous apoptotic bodies
from B cells that have not
been successful in generating
high affinity antibody
Medullary Cords
o Cortical cell mass that extends into the
medulla
Deep Cortex (Paracortex)
o Devoid of lymphoid follicles
o Site where T cells interact with APCs
and undergo activation and clonal
expansion
o Helper T cells go into the medulla to
help B cells while cytotoxic T cells
migrate out of the node to perform
their function
o Interdigitating Dendritic Cell
Main antigen presenting cell
in paracortex
Derived from macrophage
precursors
o Paracortical Reaction
Expansion of paracortex
during T cell dominated
immune response
Lymph Node Medulla
Less cellular central region
Continuous with hilum
Medullary Cords
o Major cell types include plasma cells,
plasmablasts which have migrated
from germinal centers
Medullary Sinus
o Paler-stained
o Contains mainly sinus macrophages
Circulation
Lymphocytes enter the lymph nodes via the
arterial system, through migration across the
walls of High Endothelial Venules
High endothelial venules
o Specialized post-capillary venules that
drain into small veins that leave the
hilum
o Within the paracortex, have cuboidal
endothelium specialized for the exit of
lypmphocytes
o These exit points are recognized by
lymphocytes though the presence of
adhesion molecules or vascular
addressins on the surface of
endothelial cells and lymphocytes
Cycle of Blast Formation
Resting B cells enter the lymph node and
become activated when it encounters antigens
The cycle produces clones of plasma cells and
memory B cells
Cycle:
o Activation gives rise to centroblasts,
found in the darker zone of the
germinal center; with rounded nuclei
o Centroblasts give rise to centrocytes
that are found in the pale midzone of
the germinal center; with irregular
nuclei
o Centrocytes migrate towards paler
capsular zone of the erminal center
where further cycles of division are
made to produce immunoblasts or
memory B cells
o Immunoblasts may move to medullary
cords to mature further into plasma
cells
o Memory cells reside in the mantle
zone of the follicle or may join
recirculating pool of lymphocytes
Mucosa-Associated Lymphoid Tissue
Refer to the total mass of lymphoid tissue in the
GI, respiratory, and GU tracts
Function is analogous to lymph nodes
Contain mainly diffusely scattered T cells with
smaller number of B cells
By: Sachi Estreller |Section B 23
UST FACULTY OF MEDICINE AND SURGERY
Class of 2016

All kinds of Igs are produced with predominating Periarteriolar Lymphoid

IgA Sheath (PALS)
o Secretory Piece T cell areas
Carbohydrate moiety that surround central
binds IgA and renders it arteries forming
resistant to proteolytic this structure, PALS
enzymes Consist mainly of
Helper T cells
Palatine Tonsil o B Cells
Forms the Waldeyers Ring together with the Form follicles located in the
lingual, pharyngeal, and tubal tonsils vicinity of the arteriole
Luminal surface covered by stratified squamous Follicles have germinal
non-keratinizing epithelium and forms centers but the number of
invaginations called tonsillar crypts follicles with germinal
Tonsilar parenchyma contains numerous centers decreases with age
lymphoid follicles with germinal centers Mantle zone: small
Pathogens entering crypts are passed to the lymphocytes
follicles via transcytosis Marginal zone: medium
lymphocytes
Gut Associated Lymphoid Tissue Red Pulp
Peyers Patches o Highly vascular tissue consisting of
o Largest lymphoid aggregates under parenchyma permeated by venous
GALT sinuses
o Groups of lymphoid follicles located in o Parenchymal component also called
the mucosa of the small intestine the Cords of Bilroth
o With only few overlying villi Composed of macrophages
o Least numerous in duodenum, most of sheathed capillaries and
prominent in ileum blood cells in transit
o Venous Sinuses
Spleen Lined by elongated, spindle-
Large lymphoid organ in the LUQ of the shaped endothelial cells with
abdomen narrow slits that allow blood
cells to pass through
Receives blood supply from the splenic artery
(described as stave cells)
and drained by the splenic vein into the hepatic
Drain into larger vessels
portal system
which eventually converge to
form the splenic vein
Functions
o Perilymphoid (perifollicular) Zones
Production of immune response against blood-
Zone of red pulp
borne antigens
immediately surrounding
Removal of particulate matter and aged or
white pulp
defective blood cells
Differs from other areas in
Hemopoiesis in normal fetus and in adults with
that it is devoid of sinuses,
disease
having only sparse reticulin
and a large number of RBCs
Structure
and WBCs in the same
Consist of discrete 0.5-1mm white nodules called proportion as that of blood
white pulp embedded in red pulp Area of sluggish blood flow
Capsule enhances interaction
o Thin and fibroelastic between Ags and Abs
o With trabeculae that extend into
parenchyma Circulation
o Thickened at hilum Splenic Artery branch repeatedly and form
White Pulp central arteries ensheathed in PALS branches
o Consist of lymphoid aggregations at right angles to form penicilliary arteries
o T Cells terminate into sheathed capillaries with no

By: Sachi Estreller |Section B 24

UST FACULTY OF MEDICINE AND SURGERY
Class of 2016

endothelial lining but surrounded by an

aggregate of macrophages red pulp
Open Circulation
o Blood cells enter parenchyma from
sheathed capillaries squeeze through
walls of sinuses to drain into splenic
vein
Closed Circulation
o Formed by small patches of red pulp
parenchyma that are devoid of
capillaries and contain mainly T and B
cells and macrophages
o Sinuses are blind-ended and
endothelial lining cells are similar to
the high endothelial venules of the
lymph nodes
o Lymphocytes exit sinuses and enter
non-filtering areas of the red pulp

________________________________________________

All Wheaters based. No notes incorporated dahil badong

lahat ng notes ko for second shift.

Please read more on hemopoiesis, MALT, and spleen

circulation if kaya kasi di ko siya ma-outline ng matino.
HAHA lalo na MALT and spleen. Inaantok na kasi ako
HAHAHA.

GOOD LUCK AND GOD BLESS!!

By: Sachi Estreller |Section B 25