Key Points

• B lymphocytes produce immunoglobulins; T lymphocytes function as helper, suppressor, or cytotoxic cells; NK lymphocytes function as natural killer cells.

• Suspect malignancy for lymph node enlargement that is one sided, in the neck or mandibular region, in older patients with no evidence of infection.

• Biopsy reveals malignancy in 17% of patients with persistent lymph node enlargement from strictly primary care practices.

The lymphoid system is made up of the primary and secondary tissues or organs. The primary lymphoid system consists of the bone marrow and thymus and generates B and T lymphocytes. The secondary lymphoid system consists of the lymph nodes, spleen, tonsils, and special lymphocytic tissue in the GI and respiratory tracts. Lymphocytes reside in these tissues; B and T cells may be segregated but can interact. T cells are more localized between follicles and B cells more within follicles. Macrophages, histiocytes, dendritic cells, and endothelial cells form the supporting structures of lym-phoid organs and facilitate interactions that allow lymphocytes to generate appropriate cellular and humoral immune responses. T cells make up 60% to 80% of the normal lymphocyte population, B cells 10% to 20%, and natural killer (NK) cells 5% to 10%. NK cells are related to T cells in that they both arise from thymic precursors.

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