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Thymus surgical anatomy and physiology

DR RANJEETHA SHENOY
MBBS, MS
DNBTHORACIC SURGERY

 Derived from word “thymos” due to its
resemblance to the flowers of the thyme
plant.
 Specialized primary lymphoid orga...

Image:http://www.aphotoflora.com/d_orobanche_alba_thyme_broomrape.html

 Function of thymus in human was unknown
for a long time
 Was attributed for SIDS – Sudden infant
death syndrome, where ...

 Thymic epithelium develops from ventral
diverticulum of 3rd pharyngeal pouch alongwith
inferior PTH glands (6 wks)
 Due...

 The development of thymus is almost
complete at birth, and reaches sufficient size
and weight in the first 6 months foll...

 Bilobed , H shaped , 2 upper and 2 lower horns
 Lies in the superior and anterior mediastinum
 Extension- May extend i...

 Anterior – Pre-tracheal fascia, strap muscle,
manubrium,body of sternum
 Posterior – Great vessels of heart and
pericar...

 Arterial Supply- Internal mammary artery,
Inferior thyroid artery and Pericardiophrenic
artery
 Venous drainage- via po...

 Loose capsule of connective tissue surrounds and infiltrate
into gland and divides glands into many lobules
 Lobules ar...

 Neuroendocrine cells are postulated as the
probable reservoir for the development of
carcinoid tumors and other neuroend...

MATURETHYMUS CHILDHOOD
AND ADOLESCENTS
 Lobulation and
encapsulation
 Dual (epithelial/lymphoid)
immatureT lymphocytes
...

 Training and development ofT cells
 Receive immatureT cells, and train them into
mature, functionalT cell that attack o...

 Upon reaching medulla, survivingT cells
continue to mature and are presented with
body’s own Ags
 T cells that bind to ...

 Several hormones produced by the thymus
promote the maturation ofT cell prior to
release into bloodstream
 MatureT cell...

 Congenital open heart surgery - thymectomy is done
in order to avoid innominate vein injury and for a safe
aortic cannul...

 Considering the possible adverse
consequences of total thymectomy in the
aging process, it is suggested that partial
thy...

 References
 Annals of CTS
 Shields text book ofThoracic Surgery -
ShieldsTW, editor. General thoracic surgery.
Lippinc...

Thymus surgical anatomy and physiology

Thymus surgical anatomy and physiology

Thymus surgical anatomy and physiology

Thymus surgical anatomy and physiology

Thymus surgical anatomy and physiology

Thymus surgical anatomy and physiology

Thymus surgical anatomy and physiology
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    Thymus surgical anatomy and physiology

    1. 1.
      DR RANJEETHA SHENOY
      MBBS, MS
      DNBTHORACIC SURGERY

    2. 2.

       Derived from word “thymos” due to its
      resemblance to the flowers of the thyme
      plant.
       Specialized primary lymphoid organ of the
      immune system
       At birth larger in size and reach upto 40 g
      after puberty undergo involution and is 15 to
      20 g in weight in adult

    3. 3.

      Image:http://www.aphotoflora.com/d_orobanche_alba_thyme_broomrape.html

    4. 4.

       Function of thymus in human was unknown
      for a long time
       Was attributed for SIDS – Sudden infant
      death syndrome, where an enlarged thymus
      was attributed to choking of newborn

    5. 5.

       Thymic epithelium develops from ventral
      diverticulum of 3rd pharyngeal pouch alongwith
      inferior PTH glands (6 wks)
       Due to this embryonic origin, inferior
      parathyroids may be embedded in the
      throthymic ligament or maybe in close proxmity
      to thymus (ectopic PTH)
       Descends into anteroinferior mediastinum (8
      wks) and fuses with opposite counterpart
       Late in development hematopoeitic precursor
      cells migrate into thymus

    6. 6.

       The development of thymus is almost
      complete at birth, and reaches sufficient size
      and weight in the first 6 months following
      birth
       In course of time, it becomes a structure
      composed of fatty tissues due to
      degeneration (involution)
       Involution starts at the time of puberty and
      continues into old age

    7. 7.

       Bilobed , H shaped , 2 upper and 2 lower horns
       Lies in the superior and anterior mediastinum
       Extension- May extend into neck upto Inferior
      pole of thyroid gland (superior) and up to 4th
      costal cartilage(inferior)
       Although encapsulated,isolated microscopic
      thymic tissue islets may be found extending
      from the neck to the diaphragm, and most
      commonly found in the anterior mediastinal fat
       This causes incomplete removal of thymic tissue
      in Myasthenia gravis

    8. 8.

       Anterior – Pre-tracheal fascia, strap muscle,
      manubrium,body of sternum
       Posterior – Great vessels of heart and
      pericardium
       Lateral – Phrenic nerve
       Attached to thyroid gland by the
      Thyrothymic ligament

    9. 9.

       Arterial Supply- Internal mammary artery,
      Inferior thyroid artery and Pericardiophrenic
      artery
       Venous drainage- via posterior veins of
      Keynes which drains into Left innominate
      vein, sometimes to SVC, Internal thoracic and
      rarely also Infr thyroid vein
       Lymphatics drain- into
      Anteriormediastinal,Pulmonary hilar and
      Internal mammary nodes

    10. 10.

       Loose capsule of connective tissue surrounds and infiltrate
      into gland and divides glands into many lobules
       Lobules are comprised of a series of follicles, which have a
      medullary and cortical component:
       Cortical portion – Located peripherally within each follicle.
      It is largely composed of lymphocytes, supported
      epithelial reticular cells.
       Medullary portion – Located centrally within each follicle.
      It contains fewer lymphocytes than the cortex, and an
      increased number of epithelial cells. Hassall’s corpuscles
      are also present – these are concentric arrangements
      of epithelial reticular cells.Their function is unclear.

    11. 11.

       Neuroendocrine cells are postulated as the
      probable reservoir for the development of
      carcinoid tumors and other neuroendocrine
      neoplasms, including calcitonin-positive
      medullary carcinomas.
       Myoid cells are postulated a potential in the
      pathogenesis of myasthenia
       Striations of myoid cells react with antisera to
      actin and myosin.
       Myoid cells also react to troponin and to
      acetylcholine receptor

    12. 12.

      MATURETHYMUS CHILDHOOD
      AND ADOLESCENTS
       Lobulation and
      encapsulation
       Dual (epithelial/lymphoid)
      immatureT lymphocytes
       Perivascular spaces
       Areas of “medulary”
      differentiation
      INVOLUTEDTHYMUS OFTHE ADULT
       Spindle-cell population
      devoid of cytologic atypia

       Scant immatureT
      lymphocytes
       Rosette-like epithelial
      structures
       Cystic and glandular
      structures

    13. 13.

       Training and development ofT cells
       Receive immatureT cells, and train them into
      mature, functionalT cell that attack only foreign
      antigens
       T cells first reside in the cortex where they come
      in contact with epithelial cells presenting various
      antigens
       ImmatureT cells that respond to foreign are
      selected to survive and mature while the rest are
      destroyed by apoptosis and macrophages AKA
      ‘POSITIVE SELECTION’

    14. 14.

       Upon reaching medulla, survivingT cells
      continue to mature and are presented with
      body’s own Ags
       T cells that bind to the bodys Ags are tested
      positive and autoimmuneT cells are
      eliminated by apoptosis
       AKA ‘NEGATIVE SELECTION’

    15. 15.

       Several hormones produced by the thymus
      promote the maturation ofT cell prior to
      release into bloodstream
       MatureT cells circulate in the body where
      they recognize and kill pathogens , activate B
      cells to produce Abs and store memory of past
      infections
       May have pathological role in dev’t of
      autoimmune disease like Myasthenia Gravis

    16. 16.

       Congenital open heart surgery – thymectomy is done
      in order to avoid innominate vein injury and for a safe
      aortic cannulation, especially in babies in the 1 st year
      of life due to the large volume of the thymus
       Significant decrease inT-lymphocytes andTreg cell
      receptor excision circles were found in children who
      underwent neonatal thymectomy, consistent with
      cessation of thymopoiesis
       Although thymectomy is tolerated in patients older
      than 6 months without any known adverse
      consequences, the long-term effects of total
      thymectomy under certain conditions such as
      malignancies or infections still have not been proven.

    17. 17.

       Considering the possible adverse
      consequences of total thymectomy in the
      aging process, it is suggested that partial
      thymectomy should be preferred instead of
      total thymectomy in neonates/infants
      undergoing open heart surgery.
       Ekim H, Ekim M.The cause and effects of neonatal/infantile thymectomy . Med J DY Patil Univ [serial
      online] 2016 [cited 2017Aug 6];9:148-9. Available
      from: http://www.mjdrdypu.org/text.asp?2016/9/1/148/167996

    18. 18.

       References
       Annals of CTS
       Shields text book ofThoracic Surgery –
      ShieldsTW, editor. General thoracic surgery.
      LippincottWilliams &Wilkins; 2005

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