Lymphatic system of the pancreas.

A network of lymphatic vessels exists within the pancreas. The majority of vessels forming this network lie in the interlobular septa of connective tissue that subdivide the pancreas into lobes and lobules. Peripheral extensions of these interlobular lymphatics can be found within the lobules, but these intralobular lymphatics are relatively sparse. In the main, the intimate relationships of these internal pancreatic lymphatics are with the blood vessels and associated connective tissue. However in random areas, both intra- and interlobular lymphatics come into close relationship with acinar cells. Rarely are there lymphatics associated with islets of Langerhans, and then only where lymphatic vessels in connective tissue septa pass close to a pancreatic lobule that contains an islet at its periphery. Intra- and interlobular lymphatics are similar in structure. Both are thin walled having an endothelial lining and a delicate component of connective tissue. The pattern of interendothelial cell contacts and the sparsity of gaps between adjacent cells suggest that fluid movement through the intracytoplasmic system of vesicles is important in lymph formation in the pancreas. However intercellular transport is also likely to occur by a dynamic process involving fluid movement through dilatations between cells from interstitium to lymphatic lumen. Both exocrine and endocrine secretions of the pancreas may enter thoracic duct lymph directly in pancreatic lymph, but in normal circumstances this route of entry is not quantitatively important. The structural relationships between lymphatics and pancreatic parenchymal cells also make clear that lymph is not a significant pathway for their secretory products. Rather, the arrangement of lymphatics in the pancreas supports the view that lymph is primarily the drainage medium for substances that, for whatever reason, enter the interstitium. In addition, the low flow of lymph compared with that of plasma lends credence to the view that lymph is not a functionally important pathway for endocrine secretions from the pancreas to reach the blood. Both structural and functional evidence suggests that the proper functioning of the lymphatic system is of critical importance in the homeostasis of the pancreas. The lymphatic system of the pancreas, like that in other organs, is essential in the removal of excess fluid from the interstitium. In this sense, the lymphatics may be considered to serve as an overflow, protective, or safety system. When the system is inadequate or its capacity is exceeded, as in inflammation of the pancreas, exocrine secretions entering the interstitium are not cleared and the proteolytic enzymes cause major damage to the tissue. This, in turn, exacerbates the edema, accentuates the inability of lymphatics to drain the fluid, and results in further damage. The fibrosis that ensues damages the lymphatics either directly or through stricture of the surrounding connective tissue. In consequence, they become inadequate at an even earlier stage in subsequent attacks of inflammation and thereby predispose to chronic and recurrent pancreatitis. The larger interlobular lymphatics formed by the junction of their tributaries emerge upon the surface of the pancreas. There they travel primarily with blood vessels and stream toward a ring of lymph nodes that intimately surrounds the pancreas. A second system of nodes extensively involved in drainage from the pancreas is related to the front and sides of the aorta from the level of the celiac trunk to the origin of the superior mesenteric artery. This second set of nodes receives lymph either directly from the pancreas or indirectly from the first echelon of nodes that rings the organ. Although there is general agreement on the disposition of the groups within these sets of nodes, confusion results from the different classifications used by various authors. These classifications range from being purely descriptive, through an alpha and num