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=The Development Of The Human Pharyngeal Tonsil=
Theodore Snook
Laboratory of Histology and Embryology, Cornell Umwersity, Ithaca, New Y ark
One Text Figure And Three Plates (Thirty Figures)
Introduction
The factors determining the appearance of large and small
accumulations of lymphoid tissue in the tunica propria of the
mucosa of the digestive and respiratory passageways have
in the past received only scant attention. In more recent
years, attempts have been made to ascertain What factors
might be responsible for the formation of the tonsils making
up the well-known Waldeyer’s ring, the Peyer’s patches of the
ileum, the nodules of the vermiform process, and the numerous
isolated nodules and difiuse lymphatic tissue scattered
throughout the tracts immediately under the epithelium.
Of the older views, that of Stohr (1891) has been widely
quoted. It Was his belief that accumulations of lymphocytes
outside of lymphatic nodes and lymphatic and blood Vessels
are agents of resorptive processes utilized in the removal of
structures which have entered upon a partial or complete
regression and illustrated by the collections of lymphocytes
in degenerating organs, such as the pronephros of lower vertebrates, gills of Anura, thymus, vermiform process, and palatine tonsils; the last were then believed to be derived from
the ‘degenerating’ second pharyngeal pouch. In this connection, Kingsley (’24) found that the true gland of the nictitating membrane of the cat and rabbit is a regressive structure and that this bears a close relation to the lymphoid tissue
present.
323
324 THEODORE SNOOK
That the regressive nature of the tonsils is the explanation
of the lymphocytopoietic reaction of the mesenchyme at those
sites seem improbable. In this connection, Kingsbury ( ’32 a)
states:
It is obvious, however, that as an interpretation of the intimate relationship of lymphocyte formation and epithelium
such as occurs in the tonsils, the suggestion is not thoroughly
adequate in itself, since it covers, in any event, but a superficial aspect of the matter. The developmental factors responsible for the differentiation must lie deeper.
A second interpretation was proposed by Schaffer (1898),
who believed that the formation of lymph nodules was bound
causally with the presence of gland ducts, there being a positive chemotactic action involved. A chemical stimulation was
again offered by Loeb (’15) as an explanation for the close
relation between regressive organs (transplanted tissue) and
lymphocyte production. He concluded “that the metabolic
changes taking place in tissues after homoio-transplantation
stimulate the activity of the lymphocytes and cause the altered function of the fibroblasts which now produce fibrous tissues in great quantities.”
Kingsbury and Rogers (’27) and Kingsbury (’32 a) analyzed carefully the development of the palatine tonsil of the
calf and pharyngeal tonsil of the cat, respectively. They
reached the same conclusion from each investigation, viz.,
that, as a result of the developmental mechanics of the regions
in question, areas of negative tension were formed which were
particularly favorable for lymphocyte proliferation. Besides
stress, another factor closely linked with this free cell proliferation was found to be the vasculogensis of the region, i.e.,
the production of lymphocytes is closely linked with the vascular endothelium.
The pharyngeal tonsil of the cat was selected by Kingsbury
(’32 a) for analysis because of its relatively simple structure;
i.e., it is not complicated as in man by the presence of longitudinal folds and the bursa pharyngea (50 per cent of the
cases). It was one purpose of the present investigation to
PHARNGEAL TONSIL : HOMO 325
analyze the development of the human pharyngeal tonsil
from the standpoint of the growth tensions involved, in order
to see if it conformed to the relations found in the cat, the ultimate aim being to discover the reasons for the lymphocytic
differentiation there existent. Furthermore, the need was
felt for checking the statements relevant; to the embryology of
that organ since numerous contradictions and misstatements
are found in the literature.
MATERIALS AND METHODS
Sections of 221 human embryos, ranging in size from 7 mm.
0.1%. length to newborn, were examined. These included
140 series and 12 dissected tonsillar regions from the Carnegie
Institution, Department of Embryology, and 50 series and 19
dissected tonsillar regions from the Cornell collection.1 The
dissected regions for the most part included the basis cranii
and were first examined under the dissecting microscope and
photographed. Most of the material was formalin fixed and
stained in toto with carmine, Lyon’s blue being used as a
counterstain in some cases. The dissected regions of two
fresh fetuses were fixed in Helly and stained with azure IIeosin.
OBSERVATIONS
External anatomy of the tonséllar region
In human fetuses aged 3 months or over, that part of the
nasal pharynx which is termed the vault, fornix, or roof is
very clearly delimited from the posterior and lateral pharyngeal walls. It has been described (Poirier and Charpy,
’01) as a roughly quadrilateral area bounded rostrad by the
superior border of the choanae and nasal. septum; posteriorly
by a line which cuts the pharyngeal tubercle and the beginning
of the posterior wall; laterally by the lateral recess of Ros
‘The work was carried out under the direction of Prof. B. F. Kingsbury, to
whom I am grateful for his kind assistance. I also wish to acknowledge the gen
erous help of Dr. G. L. Btreeter, Carnegie Institution of Embryology, in placing
at my disposal abundant material.
THE AMERICAN JOURNAL OF ANATOMY, VOL. 55, N0. 2
326 THEODORE SNOOK
enmiiller and the pharyngeal opening of the auditory tube
(of Eustacheus). Since the ph'aryngeal tonsil (adenoids)
eventually occupies the entire vault, it is proper to name it
the tonsillar region.
In the younger fetuses the region is distinctly more triangular in sha.pe with the apex at the junction of vault and
posterior wall. The bursa pharyngea (embryonalis) when
present is always found at this point.
A system of folds running longitudinally was clearly discernible in the youngest specimens examined from the surface.
In older fetuses the folds become more numerous and distinct,
tending to radiate rostrally from the apex of the bursa to
reconverge around the nasal septum (Snook, ’34, figures 1
to 10). In fetuses under 100 mm. no lymphatic tissue is
present within the tonsillar area. In the late fetus and newborn_ the folds found in the posterior half of the vault are
densely ‘packed’ with lymphatic tissue. Rounded eminences
appear along these folds, which are centers of lymphocyte
formation.
This system of folds and grooves, the median recess in particular, has been regarded by some as the first indication of
the pharyngeal tonsil, (Schwabach, 1887; Testut, ’12). However, since well-developed folds appear before any lymphatic
tissue is formed, they must be the expression of the developmental transformations of the region. It will similarly be
shown that the appearance ofilymphatic tissues bears a definite
relation to the developmental tensions in the pharyngeal Vault.
Growth tensions in the tonsillar region
Certain growth tendencies in the tonsillar region can readily
be followed; others are more obscure. The anterior part of
the pharyngeal roof early becomes involved in the formation
of the nasal septum. The down-growth carries with it as indicator of the extent of growth the hypophyseal stalk which is
destined to diflerentiate into the glandular pharyngeal hypophysis. In every case examined, the pharyngeal (proximal) extremity of the stalk was found to have been drawn
PHARNGEAL TONSILZ HOMO 327
rostrad ; in some cases the stalk was found to lie nearly parallel with the epithelium. Cases have been reported in which
the pharyngeal hypophysis was found far down on the septum
(Oitelli, ’11; see also figs. 1 and 3). The evidence indicates
that the region rostrad of the tonsillar area is one subjected
to active growth stresses in a longitudinal direction, and that
this stress is transmitted ‘over’ the tonsillar region proper
as indicated by the extent of fascia pharyngobasilaris. In
the septal region the entire space between epithelium and
Fig. 1 Median plane reconstruction of a 55-mm. human fetus series (somewhat diagrammatic) with the fascia pharyngobasilaris lgiotted in from paras:1gittal section. A, pharyngeal aponeurosis; BP, bursa pharyngea embryonalis; FP,
fascia pharyngobasilaris; H, hypophysis cerehri in sellaturcici; L, median suspensory ligament (raphe); N, notochord; 0, occipital ossification; P, soft palate;
PH, pharyngeal hypophysis; V, vomer. The tonsil forms in the looe tissue rostrad of the bursa and between the fascia pharyngobasilaris and the epithelium.
X 8.5.
cartilage is filled with dense connective tissue continuous with
the fascia. The vomer ossifies "from this dense membrane.
In the vault proper, the fascia is separated from the epithelium by an area of looser tissue which is destined to form
tunica propria (and submucosa) (figs. 1 and 2). In the posterior third of the Vault the m. longus capitis inserts on the
side of the fascia and basilar periosteum (figs. 7 and 21).
The differentiation of the posterior part of tonsillar area
and posterior pharyngeal wall is more complex. There are
THE AMERICAN JOURNAL OF ANATOMY, VOL. 55, N0. 2
328 THEODORE SNOOK
involved in its transformation the m. longus capitis, m. superior constrictor, fascia pharyngobasilaris, pharyngeal aponeurosis, a.nd median raphe. From the undifferentiated condition shown in figure 11, the fascia appears as two dense
bundles of fibrous differentiation and inserts on the lateral
borders of the fascia, thus introducing a tension factor over
the posterior part of the vault. These two bundles of fascia
retain their identity in this region, but blend rostrad with
each other and with the mucous membrane.
The In. superior constrictor typically extends to a point
slightly caudal to the pharyngeal angle and is separated from
the epithelium by the aponeurosis, which occasionally extends
to the pharyngeal angle (figs. 1 and 10).
The tonsillar area is thus interpolated between the differentiation of the nasal septum rostrally and the formation of
the pharyngeal musculature posteriorly. The stresses in
the Vault are longitudinal as evidenced by the formation and
relations of the fascia pharyngobasilaris. The fascia, originating from the perichondrium of the basioccipital cartilage
near the foramen magnum, runs diagonally toward the pharyngeal epithelium, making contact with it near the region of
the pharyngeal hypophysis (figs. 1 and 3). A median and
more caudal portion of the fascia bends more sharply, and,
blending with the median raphe, reaches the mucosa just
back of the pharyngeal angle, where it blends with the aponeurosis (figs. 1 and 10, and Snook, ’34, fig. 26). Thus, the
vault is characteristic in that its mucosa is lacking the dense
connective tissue and muscular support found completely
surrounding it. In this region, it is the looser tissue between
the epithelium and the fascia which forms reticular tissue with
lymphocytopoietic potencies.
The ‘neutrality’ of the region is shown in one other respect;
viz., it is located immediately ‘under’ the occipital-sphenoid
synchondrosis. It is in relation to two opposing growth tendencies; elongation of the occipital bone posteriorly, and the
growth of the sphenoid rostrad. The cells of the synchondrosis are often seen to be aligned as they are in the epiphyseal cartilage (fig. 2).
PHARNGEAL TONSIL : HOMO 329
Histogenesis of the tonsil
Within the tonsillar area one would expect to find quite
early indications of the transformation of the mesenchym.e between fascia and epithelium into reticular tunica propria in
which lymphocytes woud presently appear.
An early stage before any difierentiation has taken place
is shown in figure 11. In figure 12 the fascia pharyngebasilaris has formed, and the mesenchymal cells between
it and the epithelium show a slightly more ‘reticular’ nature
than before. It is not until the 39-mm. stage is reached that
definitely marked out areas of ‘reticular tissue’ appear within
the looser tissue of the sub—epithelial zone in small laterally
placed ‘islands’. These areas are larger and more distinct in
the 55-mm. embryo. Figure 14 is from a section through such
an area. The area of ‘reticular’ tissue blends with the surrounding fibers. Figure 13 is from the same section, but more
rostrad, and at about the level of the pharyngeal hypophysis,
showing the fibers of the fascia running close and parallel to
the epithelium.
In both of the above specimens, the areas of reticular tissue
were found in parasagittal sections. In median sections a
raphe usually exists (figs. 6 and 21). A similar area from an
80-mm. fetus is shown in figure 15. A few scattered ‘free’
cells appear at about this stage, but the stain (carmine and
Lyon’s blue) does not permit of a detailed cell study. More
medially, the tissue between the fascia and epithelium is
loose, but the fibers still run parallel to those of the fascia, but
in the meshes are large numbers of extravasated erythrocytes
(fig. 16). Extravasation (hemorrhage) is very common in
this area in Homo, just as Kingsbury (’32 b) found in the
eat, Where he interpreted it as an expression of “a faulty vasculogenesis in the region.” We are here dealing with a highly vascular area, especially rich in small vessels, with a very
loose connective tissue support. A 1531-mm. specimen also
shows hyaline degeneration of the developing tonsillar tissue
alone.
330 THEODORE SNOOK
Except for the red cells in the previous specimen (80 mm.),
very few free cells are encountered until the 100-mm. stage
is reached, and those few which are present are widely
scattered. A 100-mm. fetus shows a marked increase in the
number of free cells, and two well-marked aggregations appear. (i‘he ‘reticular’ tunica propria is much more extensive
and is particularly marked in the anterior lateral regions of
the vault. Lymphatic channels are large and extensive, and
numerous small blood vessels permeate each area. Each
center of cell proliferation, as shown in figures 17 and 18,
is closely related to the pharyngeal side of a large lymphatic
channel and is penetrated by small blood vessels. These centers are on opposite sides of the median planes, 1.5 mm. apart
and near the middle portion of the vault. A smaller, less
dense area is still more laterad. In these three centers the
cells are clearly lymphocytes. These relations uphold the
statements made by Kingsbury (’32 a) that “there is much
to suggest that vascular factors are intimately linked with
cell proliferation”; and “It is apparent that the formation
of this particular cell type (lymphocyte) bears a relation to
the presence of lymphatic endothe1ium.” Isolated cells with
myeoblastic and erythroblastic characteristics are found in
the tunica propria and in the looser tissue between it and
the dense fascia. Here, too, are found cells with histiocytic
characteristics, viz., small deeply staining nucleus and a distinct vacuolated cytoplasm, irregular in shape. In other
words, cellular differentiation is well under way in the tonsillar area.
This close relationship between lymphocyte proliferation
and basal lymphatic channels within the tonsillar area is
much in evidence in the smaller (younger) centers appearing
in later stages, as illustrated in figures 2, 21, 24, and 25. At
120 mm., similar centers are present, but cell differentiation
is occurring in all parts of the region, proceeding more rapidly
within the tunica propria. Here the majority of the free
cells are of the lymphocytic series, i.e., large and small lymphocytes and monocytes. An occasional eosinophile is also
PHARNGEAL TONSIL : HOMO 331
seen (figs. 19, 26, and 27). The tunica propria is now quite
extensive and forms an especially thick layer in the region
under the heads of the 111. longus capitis. It is nearly lacking in the more median plane sections, and the greatest
number of differentiating cells are found laterad.
A second type of differentiation is found in the region bordering the tonsillar area. In the cat, Kingsbury (’32 b) found
that the region between the tunica propria and the fascia
(capsule) was one of myelo- and erythropoiesis. In certain
human fetuses examined the regions of myelopoiesis were
within the fibres of the pharyngeal aponeurosis, i.e., between
in. superior constrictor and epithelium, and in its lateral
reaches (fig. 21, in lower left corner). Within these areas
large numbers of eosinophilic and neutrophilic myelocytes
and lymphocytes are formed (figs. 20, 22, 28, 29). In Homo,
the regions of erythropoiesis were found to be interspersed
between bundles making up the fascia pharyngobasilaris.
Some centers were found very near the occipital periosteum.
The smaller centers of normoblasts, etc. (figs. 30 and 31), are
entirely lacking vascular connections. A few larger groups
are found related to developing blood vessels. As another
type of cellular differentiation might be incidentally mentioned the transformation of fibrocytes into osteoblasts in
the anterior part of the tonsillar area where the vomer is
forming within the fascia pharyngobasilaris.
The above evidence would indicate that the difierentiation
of a particular cell type depends, to some extent, upon the type
of tissue environment and the vascular supply, the former
being determined, in the present case, by growth tensions to
which the region is subjected. Thus lymphocyte proliferation
is greatest in the region described above as the tonsillar
region, anarea which has already been referred to being one
of ‘negative’ growth tensions.
In a fetus of about the same age, 125 mm., the difierentiation has progressed to a much greater extent. In the lateral regions there are many centers very similar to those
of figures 17 and 18. Several centers are very large and form
332 THEODORE SNOOK
elevations into the pharyngeal cavity (fig. 2). Between these
various centers are wide areas with scattered lymphocytes.
One of the largest accumulations is just rostrad of the bursa
pharyngea, but not around it (Snook, ’34, fig. 22). The
youngest fetus which shows lymphatic tissue around the bursa
and behind it is 143 mm. in length (Snook, ’34, fig. 23), and
here the lymphatic layer is much less developed than that
which is rostrad of the bursa. Thus, contrary to the views
of Schwabach (1888), the lymphoid proliferation does not begin immediately around the median recess, nor does it begin
at the tip of the bursa as figured by Huber (’12). Lymphocytes do not appear in the tunica propria of the bursa until the differentiation is well advanced within the tonsillar
area proper, especially in the posterior lateral regions where
the centers of proliferation are largest, gradually decreasing
in size in a rostral direction (figs. 4 and 7).
From 150 mm. on, the lymphatic tissue ‘spreads’ in all directions particularly rostrad and laterad and to a lesser degree over the posterior wall. The advancing borders have
the same configuration as the earliest lymphatic tissue to
appear, viz., rounded centers of cell proliferation within the
tunica propria and nearly always clearly associated with lymphatic channels and blood vessels (figs. 6, 7, and 25). The
more central parts of the tonsillar mass unite to form a continuous sheet which increa.ses in thickness and density (fig. 5).
At 195 mm. (fig. 6), the lymphatic tissue has spread to the
lateral parts of the vault and is invading the tunica ‘propria of
the lateral recesses (of Rosemiiller). At 285 mm. (fig. 7) a
large amount of lymphatic tissue has been formed and the tonsillar folds are very distinct. Transverse sections of the
tonsil at birth are shown in figures 8 and 9.
From the earliest appearance of lymphatic tissue in the
tonsillar area, definite centers of proliferation are present.
These centers are recognized by their greater density and
rounded shape and often by a definite bulging into the pharynx (figs. 2, 4, and 25). When the mass of lymphocytes has
become very dense throughout the va.ult, these centers are
PHARNGEAL TONSIL : HOMO 333
less distinct, but are still recognizable under higher powers.
However, in the newborn specimens examined, very welldefined rounded centers are scattered throughout the lymphatic tissue (figs. 8 and 9). Each has a very rich blood
supply and is composed of closely massed lymphocytes, small
and medium sized, reticular cells, an occasional monocytic
cell and many erythrocytes. From their structures and relations these centers must be considered as primary nodules.
This brings up the question of the earliest appearance of
lymphatic nodules. According to Ganghofner (1879), nodules
are lacking in the foetus and the newborn, but appear during
the first and second years. Wex (1898) states that nodules
can sometimes be recognized in the newborn. Prenant (1896)
places the first appearance of nodules at the end of the sixth
month of uterine life. In the material at hand, germinal
centers, or secondary nodules, are lacking up to the time of
birth. Whether the primary nodules of the newborn have
come directly from the centers seen in the younger fetuses
or are formed directly in the diffuse lymphatic tissue of the
later stage is a difiicult question to decide because of the incompleteness of the series for the older stages. The evidence indicates that the former is the case.
The numerous gland ducts of this region are secondarily
surrounded by lymphatic tissue (figs. 7 and 8), which sometimes even forms a sheath around the longer ducts for some
distance. This fact may be of importance in the formation
of cysts in the vault. Lindt (’07) claimed that these cysts
came from ‘tied off’ excretory glandducts; the lymphatic
tissue would then be instrumental in causing the obstruction,
with the subsequent retention of secretion. Cysts in the pharyngeal vault have also been shown to result from the closure
of the mouth of the bursa pharyngea embronalis (Snook, ’34).
SUMMARY AND CONCLUSIONS
Statements of the earliest appearance. of lymphatic tissue
in the tunica propria of the pharyngeal vault vary from 3
to 6 months (Ganghofner, 1878, and Killian, 1888). Hellman,
334 THEODORE SNOOK
(’27) states that the tonsil is laid down in the fourth month.
This agrees with the findings of the present investigation in
which the earliest accumulations of lymphocytes were observed
at 100 mm. (3 months). Germinal centers (secondary nodules) were not present in the fetuses examined, two newborn
included. This is to be expected if germinal centers represent a reaction against bacteria, etc., which would only be
present after birth.
Schwabach believed the bursa pharyngea to represent the
first anlage of the pharyngeal tonsil and that lymphocytes
first appeared around that depression. The present study
supports the statement of Killian that the pharyngeal tonsil
is developed independently of the bursa pharyngea. The first
adenoid tissue to appear was found rostrad and laterad of
the bursa. The tunica propria of the bursa was found to be
‘infiltrated’ only after a well-developed layer of lymphatic
tissue had formed in the vault (140 mm.).
The purpose of this study was to try to discover what factors favored the great proliferation of lymphocytes in the
tunica propria of the tonsillar region. It has been shown
above that the tonsil forms in a region which has little skeletal support. The connective tissue condensations (fascia
pharyngobasilaris, aponeurosis, etc.) represent regions of
growth tensions and are formed on all sides of the vault, but
the tissue of the tunica propria within these bounds retains
its loose embryonic character (fig. 1). This same region receives a particularly rich vascular supply. The relation of
the centers of cell proliferation to Vascular endothelium was
pointed out above. Thus, it is believed with Kingsbury
( ’32 a), that the loose character of the tissue ( ‘negative’ tension) a.nd the rich vascular supply are factors responsible
for the differentiation of the pharyngeal tonsil. These factors are reflected in the frequent hemorrhage and other
pathological processes there existent.
The presence of haemopoiesis in the tissues bordering the
tonsillar area suggests the close relationship of these cells
to lymphocytes and also to the adequacy of the region for
their proliferation.
PHAR-NGEAL TONSIL : HOMO 335
LITERATURE CITED
CITELLI 1911 L’Ipofisi faringea nella prima e seconda infanzia. Suoi rap
porti colla mucosa faringea e Coll’iopifisi centrale. Anat. Anz. Bd.
38, S. 242-256; 279-302; 334-349.
GANGPIOFNER, FR. 1879 Ueber die Tonsilla und Bursa pharyngea. Sitzungsber d. k. Akad. d. Wiss. in Wein., Bd. 78, S. 182-212.
HELLMAN, '1'. 1927 Der lymphatische Rachenring. S. 245-283 in Handbuch
d. mikr. Anat. des Menschen, Bd. 5, Teil 1, Ed. Wilh v. Miillendorfl’.
HUBER, G. C. 1912 On the relation of the chorda éiorsalis to the anlage of the
pharyngeal bursa or the median pharyngeal recess. Anat. Rec., vol. 6,
pp. 373--404.
KILLIAN, G. 1888 Ueber die Bursa und Tonsilla pharyngea. Eine entwiekel
ungeschichtliche und vergleichen-anatomische Studie. Morphol. J ahrb.,
Bd. 14, S. 618-711.
KINGSBURY, B. F. 1932 a The developmental significance of the mammalian pharyngeal tonsil: cat. Am. J. Anat., v. 50, pp. 201-231.
1932 b The development of the pharyngeal tonsil (cat): cell types.
Am. J. Anat., vol. 51, pp. 269-305.
KINGSBURY, B. E, AND W. M. ROGERS 1927 The development of the palatine
tonsil: calf (Bos taurus). Am. J. Anat., vol. 39, pp. 379-435.
KINGSLEY, D. W. 1924 Regressive structures and the lymphocyte. The plasma
cell; its origin and development. A study of the mammalian nicitating
membrane. Anat. Rec., vol. 29, pp. 1-19.
LOEB, L. 1915 The influence of changes in the chemical environment on the
life a11d growth in tissues. J. Am. Med. Assoc., vol. 64, pp. 726-728.
Pommn, R, AND A. CHARPY 1901 Thaité d’anatomie humaine. T. 4. p. 162-174.
PRENANT, A. 1896 Elements d’embryologie de l’homme et des vertébrés. Livre
a pp. 164-166.
SCHAFFER, J. 1898 Beitrage zur Histologie menschlieher Organe. IV. Zunge.
V. Mundhiihle-Schlundkopf, usw. Sitzungsber. Akad. Wiss. Wein.
Math.-nat. KL, Bd. 106.
SCHWABACH 1887 Ueber die Bursa pharyngea. Arch. f. mikr. Anat., Bd. 29,
S. 61-74.
1888 Zur Entwickelung der Rachentonsille. Arch. f. mikr. Anat-.,
Bd. 32, S. 187-213.
SNooK, T. 1934 The later development of the bursa pharyngea: Homo, Anat.
Rec., vol. 58, pp. 303-320.
Swiina, PH. 1891 Ueber die Mandeln und deren Entwickelung. Die Entwickelung des Adenoiden Grewebes der Zungenbiilge und der Mandeln der
Menschen. Anat. Anz., Bd. 6, S. 545-548.
TESTUT, L. 1912 Traité d’anatomie humaine, T. 4, pp. 87-95.
WEX, F. 1898 Beitriige zur normalen und pathologischen Histologie der Rachentonsille. Zeitchr. f. Ohrenheilk, Bd. 34., S. 207-240.
PLATE 1
EXPLANATION or rxeuans
2 Homo; 125-mm. fetus. Parasagittal section through vault and posterior pharyngeal wall. From above downward are seen the basilar cartilage,
fascia pharyngobasilaris, and mucosa with lymphatic channels and a protruding
‘nodule.’ Longus capitis muscle is seen at extreme right. X 12.
3 Homo; 135-mm. fetus. Median sagittal section through pharyngeal hypophysis. To the right (rostrad) the fascia blends with the mucosa; to the left,
lymphatic tisue appears between facia and epithelium. x 24.
4 Homo; 50-mm. fetus. Parasagittal section; showing a large lymphatic
nodule just rostrad of the pharyngeal angle. Fascia and occipital ossification
are above. X 12.
5 Homo; 180-mm. fetus. Sagittal section, showing a wide area of loose tissue
between tonsil and fascia. X 60.
6 Homo; 195-mm. fetus. Transverse section through pharyngeal tonsil, showing denser center of proliferation and invasion of lateral recess. Fascia and m.
longu capitis are above. X 8.
7 I-Iomo; 285-mm. fetus. Parasagittal section through the tonsil. Many
gland ducts are seen passing through the lymphatic tissue. Fascia and muscle
above. X 9.5.
8 Homo; newborn. Transection through tonsil and median reces. Definite
primary nodules are seen in diffuse lymphatic tissue. X 12.
9 Same. Two primary nodules are seen. X 50.
10 Homo; 55-mm embryo. Nearly median section, showing the actual features
from which figure 1 was traced. Superior constrictor muscle is seen in lower
right-hand corner. Fascia extends from upper right to lower left. The side of
the bursa is present in the lower left. X 76.
11 Homo; 11-mm. embryo. Undifferentiated stage. Basilar cartilage forming
at left. Sagittal ection. X 280.
PLATE 2
EXPLANATION or FIGURES
12 Homo; 18-mm. embryo. Sagittal section showing the condensation forming the fascia. pha.ryngohasi1aris. Basilar cartilage not shown. X 280.
13 Homo; 55-mm. embryo. Sagittal section showing fascia directly under
the epithelium at the rostral end of the tonsillar region. X 280.
14 Same. From within the tonsillar area, i.e., posterior to the above, showing
beginning of the formation of ‘reticular’ tuniea propria. X 280.
15 Homo; 80—mm. fetus. Parasagittal section, showing ‘reticular’ tunioa
propria from anterior portion of tonsillar area. Fascia above. X 150.
16 Same. Median section, showing hemorrhage within the loose tissue be
tween fascia (above) and epithelium. X 150.
17 Homo; 100-mm. fetus. Parasagittal section, showing one of three centers
of lymphocyte proliferation in this fetus_ A large lyxnphatio vessel is associated
with the center. X 150.
18 Same. A center from the opposite side. X 280.
19 Homo; 120-mm. fetus. Lymphocytes are seen forming in the tuniea propria of the tonsillar area. Fascia above. X 300.
20 Same. Myelocyte formation from the region bordering the tonsillar are-:1
posteriorly. X 280.
21 Homo; 135-mm. fetus. Transverse section through tonsillar region. Several nodules are shown. Basilar cartilage above. X marks the site of myelopoiesis (fig. 22). X 95.
22 Same. Myeloeyte formation in the region bordering tonsillar area. X 640.
23 Homo; 1-L3-mm. fetus. Sagittal section, showing the tunica propria ‘filled’
with lymphocytes. Fascia above. X 120_
24 Homo, 125-mm. fetus. L_vmpho<-yte proliferation under a lympliatic vessel.
X 48.
25 Homo; 180-mm. fetus. New eenters of lvmphocyte formation from anterior margin of the pharyngeal tonsil. Relation to lymphatic is clearly shown.
X 28.
PLATE 3
EXPLANATION OF FIGURES
26 and 27 Homo; 120»mm. fetus. (‘cells of the lymphocyte series forming
within the tunica propria of the tonsillar area Monocytes and an eosinophile
are also shown. X 1216.
28 and 29 Same. Myelcwyte formation from the region posterior to the tonsillar area. Some lympl10c_vtes are also S110\’V1l. X 1216.
30 and 31 Same. Erythroblasts and normoblasts from within the fascia
plxaryngobasilaris. X 1216.
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This historic 1934 paper by Snook described development of the human pharyngeal tonsil. This tonsil is associated with the mouth portion of the gastrointestinal tract development and has an important postnatal role in immune function.


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The Development Of The Human Pharyngeal Tonsil

Theodore Snook


Laboratory of Histology and Embryology, Cornell Umwersity, Ithaca, New Y ark

One Text Figure And Three Plates (Thirty Figures)

Introduction

The factors determining the appearance of large and small accumulations of lymphoid tissue in the tunica propria of the mucosa of the digestive and respiratory passageways have in the past received only scant attention. In more recent years, attempts have been made to ascertain What factors might be responsible for the formation of the tonsils making up the well-known Waldeyer’s ring, the Peyer’s patches of the ileum, the nodules of the vermiform process, and the numerous isolated nodules and difiuse lymphatic tissue scattered throughout the tracts immediately under the epithelium.

Of the older views, that of Stohr (1891) has been widely quoted. It Was his belief that accumulations of lymphocytes outside of lymphatic nodes and lymphatic and blood Vessels are agents of resorptive processes utilized in the removal of structures which have entered upon a partial or complete regression and illustrated by the collections of lymphocytes in degenerating organs, such as the pronephros of lower vertebrates, gills of Anura, thymus, vermiform process, and palatine tonsils; the last were then believed to be derived from the ‘degenerating’ second pharyngeal pouch. In this connection, Kingsley (’24) found that the true gland of the nictitating membrane of the cat and rabbit is a regressive structure and that this bears a close relation to the lymphoid tissue

present. 323 324 THEODORE SNOOK

That the regressive nature of the tonsils is the explanation of the lymphocytopoietic reaction of the mesenchyme at those sites seem improbable. In this connection, Kingsbury ( ’32 a) states:

It is obvious, however, that as an interpretation of the intimate relationship of lymphocyte formation and epithelium such as occurs in the tonsils, the suggestion is not thoroughly adequate in itself, since it covers, in any event, but a superficial aspect of the matter. The developmental factors responsible for the differentiation must lie deeper.

A second interpretation was proposed by Schaffer (1898), who believed that the formation of lymph nodules was bound causally with the presence of gland ducts, there being a positive chemotactic action involved. A chemical stimulation was again offered by Loeb (’15) as an explanation for the close relation between regressive organs (transplanted tissue) and lymphocyte production. He concluded “that the metabolic changes taking place in tissues after homoio-transplantation stimulate the activity of the lymphocytes and cause the altered function of the fibroblasts which now produce fibrous tissues in great quantities.”

Kingsbury and Rogers (’27) and Kingsbury (’32 a) analyzed carefully the development of the palatine tonsil of the calf and pharyngeal tonsil of the cat, respectively. They reached the same conclusion from each investigation, viz., that, as a result of the developmental mechanics of the regions in question, areas of negative tension were formed which were particularly favorable for lymphocyte proliferation. Besides stress, another factor closely linked with this free cell proliferation was found to be the vasculogensis of the region, i.e., the production of lymphocytes is closely linked with the vascular endothelium.

The pharyngeal tonsil of the cat was selected by Kingsbury (’32 a) for analysis because of its relatively simple structure; i.e., it is not complicated as in man by the presence of longitudinal folds and the bursa pharyngea (50 per cent of the cases). It was one purpose of the present investigation to PHARNGEAL TONSIL : HOMO 325

analyze the development of the human pharyngeal tonsil from the standpoint of the growth tensions involved, in order to see if it conformed to the relations found in the cat, the ultimate aim being to discover the reasons for the lymphocytic differentiation there existent. Furthermore, the need was felt for checking the statements relevant; to the embryology of that organ since numerous contradictions and misstatements are found in the literature.

MATERIALS AND METHODS

Sections of 221 human embryos, ranging in size from 7 mm. 0.1%. length to newborn, were examined. These included 140 series and 12 dissected tonsillar regions from the Carnegie Institution, Department of Embryology, and 50 series and 19 dissected tonsillar regions from the Cornell collection.1 The dissected regions for the most part included the basis cranii and were first examined under the dissecting microscope and photographed. Most of the material was formalin fixed and stained in toto with carmine, Lyon’s blue being used as a counterstain in some cases. The dissected regions of two

fresh fetuses were fixed in Helly and stained with azure IIeosin.

OBSERVATIONS External anatomy of the tonséllar region

In human fetuses aged 3 months or over, that part of the nasal pharynx which is termed the vault, fornix, or roof is very clearly delimited from the posterior and lateral pharyngeal walls. It has been described (Poirier and Charpy, ’01) as a roughly quadrilateral area bounded rostrad by the superior border of the choanae and nasal. septum; posteriorly by a line which cuts the pharyngeal tubercle and the beginning of the posterior wall; laterally by the lateral recess of Ros ‘The work was carried out under the direction of Prof. B. F. Kingsbury, to whom I am grateful for his kind assistance. I also wish to acknowledge the gen erous help of Dr. G. L. Btreeter, Carnegie Institution of Embryology, in placing at my disposal abundant material.

THE AMERICAN JOURNAL OF ANATOMY, VOL. 55, N0. 2 326 THEODORE SNOOK

enmiiller and the pharyngeal opening of the auditory tube (of Eustacheus). Since the ph'aryngeal tonsil (adenoids) eventually occupies the entire vault, it is proper to name it the tonsillar region.

In the younger fetuses the region is distinctly more triangular in sha.pe with the apex at the junction of vault and posterior wall. The bursa pharyngea (embryonalis) when present is always found at this point.

A system of folds running longitudinally was clearly discernible in the youngest specimens examined from the surface. In older fetuses the folds become more numerous and distinct, tending to radiate rostrally from the apex of the bursa to reconverge around the nasal septum (Snook, ’34, figures 1 to 10). In fetuses under 100 mm. no lymphatic tissue is present within the tonsillar area. In the late fetus and newborn_ the folds found in the posterior half of the vault are densely ‘packed’ with lymphatic tissue. Rounded eminences appear along these folds, which are centers of lymphocyte formation.

This system of folds and grooves, the median recess in particular, has been regarded by some as the first indication of the pharyngeal tonsil, (Schwabach, 1887; Testut, ’12). However, since well-developed folds appear before any lymphatic tissue is formed, they must be the expression of the developmental transformations of the region. It will similarly be shown that the appearance ofilymphatic tissues bears a definite relation to the developmental tensions in the pharyngeal Vault.

Growth tensions in the tonsillar region

Certain growth tendencies in the tonsillar region can readily be followed; others are more obscure. The anterior part of the pharyngeal roof early becomes involved in the formation of the nasal septum. The down-growth carries with it as indicator of the extent of growth the hypophyseal stalk which is destined to diflerentiate into the glandular pharyngeal hypophysis. In every case examined, the pharyngeal (proximal) extremity of the stalk was found to have been drawn PHARNGEAL TONSILZ HOMO 327

rostrad ; in some cases the stalk was found to lie nearly parallel with the epithelium. Cases have been reported in which the pharyngeal hypophysis was found far down on the septum (Oitelli, ’11; see also figs. 1 and 3). The evidence indicates that the region rostrad of the tonsillar area is one subjected to active growth stresses in a longitudinal direction, and that this stress is transmitted ‘over’ the tonsillar region proper as indicated by the extent of fascia pharyngobasilaris. In the septal region the entire space between epithelium and


Fig. 1 Median plane reconstruction of a 55-mm. human fetus series (somewhat diagrammatic) with the fascia pharyngobasilaris lgiotted in from paras:1gittal section. A, pharyngeal aponeurosis; BP, bursa pharyngea embryonalis; FP, fascia pharyngobasilaris; H, hypophysis cerehri in sellaturcici; L, median suspensory ligament (raphe); N, notochord; 0, occipital ossification; P, soft palate; PH, pharyngeal hypophysis; V, vomer. The tonsil forms in the looe tissue rostrad of the bursa and between the fascia pharyngobasilaris and the epithelium. X 8.5.

cartilage is filled with dense connective tissue continuous with the fascia. The vomer ossifies "from this dense membrane. In the vault proper, the fascia is separated from the epithelium by an area of looser tissue which is destined to form tunica propria (and submucosa) (figs. 1 and 2). In the posterior third of the Vault the m. longus capitis inserts on the side of the fascia and basilar periosteum (figs. 7 and 21).

The differentiation of the posterior part of tonsillar area and posterior pharyngeal wall is more complex. There are

THE AMERICAN JOURNAL OF ANATOMY, VOL. 55, N0. 2 328 THEODORE SNOOK

involved in its transformation the m. longus capitis, m. superior constrictor, fascia pharyngobasilaris, pharyngeal aponeurosis, a.nd median raphe. From the undifferentiated condition shown in figure 11, the fascia appears as two dense bundles of fibrous differentiation and inserts on the lateral borders of the fascia, thus introducing a tension factor over the posterior part of the vault. These two bundles of fascia retain their identity in this region, but blend rostrad with each other and with the mucous membrane.

The In. superior constrictor typically extends to a point slightly caudal to the pharyngeal angle and is separated from the epithelium by the aponeurosis, which occasionally extends to the pharyngeal angle (figs. 1 and 10).

The tonsillar area is thus interpolated between the differentiation of the nasal septum rostrally and the formation of the pharyngeal musculature posteriorly. The stresses in the Vault are longitudinal as evidenced by the formation and relations of the fascia pharyngobasilaris. The fascia, originating from the perichondrium of the basioccipital cartilage near the foramen magnum, runs diagonally toward the pharyngeal epithelium, making contact with it near the region of the pharyngeal hypophysis (figs. 1 and 3). A median and more caudal portion of the fascia bends more sharply, and, blending with the median raphe, reaches the mucosa just back of the pharyngeal angle, where it blends with the aponeurosis (figs. 1 and 10, and Snook, ’34, fig. 26). Thus, the vault is characteristic in that its mucosa is lacking the dense connective tissue and muscular support found completely surrounding it. In this region, it is the looser tissue between the epithelium and the fascia which forms reticular tissue with lymphocytopoietic potencies.

The ‘neutrality’ of the region is shown in one other respect; viz., it is located immediately ‘under’ the occipital-sphenoid synchondrosis. It is in relation to two opposing growth tendencies; elongation of the occipital bone posteriorly, and the growth of the sphenoid rostrad. The cells of the synchondrosis are often seen to be aligned as they are in the epiphyseal cartilage (fig. 2). PHARNGEAL TONSIL : HOMO 329

Histogenesis of the tonsil

Within the tonsillar area one would expect to find quite early indications of the transformation of the mesenchym.e between fascia and epithelium into reticular tunica propria in which lymphocytes woud presently appear.

An early stage before any difierentiation has taken place is shown in figure 11. In figure 12 the fascia pharyngebasilaris has formed, and the mesenchymal cells between it and the epithelium show a slightly more ‘reticular’ nature than before. It is not until the 39-mm. stage is reached that definitely marked out areas of ‘reticular tissue’ appear within the looser tissue of the sub—epithelial zone in small laterally placed ‘islands’. These areas are larger and more distinct in the 55-mm. embryo. Figure 14 is from a section through such an area. The area of ‘reticular’ tissue blends with the surrounding fibers. Figure 13 is from the same section, but more rostrad, and at about the level of the pharyngeal hypophysis, showing the fibers of the fascia running close and parallel to the epithelium.

In both of the above specimens, the areas of reticular tissue were found in parasagittal sections. In median sections a raphe usually exists (figs. 6 and 21). A similar area from an 80-mm. fetus is shown in figure 15. A few scattered ‘free’ cells appear at about this stage, but the stain (carmine and Lyon’s blue) does not permit of a detailed cell study. More medially, the tissue between the fascia and epithelium is loose, but the fibers still run parallel to those of the fascia, but in the meshes are large numbers of extravasated erythrocytes (fig. 16). Extravasation (hemorrhage) is very common in this area in Homo, just as Kingsbury (’32 b) found in the eat, Where he interpreted it as an expression of “a faulty vasculogenesis in the region.” We are here dealing with a highly vascular area, especially rich in small vessels, with a very loose connective tissue support. A 1531-mm. specimen also shows hyaline degeneration of the developing tonsillar tissue alone. 330 THEODORE SNOOK

Except for the red cells in the previous specimen (80 mm.), very few free cells are encountered until the 100-mm. stage is reached, and those few which are present are widely scattered. A 100-mm. fetus shows a marked increase in the number of free cells, and two well-marked aggregations appear. (i‘he ‘reticular’ tunica propria is much more extensive and is particularly marked in the anterior lateral regions of the vault. Lymphatic channels are large and extensive, and numerous small blood vessels permeate each area. Each center of cell proliferation, as shown in figures 17 and 18, is closely related to the pharyngeal side of a large lymphatic channel and is penetrated by small blood vessels. These centers are on opposite sides of the median planes, 1.5 mm. apart and near the middle portion of the vault. A smaller, less dense area is still more laterad. In these three centers the cells are clearly lymphocytes. These relations uphold the statements made by Kingsbury (’32 a) that “there is much to suggest that vascular factors are intimately linked with cell proliferation”; and “It is apparent that the formation of this particular cell type (lymphocyte) bears a relation to the presence of lymphatic endothe1ium.” Isolated cells with myeoblastic and erythroblastic characteristics are found in the tunica propria and in the looser tissue between it and the dense fascia. Here, too, are found cells with histiocytic characteristics, viz., small deeply staining nucleus and a distinct vacuolated cytoplasm, irregular in shape. In other words, cellular differentiation is well under way in the tonsillar area.

This close relationship between lymphocyte proliferation and basal lymphatic channels within the tonsillar area is much in evidence in the smaller (younger) centers appearing in later stages, as illustrated in figures 2, 21, 24, and 25. At 120 mm., similar centers are present, but cell differentiation is occurring in all parts of the region, proceeding more rapidly within the tunica propria. Here the majority of the free cells are of the lymphocytic series, i.e., large and small lymphocytes and monocytes. An occasional eosinophile is also PHARNGEAL TONSIL : HOMO 331

seen (figs. 19, 26, and 27). The tunica propria is now quite extensive and forms an especially thick layer in the region under the heads of the 111. longus capitis. It is nearly lacking in the more median plane sections, and the greatest number of differentiating cells are found laterad.

A second type of differentiation is found in the region bordering the tonsillar area. In the cat, Kingsbury (’32 b) found that the region between the tunica propria and the fascia (capsule) was one of myelo- and erythropoiesis. In certain human fetuses examined the regions of myelopoiesis were within the fibres of the pharyngeal aponeurosis, i.e., between in. superior constrictor and epithelium, and in its lateral reaches (fig. 21, in lower left corner). Within these areas large numbers of eosinophilic and neutrophilic myelocytes and lymphocytes are formed (figs. 20, 22, 28, 29). In Homo, the regions of erythropoiesis were found to be interspersed between bundles making up the fascia pharyngobasilaris. Some centers were found very near the occipital periosteum. The smaller centers of normoblasts, etc. (figs. 30 and 31), are entirely lacking vascular connections. A few larger groups are found related to developing blood vessels. As another type of cellular differentiation might be incidentally mentioned the transformation of fibrocytes into osteoblasts in the anterior part of the tonsillar area where the vomer is forming within the fascia pharyngobasilaris.

The above evidence would indicate that the difierentiation of a particular cell type depends, to some extent, upon the type of tissue environment and the vascular supply, the former being determined, in the present case, by growth tensions to which the region is subjected. Thus lymphocyte proliferation is greatest in the region described above as the tonsillar region, anarea which has already been referred to being one of ‘negative’ growth tensions.

In a fetus of about the same age, 125 mm., the difierentiation has progressed to a much greater extent. In the lateral regions there are many centers very similar to those of figures 17 and 18. Several centers are very large and form 332 THEODORE SNOOK

elevations into the pharyngeal cavity (fig. 2). Between these various centers are wide areas with scattered lymphocytes. One of the largest accumulations is just rostrad of the bursa pharyngea, but not around it (Snook, ’34, fig. 22). The youngest fetus which shows lymphatic tissue around the bursa and behind it is 143 mm. in length (Snook, ’34, fig. 23), and here the lymphatic layer is much less developed than that which is rostrad of the bursa. Thus, contrary to the views of Schwabach (1888), the lymphoid proliferation does not begin immediately around the median recess, nor does it begin at the tip of the bursa as figured by Huber (’12). Lymphocytes do not appear in the tunica propria of the bursa until the differentiation is well advanced within the tonsillar area proper, especially in the posterior lateral regions where the centers of proliferation are largest, gradually decreasing in size in a rostral direction (figs. 4 and 7).

From 150 mm. on, the lymphatic tissue ‘spreads’ in all directions particularly rostrad and laterad and to a lesser degree over the posterior wall. The advancing borders have the same configuration as the earliest lymphatic tissue to appear, viz., rounded centers of cell proliferation within the tunica propria and nearly always clearly associated with lymphatic channels and blood vessels (figs. 6, 7, and 25). The more central parts of the tonsillar mass unite to form a continuous sheet which increa.ses in thickness and density (fig. 5).

At 195 mm. (fig. 6), the lymphatic tissue has spread to the lateral parts of the vault and is invading the tunica ‘propria of the lateral recesses (of Rosemiiller). At 285 mm. (fig. 7) a large amount of lymphatic tissue has been formed and the tonsillar folds are very distinct. Transverse sections of the tonsil at birth are shown in figures 8 and 9.

From the earliest appearance of lymphatic tissue in the tonsillar area, definite centers of proliferation are present. These centers are recognized by their greater density and rounded shape and often by a definite bulging into the pharynx (figs. 2, 4, and 25). When the mass of lymphocytes has become very dense throughout the va.ult, these centers are PHARNGEAL TONSIL : HOMO 333

less distinct, but are still recognizable under higher powers. However, in the newborn specimens examined, very welldefined rounded centers are scattered throughout the lymphatic tissue (figs. 8 and 9). Each has a very rich blood supply and is composed of closely massed lymphocytes, small and medium sized, reticular cells, an occasional monocytic cell and many erythrocytes. From their structures and relations these centers must be considered as primary nodules.

This brings up the question of the earliest appearance of lymphatic nodules. According to Ganghofner (1879), nodules are lacking in the foetus and the newborn, but appear during the first and second years. Wex (1898) states that nodules can sometimes be recognized in the newborn. Prenant (1896) places the first appearance of nodules at the end of the sixth month of uterine life. In the material at hand, germinal centers, or secondary nodules, are lacking up to the time of birth. Whether the primary nodules of the newborn have come directly from the centers seen in the younger fetuses or are formed directly in the diffuse lymphatic tissue of the later stage is a difiicult question to decide because of the incompleteness of the series for the older stages. The evidence indicates that the former is the case.

The numerous gland ducts of this region are secondarily surrounded by lymphatic tissue (figs. 7 and 8), which sometimes even forms a sheath around the longer ducts for some distance. This fact may be of importance in the formation of cysts in the vault. Lindt (’07) claimed that these cysts came from ‘tied off’ excretory glandducts; the lymphatic tissue would then be instrumental in causing the obstruction, with the subsequent retention of secretion. Cysts in the pharyngeal vault have also been shown to result from the closure of the mouth of the bursa pharyngea embronalis (Snook, ’34).

SUMMARY AND CONCLUSIONS

Statements of the earliest appearance. of lymphatic tissue in the tunica propria of the pharyngeal vault vary from 3 to 6 months (Ganghofner, 1878, and Killian, 1888). Hellman, 334 THEODORE SNOOK

(’27) states that the tonsil is laid down in the fourth month. This agrees with the findings of the present investigation in which the earliest accumulations of lymphocytes were observed at 100 mm. (3 months). Germinal centers (secondary nodules) were not present in the fetuses examined, two newborn included. This is to be expected if germinal centers represent a reaction against bacteria, etc., which would only be present after birth.

Schwabach believed the bursa pharyngea to represent the first anlage of the pharyngeal tonsil and that lymphocytes first appeared around that depression. The present study supports the statement of Killian that the pharyngeal tonsil is developed independently of the bursa pharyngea. The first adenoid tissue to appear was found rostrad and laterad of the bursa. The tunica propria of the bursa was found to be ‘infiltrated’ only after a well-developed layer of lymphatic tissue had formed in the vault (140 mm.).

The purpose of this study was to try to discover what factors favored the great proliferation of lymphocytes in the tunica propria of the tonsillar region. It has been shown above that the tonsil forms in a region which has little skeletal support. The connective tissue condensations (fascia pharyngobasilaris, aponeurosis, etc.) represent regions of growth tensions and are formed on all sides of the vault, but the tissue of the tunica propria within these bounds retains its loose embryonic character (fig. 1). This same region receives a particularly rich vascular supply. The relation of the centers of cell proliferation to Vascular endothelium was pointed out above. Thus, it is believed with Kingsbury ( ’32 a), that the loose character of the tissue ( ‘negative’ tension) a.nd the rich vascular supply are factors responsible for the differentiation of the pharyngeal tonsil. These factors are reflected in the frequent hemorrhage and other pathological processes there existent.

The presence of haemopoiesis in the tissues bordering the tonsillar area suggests the close relationship of these cells to lymphocytes and also to the adequacy of the region for their proliferation. PHAR-NGEAL TONSIL : HOMO 335

LITERATURE CITED

CITELLI 1911 L’Ipofisi faringea nella prima e seconda infanzia. Suoi rap porti colla mucosa faringea e Coll’iopifisi centrale. Anat. Anz. Bd. 38, S. 242-256; 279-302; 334-349.

GANGPIOFNER, FR. 1879 Ueber die Tonsilla und Bursa pharyngea. Sitzungsber d. k. Akad. d. Wiss. in Wein., Bd. 78, S. 182-212.

HELLMAN, '1'. 1927 Der lymphatische Rachenring. S. 245-283 in Handbuch d. mikr. Anat. des Menschen, Bd. 5, Teil 1, Ed. Wilh v. Miillendorfl’.

HUBER, G. C. 1912 On the relation of the chorda éiorsalis to the anlage of the

pharyngeal bursa or the median pharyngeal recess. Anat. Rec., vol. 6, pp. 373--404. KILLIAN, G. 1888 Ueber die Bursa und Tonsilla pharyngea. Eine entwiekel ungeschichtliche und vergleichen-anatomische Studie. Morphol. J ahrb., Bd. 14, S. 618-711. KINGSBURY, B. F. 1932 a The developmental significance of the mammalian pharyngeal tonsil: cat. Am. J. Anat., v. 50, pp. 201-231. 1932 b The development of the pharyngeal tonsil (cat): cell types. Am. J. Anat., vol. 51, pp. 269-305. KINGSBURY, B. E, AND W. M. ROGERS 1927 The development of the palatine tonsil: calf (Bos taurus). Am. J. Anat., vol. 39, pp. 379-435. KINGSLEY, D. W. 1924 Regressive structures and the lymphocyte. The plasma cell; its origin and development. A study of the mammalian nicitating membrane. Anat. Rec., vol. 29, pp. 1-19. LOEB, L. 1915 The influence of changes in the chemical environment on the life a11d growth in tissues. J. Am. Med. Assoc., vol. 64, pp. 726-728. Pommn, R, AND A. CHARPY 1901 Thaité d’anatomie humaine. T. 4. p. 162-174. PRENANT, A. 1896 Elements d’embryologie de l’homme et des vertébrés. Livre a pp. 164-166. SCHAFFER, J. 1898 Beitrage zur Histologie menschlieher Organe. IV. Zunge.

V. Mundhiihle-Schlundkopf, usw. Sitzungsber. Akad. Wiss. Wein.

Math.-nat. KL, Bd. 106.

SCHWABACH 1887 Ueber die Bursa pharyngea. Arch. f. mikr. Anat., Bd. 29, S. 61-74.

1888 Zur Entwickelung der Rachentonsille. Arch. f. mikr. Anat-., Bd. 32, S. 187-213.

SNooK, T. 1934 The later development of the bursa pharyngea: Homo, Anat. Rec., vol. 58, pp. 303-320.

Swiina, PH. 1891 Ueber die Mandeln und deren Entwickelung. Die Entwickelung des Adenoiden Grewebes der Zungenbiilge und der Mandeln der Menschen. Anat. Anz., Bd. 6, S. 545-548.

TESTUT, L. 1912 Traité d’anatomie humaine, T. 4, pp. 87-95.

WEX, F. 1898 Beitriige zur normalen und pathologischen Histologie der Rachentonsille. Zeitchr. f. Ohrenheilk, Bd. 34., S. 207-240.


PLATE 1 EXPLANATION or rxeuans

2 Homo; 125-mm. fetus. Parasagittal section through vault and posterior pharyngeal wall. From above downward are seen the basilar cartilage, fascia pharyngobasilaris, and mucosa with lymphatic channels and a protruding ‘nodule.’ Longus capitis muscle is seen at extreme right. X 12.

3 Homo; 135-mm. fetus. Median sagittal section through pharyngeal hypophysis. To the right (rostrad) the fascia blends with the mucosa; to the left, lymphatic tisue appears between facia and epithelium. x 24.

4 Homo; 50-mm. fetus. Parasagittal section; showing a large lymphatic nodule just rostrad of the pharyngeal angle. Fascia and occipital ossification are above. X 12.

5 Homo; 180-mm. fetus. Sagittal section, showing a wide area of loose tissue between tonsil and fascia. X 60.

6 Homo; 195-mm. fetus. Transverse section through pharyngeal tonsil, showing denser center of proliferation and invasion of lateral recess. Fascia and m. longu capitis are above. X 8.

7 I-Iomo; 285-mm. fetus. Parasagittal section through the tonsil. Many gland ducts are seen passing through the lymphatic tissue. Fascia and muscle above. X 9.5.

8 Homo; newborn. Transection through tonsil and median reces. Definite primary nodules are seen in diffuse lymphatic tissue. X 12.

9 Same. Two primary nodules are seen. X 50.

10 Homo; 55-mm embryo. Nearly median section, showing the actual features from which figure 1 was traced. Superior constrictor muscle is seen in lower right-hand corner. Fascia extends from upper right to lower left. The side of the bursa is present in the lower left. X 76.

11 Homo; 11-mm. embryo. Undifferentiated stage. Basilar cartilage forming at left. Sagittal ection. X 280.


PLATE 2 EXPLANATION or FIGURES

12 Homo; 18-mm. embryo. Sagittal section showing the condensation forming the fascia. pha.ryngohasi1aris. Basilar cartilage not shown. X 280.

13 Homo; 55-mm. embryo. Sagittal section showing fascia directly under the epithelium at the rostral end of the tonsillar region. X 280.

14 Same. From within the tonsillar area, i.e., posterior to the above, showing beginning of the formation of ‘reticular’ tuniea propria. X 280.

15 Homo; 80—mm. fetus. Parasagittal section, showing ‘reticular’ tunioa propria from anterior portion of tonsillar area. Fascia above. X 150.

16 Same. Median section, showing hemorrhage within the loose tissue be tween fascia (above) and epithelium. X 150.

17 Homo; 100-mm. fetus. Parasagittal section, showing one of three centers of lymphocyte proliferation in this fetus_ A large lyxnphatio vessel is associated with the center. X 150.

18 Same. A center from the opposite side. X 280.

19 Homo; 120-mm. fetus. Lymphocytes are seen forming in the tuniea propria of the tonsillar area. Fascia above. X 300.

20 Same. Myelocyte formation from the region bordering the tonsillar are-:1 posteriorly. X 280.

21 Homo; 135-mm. fetus. Transverse section through tonsillar region. Several nodules are shown. Basilar cartilage above. X marks the site of myelopoiesis (fig. 22). X 95.

22 Same. Myeloeyte formation in the region bordering tonsillar area. X 640.

23 Homo; 1-L3-mm. fetus. Sagittal section, showing the tunica propria ‘filled’ with lymphocytes. Fascia above. X 120_

24 Homo, 125-mm. fetus. L_vmpho<-yte proliferation under a lympliatic vessel. X 48.

25 Homo; 180-mm. fetus. New eenters of lvmphocyte formation from anterior margin of the pharyngeal tonsil. Relation to lymphatic is clearly shown.

X 28.


PLATE 3 EXPLANATION OF FIGURES

26 and 27 Homo; 120»mm. fetus. (‘cells of the lymphocyte series forming within the tunica propria of the tonsillar area Monocytes and an eosinophile are also shown. X 1216.

28 and 29 Same. Myelcwyte formation from the region posterior to the tonsillar area. Some lympl10c_vtes are also S110\’V1l. X 1216.

30 and 31 Same. Erythroblasts and normoblasts from within the fascia plxaryngobasilaris. X 1216.

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Pages where the terms "Historic" (textbooks, papers, people, recommendations) appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms, interpretations and recommendations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)