The incidence and severity of various histologic changes were studied in the thymuses from 35 Down syndrome (DS) patients. Variable histologic alterations up to fibrotic involution of the gland were found. In addition, immunohistochemical investigation showed a reduction or absence of interdigitating reticulum cells roughly correlated with the severity of morphologic changes. The complex architectural and cellular thymic alterations, concerning both cortical and medullary microenvironment, could be correlated with the imbalances of immunity in DS patients.