Histological study of the structural layers around the esophagus in the lower mediastinum
In Japan, the transhiatal approach, including lower mediastinal lymph node dissection, is widely performed for Siewert type II esophagogastric junction adenocarcinoma. This procedure is generally performed in a magnified view using laparoscopy or a robotic system, therefore, the microanatomy of the...
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Veröffentlicht in: | World journal of gastrointestinal surgery 2023-07, Vol.15 (7), p.1331-1339 |
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creator | Saito, Toshifumi Muro, Satoru Fujiwara, Hisashi Umebayashi, Yuya Sato, Yuya Tokunaga, Masanori Akita, Keiichi Kinugasa, Yusuke |
description | In Japan, the transhiatal approach, including lower mediastinal lymph node dissection, is widely performed for Siewert type II esophagogastric junction adenocarcinoma. This procedure is generally performed in a magnified view using laparoscopy or a robotic system, therefore, the microanatomy of the lower mediastinum is important. However, mediastinal microanatomy is still unclear and classification of lower mediastinal lymph nodes is not currently based on fascia or other microanatomical structures.
To clarify the fascia and layer structures of the lower mediastinum and classify the lower mediastinal tissue.
We dissected the esophagus and surrounding organs
from seven cadavers fixed in 10% formalin. Organs and tissues were then cut at the level of the lower thoracic esophagus, embedded in paraffin, and serially sectioned. Tissue sections were stained with Hematoxylin-Eosin (all cadavers) and immunostained for the lymphatic endothelial marker D2-40 (three cadavers). We observed the periesophageal fasciae and layers, and defined lymph node boundaries based on the fasciae. Lymphatic vessels around the esophagus were observed on immunostained tissue sections.
We identified two fasciae, A and B. We then classified lower mediastinal tissue into three areas, paraesophageal, paraaortic, and intermediate, using these fasciae as boundaries. Lymph nodes were found to be present and were counted in each area. The dorsal part of the intermediate area was thicker on the caudal side than on the cranial side in all cadavers. On the dorsal side, no blood vessels penetrated the fasciae in six of the seven cadavers, whereas the proper esophageal artery penetrated fascia B in one cadaver. D2-40 immunostaining showed lymphatic vessel connections between the paraesophageal and intermediate areas on the lateral and ventral sides of the esophagus, but no lymphatic connection between areas on the dorsal side of the esophagus.
Histological studies identified two fasciae surrounding the esophagus in the lower mediastinum and the layers separated by these fasciae were used to classify the lower mediastinal tissues. |
doi_str_mv | 10.4240/wjgs.v15.i7.1331 |
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To clarify the fascia and layer structures of the lower mediastinum and classify the lower mediastinal tissue.
We dissected the esophagus and surrounding organs
from seven cadavers fixed in 10% formalin. Organs and tissues were then cut at the level of the lower thoracic esophagus, embedded in paraffin, and serially sectioned. Tissue sections were stained with Hematoxylin-Eosin (all cadavers) and immunostained for the lymphatic endothelial marker D2-40 (three cadavers). We observed the periesophageal fasciae and layers, and defined lymph node boundaries based on the fasciae. Lymphatic vessels around the esophagus were observed on immunostained tissue sections.
We identified two fasciae, A and B. We then classified lower mediastinal tissue into three areas, paraesophageal, paraaortic, and intermediate, using these fasciae as boundaries. Lymph nodes were found to be present and were counted in each area. The dorsal part of the intermediate area was thicker on the caudal side than on the cranial side in all cadavers. On the dorsal side, no blood vessels penetrated the fasciae in six of the seven cadavers, whereas the proper esophageal artery penetrated fascia B in one cadaver. D2-40 immunostaining showed lymphatic vessel connections between the paraesophageal and intermediate areas on the lateral and ventral sides of the esophagus, but no lymphatic connection between areas on the dorsal side of the esophagus.
Histological studies identified two fasciae surrounding the esophagus in the lower mediastinum and the layers separated by these fasciae were used to classify the lower mediastinal tissues.</description><identifier>ISSN: 1948-9366</identifier><identifier>EISSN: 1948-9366</identifier><identifier>DOI: 10.4240/wjgs.v15.i7.1331</identifier><identifier>PMID: 37555123</identifier><language>eng</language><publisher>United States: Baishideng Publishing Group Inc</publisher><subject>Basic Study</subject><ispartof>World journal of gastrointestinal surgery, 2023-07, Vol.15 (7), p.1331-1339</ispartof><rights>The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.</rights><rights>The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. 2023</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c335t-5369bb8252700bf9b74b1987a919fc9f8507460a8c58b5902b9cca8e69330a783</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10405116/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10405116/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,886,27926,27927,53793,53795</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37555123$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Saito, Toshifumi</creatorcontrib><creatorcontrib>Muro, Satoru</creatorcontrib><creatorcontrib>Fujiwara, Hisashi</creatorcontrib><creatorcontrib>Umebayashi, Yuya</creatorcontrib><creatorcontrib>Sato, Yuya</creatorcontrib><creatorcontrib>Tokunaga, Masanori</creatorcontrib><creatorcontrib>Akita, Keiichi</creatorcontrib><creatorcontrib>Kinugasa, Yusuke</creatorcontrib><title>Histological study of the structural layers around the esophagus in the lower mediastinum</title><title>World journal of gastrointestinal surgery</title><addtitle>World J Gastrointest Surg</addtitle><description>In Japan, the transhiatal approach, including lower mediastinal lymph node dissection, is widely performed for Siewert type II esophagogastric junction adenocarcinoma. This procedure is generally performed in a magnified view using laparoscopy or a robotic system, therefore, the microanatomy of the lower mediastinum is important. However, mediastinal microanatomy is still unclear and classification of lower mediastinal lymph nodes is not currently based on fascia or other microanatomical structures.
To clarify the fascia and layer structures of the lower mediastinum and classify the lower mediastinal tissue.
We dissected the esophagus and surrounding organs
from seven cadavers fixed in 10% formalin. Organs and tissues were then cut at the level of the lower thoracic esophagus, embedded in paraffin, and serially sectioned. Tissue sections were stained with Hematoxylin-Eosin (all cadavers) and immunostained for the lymphatic endothelial marker D2-40 (three cadavers). We observed the periesophageal fasciae and layers, and defined lymph node boundaries based on the fasciae. Lymphatic vessels around the esophagus were observed on immunostained tissue sections.
We identified two fasciae, A and B. We then classified lower mediastinal tissue into three areas, paraesophageal, paraaortic, and intermediate, using these fasciae as boundaries. Lymph nodes were found to be present and were counted in each area. The dorsal part of the intermediate area was thicker on the caudal side than on the cranial side in all cadavers. On the dorsal side, no blood vessels penetrated the fasciae in six of the seven cadavers, whereas the proper esophageal artery penetrated fascia B in one cadaver. D2-40 immunostaining showed lymphatic vessel connections between the paraesophageal and intermediate areas on the lateral and ventral sides of the esophagus, but no lymphatic connection between areas on the dorsal side of the esophagus.
Histological studies identified two fasciae surrounding the esophagus in the lower mediastinum and the layers separated by these fasciae were used to classify the lower mediastinal tissues.</description><subject>Basic Study</subject><issn>1948-9366</issn><issn>1948-9366</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNpVkc1PwyAYxonRODN392R69LIKBVo4GbOoM1niRQ-eCGW0Y-nKhLJl_710m8vkArwfz_Pm_QFwh2BKMgIft8vapxtEU1OkCGN0AW4QJ2zMcZ5fnr0HYOT9EsZDSM45vAYDXFBKUYZvwPfU-M42tjZKNonvwnyX2CrpFjp-XFBdcDHeyJ12PpHOhna-T2pv1wtZB5-Ydh9o7Fa7ZKXnRvrOtGF1C64q2Xg9Ot5D8PX68jmZjmcfb--T59lYYUy7McU5L0uW0ayAsKx4WZAScVZIjnileMUoLEgOJVOUlZTDrORKSaZzjjGUBcND8HTQXYcy2ivddnFksXZmJd1OWGnE_0xrFqK2G4EggRShPCo8HBWc_Qnad2JlvNJNI1ttgxcZIyzDcXu9GTyUKme9d7o6-SAoeiqipyIiFWEK0VOJLffn850a_hjgX-Igi5U</recordid><startdate>20230727</startdate><enddate>20230727</enddate><creator>Saito, Toshifumi</creator><creator>Muro, Satoru</creator><creator>Fujiwara, Hisashi</creator><creator>Umebayashi, Yuya</creator><creator>Sato, Yuya</creator><creator>Tokunaga, Masanori</creator><creator>Akita, Keiichi</creator><creator>Kinugasa, Yusuke</creator><general>Baishideng Publishing Group Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230727</creationdate><title>Histological study of the structural layers around the esophagus in the lower mediastinum</title><author>Saito, Toshifumi ; Muro, Satoru ; Fujiwara, Hisashi ; Umebayashi, Yuya ; Sato, Yuya ; Tokunaga, Masanori ; Akita, Keiichi ; Kinugasa, Yusuke</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c335t-5369bb8252700bf9b74b1987a919fc9f8507460a8c58b5902b9cca8e69330a783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Basic Study</topic><toplevel>online_resources</toplevel><creatorcontrib>Saito, Toshifumi</creatorcontrib><creatorcontrib>Muro, Satoru</creatorcontrib><creatorcontrib>Fujiwara, Hisashi</creatorcontrib><creatorcontrib>Umebayashi, Yuya</creatorcontrib><creatorcontrib>Sato, Yuya</creatorcontrib><creatorcontrib>Tokunaga, Masanori</creatorcontrib><creatorcontrib>Akita, Keiichi</creatorcontrib><creatorcontrib>Kinugasa, Yusuke</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>World journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Saito, Toshifumi</au><au>Muro, Satoru</au><au>Fujiwara, Hisashi</au><au>Umebayashi, Yuya</au><au>Sato, Yuya</au><au>Tokunaga, Masanori</au><au>Akita, Keiichi</au><au>Kinugasa, Yusuke</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Histological study of the structural layers around the esophagus in the lower mediastinum</atitle><jtitle>World journal of gastrointestinal surgery</jtitle><addtitle>World J Gastrointest Surg</addtitle><date>2023-07-27</date><risdate>2023</risdate><volume>15</volume><issue>7</issue><spage>1331</spage><epage>1339</epage><pages>1331-1339</pages><issn>1948-9366</issn><eissn>1948-9366</eissn><abstract>In Japan, the transhiatal approach, including lower mediastinal lymph node dissection, is widely performed for Siewert type II esophagogastric junction adenocarcinoma. This procedure is generally performed in a magnified view using laparoscopy or a robotic system, therefore, the microanatomy of the lower mediastinum is important. However, mediastinal microanatomy is still unclear and classification of lower mediastinal lymph nodes is not currently based on fascia or other microanatomical structures.
To clarify the fascia and layer structures of the lower mediastinum and classify the lower mediastinal tissue.
We dissected the esophagus and surrounding organs
from seven cadavers fixed in 10% formalin. Organs and tissues were then cut at the level of the lower thoracic esophagus, embedded in paraffin, and serially sectioned. Tissue sections were stained with Hematoxylin-Eosin (all cadavers) and immunostained for the lymphatic endothelial marker D2-40 (three cadavers). We observed the periesophageal fasciae and layers, and defined lymph node boundaries based on the fasciae. Lymphatic vessels around the esophagus were observed on immunostained tissue sections.
We identified two fasciae, A and B. We then classified lower mediastinal tissue into three areas, paraesophageal, paraaortic, and intermediate, using these fasciae as boundaries. Lymph nodes were found to be present and were counted in each area. The dorsal part of the intermediate area was thicker on the caudal side than on the cranial side in all cadavers. On the dorsal side, no blood vessels penetrated the fasciae in six of the seven cadavers, whereas the proper esophageal artery penetrated fascia B in one cadaver. D2-40 immunostaining showed lymphatic vessel connections between the paraesophageal and intermediate areas on the lateral and ventral sides of the esophagus, but no lymphatic connection between areas on the dorsal side of the esophagus.
Histological studies identified two fasciae surrounding the esophagus in the lower mediastinum and the layers separated by these fasciae were used to classify the lower mediastinal tissues.</abstract><cop>United States</cop><pub>Baishideng Publishing Group Inc</pub><pmid>37555123</pmid><doi>10.4240/wjgs.v15.i7.1331</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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title | Histological study of the structural layers around the esophagus in the lower mediastinum |
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