Histological study of the thin membranous structure made of dense connective tissue around the esophagus in the upper mediastinum

• Published in: Esophagus : official journal of the Japan Esophageal Society 2018-10, Vol.15 (4), p.272-280
• Main Authors: Tokairin, Yutaka, Nakajima, Yasuaki, Kawada, Kenro, Hoshino, Akihiro, Okada, Takuya, Ryotokuji, Tairo, Okuda, Masafumi, Kume, Yuichiro, Kawamura, Yudai, Yamaguchi, Kazuya, Nagai, Kagami, Akita, Keiichi, Kinugasa, Yusuke
• Format: Article
• Language: English
• Subjects: Cadaver; Connective tissue; Connective Tissue - anatomy & histology; Connective Tissue - pathology; Esophagus; Esophagus - anatomy & histology; Esophagus - pathology; Gastroenterology; Histological Techniques - methods; Humans; Lymph Nodes - anatomy & histology; Lymph Nodes - pathology; Mediastinoscopy - methods; Mediastinum - anatomy & histology; Mediastinum - pathology; Medicine; Medicine & Public Health; Original Article; Surgical Oncology; Thoracic Duct - anatomy & histology; Thoracic Duct - pathology; Thoracic Surgery; Thoracoscopy - methods; Trachea - anatomy & histology; Trachea - pathology
• ISSN: 1612-9059; 1612-9067
• DOI: 10.1007/s10388-018-0625-9

Background The structure of the fascia in upper mediastinum has already been reported from gross anatomical viewpoints by Sarrazin. But it is necessary to understand meticulous anatomy for thoracoscopic or mediastinoscopic surgery. So herein, we investigate histologically the thin membranous structure made of dense connective tissues. Methods Semi-sequential transverse sections of the mediastinum were obtained from three cadavers. Hematoxylin and eosin staining, Elastica van Gieson staining, and Masson trichrome staining were performed to identify the presence and location of the thin membranous structure made of dense connective tissues. Results The “visceral sheath” and “vascular sheath,” as previously described by Sarrazin, were observed histologically. These two thin membranous structures do not surround the esophagus and trachea cylindrically. In addition, the “visceral sheath” on the right side of the upper mediastinum was unclear in comparison to the left side. The “visceral sheath” (on the left side) gradually became unclear, and seemed to almost disappear; the esophagus was found to be very close to the thoracic duct on the caudal side of the bifurcation of the trachea. Although the left recurrent nerve was located inside the “visceral sheath” in all cadavers, the left recurrent nerve lymph nodes were located inside the “visceral sheath” in cadaver 1 and between the “visceral sheath” and “vascular sheath” in cadaver 3. Conclusion The “visceral sheath” around the esophagus in the upper mediastinum was histologically demonstrated; however, the findings were not constant.