Submucosa

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Submucosa
GI Organization.svg
Mid esophageal mass.jpg
Endoscopy and radial endoscopic ultrasound images of submucosal tumour in mid-esophagus. The submucosa is seen as a dark ring on the ultrasound image.
Details
Identifiers
Latin tela submucosa
TA98 A05.3.01.028
A05.4.01.014
A05.5.01.026
A05.6.01.008
A05.7.01.005
A06.4.02.028
A08.3.01.022
TA2 2857, 2891, 2913, 2939, 2967, 3221, 3234, 3419
FMA 85391
Anatomical terminology

The submucosa (or tela submucosa) is a thin layer of tissue in various organs of the gastrointestinal, respiratory, and genitourinary tracts. It is the layer of dense irregular connective tissue that supports the mucosa (mucous membrane) and joins it to the muscular layer, the bulk of overlying smooth muscle (fibers running circularly within layer of longitudinal muscle).

Contents

The submucosa ( sub- + mucosa) is to a mucous membrane what the subserosa ( sub- + serosa) is to a serous membrane.

Structure

Blood vessels, lymphatic vessels, and nerves (all supplying the mucosa) will run through here. In the intestinal wall, tiny parasympathetic ganglia are scattered around forming the submucous plexus (or "Meissner's plexus") where preganglionic parasympathetic neurons synapse with postganglionic nerve fibers that supply the muscularis mucosae. Histologically, the wall of the alimentary canal shows four distinct layers (from the lumen moving out): mucosa, submucosa, muscularis externa, and either a serous membrane or an adventitia.

In the gastrointestinal tract and the respiratory tract the submucosa contains the submucosal glands that secrete mucus.

Clinical significance

Identification of the submucosa plays an important role in diagnostic and therapeutic endoscopy, where special fibre-optic cameras are used to perform procedures on the gastrointestinal tract. Abnormalities of the submucosa, such as gastrointestinal stromal tumors, usually show integrity of the mucosal surface.

The submucosa is also identified in endoscopic ultrasound to identify the depth of tumours and to identify other abnormalities. An injection of dye, saline, or epinephrine into the submucosa is imperative in the safe removal of certain polyps.

Endoscopic mucosal resection involves removal of the mucosal layer, and in order to be done safely, a submucosal injection of dye is performed to ensure integrity at the beginning of the procedure.

Female uterine submucosal layers are liable to develop fibroids during pregnancy and are often excised upon discovery. [1]

Small intestinal submucosa

Small intestinal submucosa (SIS) is submucosal tissue in the small intestines of vertebrates. SIS is harvested (typically from pigs) for transplanted structural material in several clinical applications, typically biologic meshes. They have low immunogenicity. Some uses under investigation include a scaffold for intervertebral disc regeneration. [2] [3]

Unlike other scaffold materials, the resorbable SIS extracellular matrix (SIS-ECM) scaffold is replaced by well-organized host tissues, including differentiated skeletal muscle. [4]

History

A scientific article published in March 2018 [5] proposed a revision of the anatomical definition of the submucosa. They first saw a non compact tissue which should be submucosa using a technology called endomicroscopy. They hypothesised that the submucosa was not compact as it was previously seen on histological analysis but form a reticular pattern. To confirm their findings, they performed fixed samples of bile duct into a freezing media in order to conserve the shape of the submucosa. They then performed a histological analysis and with several staining techniques, they described the submucosa as a network of collagenous bands separating open, formerly fluid-filled spaces. Theses spaces are bordered by fibroblast-like cells CD34 positive. However, these cells are devoid of ultrastructural features indicative of endothelial differentiation, including pinocytotic vesicles and Weibel-Palade bodies.

Additional images

Related Research Articles

<span class="mw-page-title-main">Mucous membrane</span> Protective layer which lines the interior of hollow organs

A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is mostly of endodermal origin and is continuous with the skin at body openings such as the eyes, eyelids, ears, inside the nose, inside the mouth, lips, the genital areas, the urethral opening and the anus. Some mucous membranes secrete mucus, a thick protective fluid. The function of the membrane is to stop pathogens and dirt from entering the body and to prevent bodily tissues from becoming dehydrated.

<span class="mw-page-title-main">Gastrointestinal tract</span> Organ system within humans and other animals

The gastrointestinal tract is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and other animals, including the esophagus, stomach, and intestines. Food taken in through the mouth is digested to extract nutrients and absorb energy, and the waste expelled at the anus as faeces. Gastrointestinal is an adjective meaning of or pertaining to the stomach and intestines.

<span class="mw-page-title-main">Ileum</span> Final section of the small intestine

The ileum is the final section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms posterior intestine or distal intestine may be used instead of ileum. Its main function is to absorb vitamin B12, bile salts, and whatever products of digestion that were not absorbed by the jejunum.

<span class="mw-page-title-main">Autonomic nervous system</span> Division of the nervous system supplying internal organs, smooth muscle and glands

The autonomic nervous system (ANS), formerly referred to as the vegetative nervous system, is a division of the nervous system that operates internal organs, smooth muscle and glands. The autonomic nervous system is a control system that acts largely unconsciously and regulates bodily functions, such as the heart rate, its force of contraction, digestion, respiratory rate, pupillary response, urination, and sexual arousal. This system is the primary mechanism in control of the fight-or-flight response.

<span class="mw-page-title-main">Esophagus</span> Vertebrate organ through which food passes to the stomach

The esophagus or oesophagus, colloquially known also as the food pipe, food tube, or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the stomach. The esophagus is a fibromuscular tube, about 25 cm (10 in) long in adults, that travels behind the trachea and heart, passes through the diaphragm, and empties into the uppermost region of the stomach. During swallowing, the epiglottis tilts backwards to prevent food from going down the larynx and lungs. The word oesophagus is from Ancient Greek οἰσοφάγος (oisophágos), from οἴσω (oísō), future form of φέρω + ἔφαγον.

<span class="mw-page-title-main">Enteric nervous system</span> Vital system controlling the gastrointestinal tract

The enteric nervous system (ENS) or intrinsic nervous system is one of the main divisions of the peripheral nervous system (PNS) and consists of a mesh-like system of neurons that governs the function of the gastrointestinal tract. It is capable of acting independently of the sympathetic and parasympathetic nervous systems, although it may be influenced by them. The ENS is nicknamed the "second brain". It is derived from neural crest cells.

<span class="mw-page-title-main">Lamina propria</span> Thin connective layer forming part of the mucous membranes

The lamina propria is a thin layer of connective tissue that forms part of the moist linings known as mucous membranes or mucosae, which line various tubes in the body, such as the respiratory tract, the gastrointestinal tract, and the urogenital tract.

<span class="mw-page-title-main">Brunner's glands</span> Duodenal submucosal cells secreting bicarbonate-rich mucus

Brunner's glands are compound tubuloalveolar submucosal glands found in that portion of the duodenum proximal to the hepatopancreatic sphincter.

The mucosa-associated lymphoid tissue (MALT), also called mucosa-associated lymphatic tissue, is a diffuse system of small concentrations of lymphoid tissue found in various submucosal membrane sites of the body, such as the gastrointestinal tract, nasopharynx, thyroid, breast, lung, salivary glands, eye, and skin. MALT is populated by lymphocytes such as T cells and B cells, as well as plasma cells, dendritic cells and macrophages, each of which is well situated to encounter antigens passing through the mucosal epithelium. In the case of intestinal MALT, M cells are also present, which sample antigen from the lumen and deliver it to the lymphoid tissue. MALT constitute about 50% of the lymphoid tissue in human body. Immune responses that occur at mucous membranes are studied by mucosal immunology.

<span class="mw-page-title-main">Gastric lymphoma</span> Medical condition

Primary gastric lymphoma is an uncommon condition, accounting for less than 15% of gastric malignancies and about 2% of all lymphomas. However, the stomach is a very common extranodal site for lymphomas. It is also the most common source of lymphomas in the gastrointestinal tract.

<span class="mw-page-title-main">Submucosal plexus</span>

The submucosal plexus lies in the submucosa of the intestinal wall. The nerves of this plexus are derived from the myenteric plexus which itself is derived from the plexuses of parasympathetic nerves around the superior mesenteric artery. Branches from the myenteric plexus perforate the circular muscle fibers to form the submucosal plexus. Ganglia from the plexus extend into the muscularis mucosae and also extend into the mucous membrane.

<span class="mw-page-title-main">Muscularis mucosae</span> Thin layer of muscle of the gastrointestinal tract

The muscularis mucosae is a thin layer of muscle of the gastrointestinal tract, located outside the lamina propria, and separating it from the submucosa. It is present in a continuous fashion from the esophagus to the upper rectum. A discontinuous muscularis mucosae–like muscle layer is present in the urinary tract, from the renal pelvis to the bladder; as it is discontinuous, it should not be regarded as a true muscularis mucosae.

<span class="mw-page-title-main">Muscular layer</span>

The muscular layer is a region of muscle in many organs in the vertebrate body, adjacent to the submucosa. It is responsible for gut movement such as peristalsis. The Latin, tunica muscularis, may also be used.

<span class="mw-page-title-main">Subserosa</span> Thin layer of tissue in the walls of various organs

The subserosa or tela subserosa, is a thin layer of tissue in the walls of various organs. It is a layer of connective tissue between the muscular layer and the serosa.

Endoscopic mucosal resection is a technique used to remove cancerous or other abnormal lesions found in the digestive tract. It is one method of performing a mucosectomy.

Solitary rectal ulcer syndrome or SRUS is a chronic, benign disorder of the rectal mucosa. It commonly occurs with varying degrees of rectal prolapse. The condition is thought to be caused by different factors, such as long term constipation, straining during defecation, and dyssynergic defecation. Treatment is by normalization of bowel habits, biofeedback, and other conservative measures. In more severe cases various surgical procedures may be indicated. The condition is relatively rare, affecting approximately 1 in 100,000 people per year. It affects mainly adults aged 30–50. Females are affected slightly more often than males. The disorder can be confused clinically with rectal cancer or other conditions such as inflammatory bowel disease, even when a biopsy is done.

<span class="mw-page-title-main">Gastrointestinal wall</span> Digestive system structure

The gastrointestinal wall of the gastrointestinal tract is made up of four layers of specialised tissue. From the inner cavity of the gut outwards, these are:

  1. Mucosa
  2. Submucosa
  3. Muscular layer
  4. Serosa or adventitia
<span class="mw-page-title-main">Human digestive system</span> Digestive system in humans

The human digestive system consists of the gastrointestinal tract plus the accessory organs of digestion. Digestion involves the breakdown of food into smaller and smaller components, until they can be absorbed and assimilated into the body. The process of digestion has three stages: the cephalic phase, the gastric phase, and the intestinal phase.

Endoscopic submucosal dissection (ESD) is an advanced surgical procedure using endoscopy to remove gastrointestinal tumors that have not entered the muscle layer. ESD may be done in the esophagus, stomach or colon. Application of endoscopic resection (ER) to gastrointestinal (GI) neoplasms is limited to lesions with no risk of nodal metastasis. Either polypectomy or endoscopic mucosal resection (EMR) is beneficial for patients because of its low level of invasiveness. However, to ensure the curative potential of these treatment modalities, accurate histopathologic assessment of the resected specimens is essential because the depth of invasion and lymphovascular infiltration of the tumor is associated with considerable risk for lymph node metastasis. For accurate assessment of the appropriateness of the therapy, en bloc resection is more desirable than piecemeal resection. For a reliable en bloc resection of GI neoplasms, a new method of ER called endoscopic submucosal dissection (ESD) has been developed.

<span class="mw-page-title-main">Anatomical terms of microanatomy</span> Anatomical terminology is used to describe microanatomical (or histological) structures

Anatomical terminology is used to describe microanatomical structures. This helps describe precisely the structure, layout and position of an object, and minimises ambiguity. An internationally accepted lexicon is Terminologia Histologica.

References

  1. "What is the submucosa and why is it important? - Submucosa". Archived from the original on 2019-06-23. Retrieved 2018-07-25.
  2. Oelschlager BK, Pellegrini CA, Hunter J, et al. (October 2006). "Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial". Ann. Surg. 244 (4): 481–90. doi:10.1097/01.sla.0000237759.42831.03. PMC   1856552 . PMID   16998356.
  3. Helton WS, Fisichella PM, Berger R, Horgan S, Espat NJ, Abcarian H (June 2005). "Short-term outcomes with small intestinal submucosa for ventral abdominal hernia". Arch Surg. 140 (6): 549–60, discussion 560–2. doi: 10.1001/archsurg.140.6.549 . PMID   15967902.
  4. Badylak S, Kokini K, Tullius B, Simmons-Byrd A, Morff R (April 2002). "Morphologic study of small intestinal submucosa as a body wall repair device". J. Surg. Res. 103 (2): 190–202. doi:10.1006/jsre.2001.6349. PMID   11922734.
  5. Benias, P., Wells, R., Sackey-Aboagye, B., Klavan, H., Reidy, J., Buonocore, D., Miranda, M., Kornacki, S., Wayne, M., Carr-Locke, D. and Theise, N. (2018). Structure and Distribution of an Unrecognized Interstitium in Human Tissues. Scientific Reports, 8(1).