The normal configuration and interindividual differences in intramural lymphatic vessels of the esophagus  Shinji Yajin, MD, Gen Murakami, MD, PhD, Hiromi.

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The normal configuration and interindividual differences in intramural lymphatic vessels of the esophagus  Shinji Yajin, MD, Gen Murakami, MD, PhD, Hiromi Takeuchi, MD, PhD, Tadashi Hasegawa, MD, PhD, Hiroya Kitano, MD, PhD  The Journal of Thoracic and Cardiovascular Surgery  Volume 137, Issue 6, Pages 1406-1414 (June 2009) DOI: 10.1016/j.jtcvs.2008.08.069 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Mucosal lymphatic vessel distribution at level immediately inferior to tracheal bifurcation. A, Almost entire horizontal section of esophagus at level of tracheal bifurcation. Upper part corresponds to ventral side of esophagus. Arrows indicate vascular bundle passing through inner circular and outer longitudinal muscle layers (inner muscle, outer muscle). B and C, D2-40 immunohistochemical staining for area indicated by square is shown. B, Higher-magnification view displays abundant lymphatic vessels (arrows) in lamina propria mucosae between stratified squamous epithelium and muscularis mucosa. Some vessels are dilated, and others are flattened or collapsed. Squamous epithelium basal layer and lymphatic vessels stain for D2-40. Most mucosal vessels are cut transversely or obliquely. C, Lower-magnification view includes area in B. D, Hand tracing with pen of C. Because of lower magnification, C and D exhibit no difference in mucosal lymphatic vessel density between parts or quarters of section. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1406-1414DOI: (10.1016/j.jtcvs.2008.08.069) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Esophageal intramural lymphatics outside mucosal layer. A, Entire esophageal wall (squamous epithelium, muscularis mucosae, tela submucosa, and inner circular and outer longitudinal muscle layers) at level of tracheal bifurcation. Arrows indicate lymphatic vessels staining for D2-40. Lymphatic vessels are evident (1) in lamina propria mucosae, (2) along outer surface of tela submucosa, and (3) between inner and outer muscle layers. Latter two vessels appear to run circumferentially. B and C, Specimens obtained from different cadavers exhibiting lymphatic vessels running between inner and outer muscle layers at level of the aortic arch. Note abundant muscle fibers cut axially in inner circular layer. All panels were photographed at same magnification; bar in B represents 200 μm. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1406-1414DOI: (10.1016/j.jtcvs.2008.08.069) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Drainage routes of the intermuscular and submucosal vessels. A, Left side corresponds to outer aspect of esophagus and displays drainage vessel (arrows) of intermuscular lymphatics. B, Lymphatic vessel (arrows) passing through inner circular muscle mass and connecting submucosal and intermuscular lymphatic vessels. Both A and B were taken at level of tracheal bifurcation, but from different specimens, and are at same magnification; bar in A represents 200 μm. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1406-1414DOI: (10.1016/j.jtcvs.2008.08.069) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Graphic demonstrations of interindividual differences in lymphatic vessel density and vascular length. Data for cervical (A), upper thoracic (B), and midthoracic (C) esophagus. White bars represent numeric density according to hot spot method (greatest number of vessels in selected visual field with ×40 objective lens). Dotted bars represent numeric density per 1-mm epithelium (numbers of all lymphatic vessels divided by circumferential length of epithelial basement membrane). Black bars represent length of mucosal lymphatics per 1-mm length of epithelium (epithelial length of all lymphatic vessels divided by circumferential length of epithelial basement membrane). Axes: x axis indicates (1) two types of numeric density with scales of 0, 5, 10, 15, and 20, and (2) lymphatic vascular length (mm) with scales in parentheses of 0, 0.5, 1.0, 1.5, and 2.0; y axis indicates specimen numbers. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1406-1414DOI: (10.1016/j.jtcvs.2008.08.069) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Schematic representation of intramural lymphatics of thoracic esophagus. Lamina propria mucosae contains abundant longitudinally running lymphatic vessels, whereas circumferentially running vessels are dominant in intermuscular space between inner and outer muscle layers of muscularis propria, as well as along outer margin of tela submucosa. Efferent vessels usually accompany artery and vein (artery and vein not shown) but sometimes penetrate muscularis propria (arrowheads). Thick direct drainage vessel from mucosal lymphatics (stars) passes along large gap in muscularis propria. LN, Lymph node. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1406-1414DOI: (10.1016/j.jtcvs.2008.08.069) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions