Distribution of deep fascia

Deep fascia

Definition: Deep fascia is a fascia, a layer of dense irregular connective tissue that wraps the neck, the limbs and body wall like a bandage or stocking 

It covers muscles, nerves, bone and blood vessel.

Important features of deep fascia:

·         It is devoid of fat

·         It is inelastic and tough

·         It has nerve supply and very sensitive structure.

·         It is a golden rule that when fascia approaches bone it becomes attached to it , blending with the covering periosteum

Distribution of deep fascia

Very well developed: 

1.       iliotibial tract of fascia lata

2.       palmar and planter aponeurosis

3.       flexor and extensor retinaculum

Well developed:

• In the limbs,  it forms tough &  tight sleeves
•  In the neck, it forms a collar.

So thin usually considered as absent:

·         Over the rectus sheath of abdomen

·         Over the trunk  except thoracolumbar fascia at the back of thorax & abdomen

Absent

·         Face except  parotid fascia

·         Ischioanal fascia

Internal urethral sphincter / Sphincter urethrae : easy and brief description

Sphincter vesicae  

·         The internal sphincter muscle of urethra: located at the bladder's inferior end and the urethra's proximal end at the junction of the urethra with the urinary bladder. The internal sphincter is a continuation of the detrusor muscle and is made of smooth muscle, therefore it is under involuntary or autonomic control. This is the primary muscle for prohibiting the release of urine.

In males and females, both internal and external urethral sphincters function to inhibit the release of urine. In males, the internal sphincter muscle of urethra functions to prevent reflux of seminal fluids into the male bladder during ejaculation.

Histology of sphincter urethrae:

All part of musculature of urinary bladder is composed of outer and inner longitudinal and middle circularly arranged smooth muscle cell . in the bladder neck the outer longitudinal layer merge with circular layer and it become thick and formed sphincter urethrae

Function

The internal urethral sphincter provides involuntary control of urination.

The muscular coat of the urinary bladder is composed of inner longitudinal, middle circular,and outer longitudinal layers of smooth muscle that are frequently interlaced and are indistinguishable as distinct layers. The internal sphincter muscle of the urethra is formed by the thick, middle circular layer

Verumontanum or seminal colliculus : easy and brief description

Verumontanum is translated from Latin to mean 'mountain ridge
Verumontanum or  seminal colliculus  is a median elevation situated within the posterior wall of prostatic  urethra.
It is used as landmark of prostatic urethra during different laparoscopic procedure
.Embryologically, it is derived from the uterovaginal primordium.
The landmark is important in classification of several urethral developmental disorders.
Relation of verumontanum :
Median portion of verumontanum is elevated receive three opening
One opening of prostatic utricle at the centra
Two opening of ejaculatory duct on the two side of opening of prostatic utricle
Urethral crest: it is situated at the upper part of verumontanum , near the neck of urinary bladder.
Urethral sinus: it is situated in the lateral side of the verumontanum with receive several opening of prostatic gland

Clinical features  Verumontanum mucosal hyperplasia

• The presence of verumontanum mucosa gland hyperplasia is an asymptomatic morphologic variant of the glands underlying the posterior wall of the prostatic urethra

Diagnosis

• Can be identified in TURP specimens or in needle biopsies of the prostate

Treatment

• Not required

Microscopic (histologic) description

• Crowded small acinar proliferation, usually arranged in a well circumscribed nodule
• The glands can have intraluminal concretions that vary in color from orange to gray or green
• May be seen underlying the urethral urothelium

Differential diagnosis

• Verumontanum mucosal gland hyperplasia (VMGH), when present in a prostate needle biopsy, could be mistaken for low grade prostatic adenocarcinoma (Gleason pattern 3)
• The lobular architecture and the presence of basal cells are features to differentiate it from Gleason pattern 3 cancer
• Another helpful feature is the presence of corpora amylacea or the orange-grey-green concretions that are features of VMGH and not of prostatic carcinoma
• Occasionally, it can present with a papillary architecture simulating prostatic duct adenocarcinoma
• In contrast to prostatic duct carcinoma, the cells in VMGH are more cuboidal and without nuclear atypia

Identifying point of histological slide of Smooth muscle

Smooth muscle 

Slide identification

1.      Centrally placed single flat nucleus 

Shape  of cell: spindle shape

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Identifying point of histological slide of cardiac muscle

Cardiac muscle 

Slide identification 

1.      Centrally placed single nucleus

2.      Branching present  

3.      Shape of cells : short, cylindrical 

Histological features of higher magnification: 

1.      Cross striation present 

2.      Intercalated disc is present 

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