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| Submucosa | |
|---|---|
 | |
 Endoscopy and radialendoscopic 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 | |
Thesubmucosa (ortela submucosa) is a thin layer oftissue in variousorgans of thegastrointestinal,respiratory, andgenitourinary tracts. It is the layer ofdense irregular connective tissue that supports the mucosa (mucous membrane) and joins it to themuscular layer, the bulk of overlyingsmooth muscle (fibers running circularly within layer of longitudinal muscle).
The submucosa (sub- +mucosa) is to a mucous membrane what thesubserosa (sub- +serosa) is to aserous membrane.
Blood vessels,lymphatic vessels, andnerves (all supplying themucosa) will run through here. In the intestinal wall, tinyparasympathetic ganglia are scattered around forming thesubmucous plexus (or "Meissner's plexus") wherepreganglionic parasympathetic neurons synapse withpostganglionic nerve fibers that supply themuscularis mucosae. Histologically, the wall of the alimentary canal shows four distinct layers (from the lumen moving out): mucosa, submucosa, muscularis externa, and either aserous membrane or anadventitia.
In thegastrointestinal tract and therespiratory tract the submucosa contains thesubmucosal glands that secretemucus.
Identification of the submucosa plays an important role in diagnostic and therapeuticendoscopy, where specialfibre-optic cameras are used to perform procedures on thegastrointestinal tract. Abnormalities of the submucosa, such asgastrointestinal stromal tumors, usually show integrity of the mucosal surface.
The submucosa is also identified inendoscopic ultrasound to identify the depth of tumours and to identify other abnormalities. An injection ofdye,saline, orepinephrine into the submucosa is imperative in the safe removal of certainpolyps.
Endoscopic mucosalresection 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 (SIS) is submucosaltissue in thesmall intestines ofvertebrates. SIS is harvested (typically from pigs) fortransplanted structural material in severalclinical applications, typicallybiologic meshes. They have lowimmunogenicity. Some uses under investigation include ascaffold forintervertebral disc regeneration.[2][3]
Unlike other scaffold materials, theresorbable SISextracellular matrix (SIS-ECM) scaffold is replaced by well-organized host tissues, including differentiatedskeletal muscle.[4]
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 calledendomicroscopy. 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 cellsCD34 positive. However, these cells are devoid of ultrastructural features indicative of endothelial differentiation, including pinocytotic vesicles and Weibel-Palade bodies.
