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ON THE IMPORTANCE OF BUCK'S TN THE CASE OF PENILE LANCER. Pr of. Tokuji Ichikawa, M. D., and Assistant Koizo Shida

A certain book tells of the important role which (Fig. I a). Buck's fascia plays in respect of the extravasation Buck's fascia originates as fascia of M. bulboca- of blood and urine on the occasion of injuries of vernosus and M. is hiocavernosus and its rear the . However, little has been written of the connects with the triangular ligament and, enveloping stand which Buck's fascia takes against the invasion corpora cavernosa and corpus spongiosum, its of neoplasm. front reaches the glans. The fasciculi of fiber which The corpora cavernosa penis which is wrapped constitutes Buck's fascia bisect themselves after by a dense is surrounded by Buck's extending to the part of the glans, and one half of fascia, together with corpus mspongiosum urethrae. which end in corona glandis, but the other half, Outside of this fascia there lies layer, enveloping corpora cavernosa, enter into the interior separated by fatty, loose connective tissues. of the glans (Fig. I a). And, on the side of Tunica albuginea is a dense sheath consistin of it terminates in the region of frenulum entangled rich collagenous fiber, destitute of elastic fiber, and with the elastic fiber of the glans. Buck's fascia is made up of fasciculi of rich elastic In the region of penii shaft, the fascia is cons- fiber. And, dartos layer is composed of smooth picuous on the dorsum, but on the side of the urethra, muscle and elastic fiber, and amongst them, against it is less conspicuous. However, when it reaches the invasion of neoplasm., Buck's fascia is of prime the glans in its front the arrangement of the significance. This is because the elastic fiber consti- fasciculi of fiber becomes gradually disordered, tutes a powerful resistance against the invasion of and its anterior end is interlaced with the fibers of neoplasm. corpus cavernosum glandis. That is to day, Buck's In the interspace between each of the cavernous fascia, at the anterior end, that is, in the part of body, Buck's fascia and dartos layer, layer of loose the glans, is in a state of opening to corpus caver- connective tissue containing blood vessels and nosum glandis (Fig. I b). , lies, which offers capital ground for the In most of the cases of carcinoma of the penis, proliferation of neoplasm. the carcinoma which developed in the cavernous Dartos layer, as above mentioned, lying between tissue of the glans is observed to soon make its the skin and Buck's fascia, forms the subcutaneous way through this aperture and invade into the connective tissue embracing circular elastic fiber connective tissue that lies between Buck's fascia and and smooth muscle, and it connects itself with tunica albuginea Fig. II a, b). Scarpa's fascia in the upper region, with Colles' Carcinoma is said to break through the extremity fascia in the lower region, with dartos muscle of of tunica albuginea and invade the interior of cor- the and the superficial fascia of the thigh, pora cavernosa. However, in the above case, we and its front ends in the part of collum glandis observed that carcinoma does not invade intIcaver- 2 nous tissue from the first, but invades into and deve. REFERENCES lops in layers of the loose connective tissues in (1) Braus, H., Anatomie des Menschen, Bd the interspace between Buck's fascia and tunica III, 1924. albuginea, and further breaks through tunica albu- (2) Hinman, F., The Principles ancL Practice ginea and invades into the cavernous tissue (Fig. II, of Urology, 1936. a, b.). (3) Matsui, T., Peniskrebs, Acta Dermatologica, The corpus spongiosum urethrae, although of the Vol. 37, 121--135, 183--216, 1941. same cavernous body, contains much more quantity (4) Mollendorff, W., Handbuch der mikrosko- of elastic fiber as compared with corpora cavernoua pischen Anatomie des Menschen, VII J2, penis and is but slightly invaded by carcinoma. 1930. We have experienced cases of highly developed (5) Lenowitz, H. & Graham, A. P., Carcinoma stage of carcinoma in which the interior is wholly of the Penis. J. Urol., Vol.56, Nr. 4, 458- occupied by carcinoma and the outer cover is also 484, 1946. in a state of carcinoinatous ulcer but is still barely (6) Tandler, J., Lehrbuch der systematischen enabled to maintain the shape of the penis owing Anatomic. Bd II, 1923, Leibzig. to the corpus spongiosum urethrae and Buck's fascia (7) Tobin, C. E., Benjamin, J. A. & Wells, J. being in sound condition. C., Continuity of the Fasciae lining the Cane lesion Abdomen, Pelvis and . Surg. Buck's fascia, thanks to its rich elastic fiber, Gyne. & Obst., Vol. 83, Nr. 575-596, offers strong resistance against the invasion of 1946. carcinoma, and the state of its arrangement has an (8) Wesson, M. B., The Value of Buck's and important significance as against the development Colles' Fasciae. J. Urol., Vol. 53, Nr. 2. and proliferation of carcinoma. 365-372, 1945.

Fig Ia Fig Ib

Fig ha Fig IIb B. Buck's fascia C. Carcinoma D. Dartos layer T. Tunica albuginea