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Variant Branching Pattern of the Right Internal Iliac Vessels in a Male

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Variant Branching Pattern of the Right Internal Iliac Vessels in a Male Case Report Original Article Archives of Clinical Experimental Surgery Increased of Langerhans Cells in Smokeless Tobacco-Associated Oral Mucosal Lesions Érica Dorigatti de Ávila1, Rafael Scaf de Molon2, Melaine de Almeida Lawall1, Renata Bianco Consolaro1, Alberto Consolaro1 Variant Branching Pattern of the Right Internal Iliac Vessels in A Male: A Case Report Satheesha Nayak Badagabettu, Naveen Kumar, Surekha Devadasa Shetty, Srinivasa Rao Sirasanagandla 1Bauru Dental School Abstract University of São Paulo Department of AnatomyBauru–SP, Brazil AbstractObjective: To evaluate the changes in the number of Langerhans Cells (LC) observed in the epitheliumMelaka ofManipal Medical College 2Araraquara Dental School smokeless tobacco (SLT-induced) lesions. (Manipal Campus) Internal iliac vessels show frequent variations in their branching pattern. We saw variations in the São Paulo State University Methods: Microscopic sections from biopsies carried out in the buccal mucosa of twenty patients, whoManipal were University branching pattern of right internal iliac vessels in a male cadaver. The internal iliac artery did not divide Manipal, Karnataka,Araraquara-SP, India Brazil intochronic anterior users and of posteriorsmokeless divisions. tobacco There (SLT), were were three utilized. common For thetrunks: control one group,for iliolumbar twenty andnon-SLT lateral users of SLT Received: Aug 09,Received: 2012 February 05, 2012 sacralwith normalarteries, mucosa another forwere inferior selected. gluteal The and sections internal werepudendal studied arteries, with routineand the thirdcoloring one forand superior were immunostained Accepted: Oct 09,Accepted: 2012 February 29, 2012 vesicalfor S-100, and CD1a,obturator Ki-67 arteries. and p63.The Thesesuperior data gluteal were and statistically middle rectal analyzed arteries by thearose Student’s directly t-testfrom tothe investigate Arch Clin the Exp SurgArch 2014;3:197-200 Clin Exp Surg 2012;X: X-X DOI:10.5455/aces.20121009120145 maindifferences trunk of in the the internal expression iliac artery. of immune The internal markers iliac in vein normal did notmucosa have a andmain in trunk. SLT-induced Its anterior leukoplakia and lesions. DOI: 10.5455/aces.20120229052919 posteriorResults: divisions There joinedwas a significant with the external difference iliac vein in theto form immunolabeling the common ofiliac all vein. markers Knowledge between of normalCorresponding mucosa author: Dr. Satheesha NayakCorresponding Badagabettu author these variations might be useful for the urologists and surgeons. and SLT-induced lesions (p<0.001). The leukoplakia lesions in chronic SLT users demonstrated a significantDepartment of AnatomyÉrica Dorigatti de Avila Melaka Manipal Departamento de Estomatologia Keyincrease words: in Internalthe number iliac artery, of Langerhans internal iliac cells vein, and pelvic in the vessels, absence variation of epithelial dysplasia. Medical College da Faculdade de Odontologia de Conclusion: The increase in the number of these cells represents the initial stage of leukoplakia. (Manipal Campus) International CentreBauru for KeyIntroduction words: Smokeless tobacco, leukoplakic lesions, cancer,inferior langerhans vesical, cells, obturator, chewing middletobacco. rectal, in- Health Sciences Universidade de São Paulo (USP) The internal iliac artery (IIA) is among ferior gluteal, and internal pudendal arter- Manipal UniversityAvenida Alameda Octávio Madhav Nagar ManipalPinheiro Brizola, 9-75, 17012-901 the terminal branches of the common iliac ies. Thecontact posterior with division the oral gives mucosa iliolumbar, and createsUdupi District a Bauru–SP, Brasil Introduction Karnataka State, India artery. It supplies the pelvic viscera, perine- lateral moresacral, alkalineand superior environment, gluteal arteries. its products [email protected] may [email protected] Among tobacco users, there is a false be- um and the gluteal region. It begins in front The variationseven be inmore the originaggressive and branchingto tissue [5]. The oflief the that sacroiliac SLT is jointsafe becauseat the level it isof not the burned,in- pattern of IIA are said to be due to the de- percentage of SLT users is lower compared tervertebralwhich leads joint many between people the to fifth quit lumbarcigarettes velopmental reasons. Developmentally, the vertebraand start and using the sacrum.SLT [1]. It However,descends down SLT conIIA- is derivedto cigarette from theusers; umbilical however, artery usage [3]. is increasing totains the higher upper concentrationsmargin of the greater of nicotine sciatic thanVarious among authors young have attemptedindividuals to and classify it is therefore a notch and terminates by dividing into ante- the anatomicsignificant variants and of disturbingthe branching danger pat -[6,7]. riorcigarettes and posterior and, in divisions addition, [1,2]. nearly In males 30 carcitern- of IIA, based on the cadaveric studies thenogenic anterior substances, division gives such superior as tobacco-specific vesical, [4-5]. Initial studies on the effects of SLT on the N-nitrosamines (TSNA), which is formed oral mucosa demonstrated the formation of during the aging process of the tobacco, [2-4] white lesions induced by chronic exposure to and which presents high carcinogenic poten- tobacco, characterized by epithelial thicken- tial. Moreover, because the tobacco has direct ing, increased vascularization, collagen altera- 198 Badagabettu SN et al. The internal iliac vein (IIV) collects the venous blood from the pelvic organs, perineum and the gluteal region. Its tributaries correspond to the branches of the IIA, except for the iliolumbar vein. The iliolumbar vein drains into the external iliac vein. The variations in the pattern of formation of the IIV are relatively rare. The IIV may form an annulus around the IIA or it may re- ceive an unusual vessel representing a confluence of the internal pudendal, obturator, gluteal, and sciatic veins [6]. Here we present the variation in the formation and termination of the IIV. Case Report Figure 2. Dissection of the right side of the pelvis showing the unu- During the dissection classes for medical under- sual formation of the right common iliac vein. (1 – external iliac ar- graduates, we observed concurrent variations of the tery; 2 – external iliac vein; 3 – internal iliac artery; 4 – anterior divi- internal iliac vessels. The variations were found on sion of internal iliac vein; 5 – posterior division of internal iliac vein; 6 – common iliac vein; 7 – lumbosacral trunk; 8 – ventral ramus of the right side of the pelvis of a male cadaver aged ap- first sacral nerve; 9 – obturator nerve). proximately 65 years. The IIA had a normal origin and course but it did not divide into anterior and posterior sciatic foramen by passing above the lumbosacral trunk divisions. There were three common trunks: one for ili- instead of passing between the lumbosacral trunk and olumbar and lateral sacral arteries, another for inferior ventral ramus of the first sacral nerve. The superior vesi- gluteal and internal pudendal arteries, and the third one cal artery supplied the territory of the inferior vesical for superior vesical and obturator arteries (Figure 1). artery, since the inferior vesical artery was absent. The The superior gluteal and middle rectal arteries arose di- IIV did not have a main trunk. Its anterior and poste- rectly from the main trunk of IIA. The superior gluteal rior divisions joined with the external iliac vein to form artery entered the gluteal region through the greater the common iliac vein [Figs. 1 and 2]. Its posterior divi- sion ascended in front of the ventral rami of sacral spi- nal nerves, and the anterior division ascended parallel to the lumbosacral trunk (Figure 2). Discussion The IIA is known to show some variations in its branching pattern and the knowledge of these varia- tions is of utmost importance for the surgeons per- forming obstetric and gynecological surgeries. Knowl- edge of the branching pattern of this artery is pivotal in pelvic surgeries because erroneous interpretation and ligation of its branches are the sources of unexpected bleeding during the surgery. The percentage of success- ful ligation of its branches varies from 42–75% [7,8]. Figure 1. Dissection of the right side of the pelvis showing the unu- Jastschinski [4] was the first person that grouped sual internal iliac vessels. (1 – external iliac artery; 2 – external iliac vein; 3 – internal iliac artery; 4 – anterior division of internal iliac the variations of parietal branches of the IIA in the vein; 5 – posterior division of internal iliac vein; 6 – common trunk Polish population. He classified the vessels into four for iliolumbar and lateral sacral arteries; 7 – superior gluteal artery; 8 – common trunk for inferior gluteal and internal pudendal arteries; definite types. After this, Adachi et al. [4] classified the 9 – middle rectal artery; 10 – common trunk for superior vesical and branching pattern of IIA into five types with 8 groups obturator arteries; 11 – medial umbilical ligament; 12 – lumbosacral trunk; 13 – ventral ramus of first sacral nerve; 14 – obturator nerve; in a study on Japanese subjects. In both the above 15 – vas deferens). studies, the classification was based on the variations Arch Clin Exp Surg Year 2014 | Volume:3 | Issue:3 | 197-200 Variations of internal iliac vessels 199 in the origin of the branches of IIA, namely umbilical, the variations of the IIA. The IIV may cross the midline superior
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