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Morphologic and Histological Differentiation of Gubernaculum in Female Fetus: a Cadaveric Study

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Morphologic and Histological Differentiation of Gubernaculum in Female Fetus: a Cadaveric Study International Journal of Research in Medical Sciences Shrivastava T et al. Int J Res Med Sci. 2018 Jan;6(1):121-128 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20175555 Original Research Article Morphologic and histological differentiation of gubernaculum in female fetus: a cadaveric study T. Shrivastava*, S. Pandit, S. Kumar Department of Anatomy, Armed Forces Medical College (AFMC), Pune, Maharashtra, India Received: 01 December 2017 Accepted: 11 December 2017 *Correspondence: Dr. T. Shrivastava, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: In both male and female fetuses inguinal canal development entails a complex sequence of anatomic events involving the gubernaculum and processus vaginalis. Much has been written about the embryological development of the genital system, particularly the male genital system and the descent of the testes from the abdominal cavity into the scrotum. In this process, the gubernaculum plays a relevant although still unclear role. Despite all the studies that have been performed, controversy still exists in this anatomical region. Methods: Twenty round ligaments of uterus were dissected from female fetuses and microscopic structure was studied under light microscope using haematoxylin and eosin stain. The specimens were collected from female fetuses (8wks-26wks). One male fetus was also dissected. Results: Gubernaculum plays a crucial role in the development of the inguinal region. The gubernaculum is directly associated with the migration of the testis through the inguinal canal and probably to the scrotum; but the inguinal canal is present before testicular descent and females have both an inguinal canal and gubernaculum, although the ovaries do not migrate through the abdominal wall. Conclusions: In this anatomical region, and despite all the studies that have been performed, controversy still exists. This article attempts to study the morphology and histology and the differentiation of the gubernaculum with age. Keywords: Gubernaculum, Round ligament, Uterus INTRODUCTION The round ligament is continuous with the ligament of ovary and the two represent in continuity, the The round ligament of uterus represents a mammalian gubernaculum, the counterpart of the gubernaculum testis developmental novelty. The unusual structure of the of the male. Arey et al claims that the ligament appears as round ligament is related to one or more of the many early as 7th week of IUL.2 By the beginning of 3rd month unusual features of human uterine development. The a continuous cord of dense mesenchyme extends from the uterus develops as a single organ with a position deep in uterus to the labium majus. The ligament passes through the abdominal cavity below the pelvic brim and far away the abdominal muscles which organize about it to form from the posterior abdominal wall. The unusual the tubular inguinal canal with the round ligament in anatomical position may require an unusual construction females or spermatic cord in males. Shallow peritoneal of the uterine suspensory apparatus of which the round pockets persist as diverticula of Nȕck correspond to the ligament is one component.1 Its exact role in females has primary vaginal processus of the male. There is no many claims. external descent of ovary, one reason being the International Journal of Research in Medical Sciences | January 2018 | Vol 6 | Issue 1 Page 121 Shrivastava T et al. Int J Res Med Sci. 2018 Jan;6(1):121-128 mechanical block presented by the uterus which is The round ligament was divided into four regions- at interposed between ovarian and round ligaments. uterine cornu, in the pelvis, in inguinal canal and at its termination i.e., just beyond the superficial inguinal ring. The aim of the study was the morphological and These were named A, B, C, and D respectively. histological differentiation of gubernaculum in female fetus of 8 wks to 26wks (Cadaveric study). The proximal part of each of these segments was taken for the microscopic study (Figure 1). METHODS Gross anatomy Twenty round ligaments of uterus were dissected from female fetuses and microscopic structure was studied The length of the round ligament is found to vary from a under light microscope using haematoxylin and eosin minimum of 0.8 cms to a maximum of 2.6 cms in the stain. The specimens were collected from female fetuses fetuses. (8wks-26wks). One male fetus was also dissected. The round ligament in fetuses from 8-17wks is seen The round ligament was divided into four regions- at attached to the proximal part of the uterine tube (Figure uterine cornu, in the pelvis, in inguinal canal and at its 2, 3). In older fetuses it is seen attached separately to the termination i.e., just beyond the superficial inguinal ring. lateral border of the uterus as in adult females. These were named A, B, C and D respectively. The proximal part of each of these segments was taken for the microscopic study (Figure 1). To study the microscopic structure of the round ligament, each round ligament was cut transversely and cut parts were subjected to tissue processing for histological study. The specimens were dehydrated in ascending grades of alcohol, cleared in chloroform and embedded in paraffin wax. 5μ thick sections were cut and were examined with H and E stain. RESULTS The gross anatomy and microscopic structure of the round ligament of uterus has been studied in each of 20 round ligaments from fetuses ranging from 8-26wks. The microscopic structure of the gubernaculum testis was Figure 2: Fetus 10wks. The round ligament (RL) is studied for comparison. seen arising from the uterine tube UB: Urinary bladder, Ut: Uterus. Figure 1: Fetus 26wks. The four regions from where the specimen is taken for histological study are shown Figure 3: Fetus 17wks. The Round ligament(RL) is A: at uterine cornu B: in the pelvis C: in inguinal seen passing medial to the external iliac vessels (Ext canal D: At Termination Sig C: Sigmoid colon, UB: iliac Vs). Urinary Bladder, RL: Round ligament. International Journal of Research in Medical Sciences | January 2018 | Vol 6 | Issue 1 Page 122 Shrivastava T et al. Int J Res Med Sci. 2018 Jan;6(1):121-128 It passes forwards and laterally in the anterior leaf of broad ligament. In the fetus, the external iliac vessels are lateral to the ligament (Figure 3) while in the adult it reaches the side wall of the pelvis and crosses the vescical vessels, obturator vessels and nerve, obliterated umblical artery and also the external iliac vessels. At the deep inguinal ring, it hooks round the inferior epigastric vessels and then traverses the inguinal canal. In its course in the inguinal canal it receives coverings corresponding to those of the spermatic cord in male. Further it is accompanied by a branch from the ovarian artery and in the caudal part by a branch from the inferior epigastric artery. Ilioinguinal nerve and the genital branch Figure 5: (X40) TS through RL at uterine cornu in of genitofemoral nerve also accompany it in the inguinal 10wks fetus showing fibroblasts, mesenchymal canal. In the fetus, a tubular process of the peritoneum is cells(M), very few blood vessels (Bld Vs) and carried with it for a short distance into the inguinal canal myoblasts (M). (Canal of Nück). The ligament loses its identity among the deep tissue of the labium majus after coming out of Fibroblasts are irregular to fusiform, branching basophilic the superficial inguinal ring in all the specimens although cells with ovoid euchromatic nucleus. In 10-12wks, the the mode of termination of the ligament is different in the section shows plenty of fibroblasts in the mesenchyme. fetuses and the adult. Mesenchymal cells differentiate into myoblasts which give rise to the muscle. Myoblasts are seen as darkly staining elongated basophilic structures with elongated nucleus as compared to the surrounding mesenchymal cells. Figure 4: Fetus 24wks. Depicting termination of the Round ligment in one specimen. It remains as a fibrous band in the fetuses (Figure 4) while it breaks up into 4-5 fibrous strands in the adult Figure 6: (X20) TS through RL at uterine cornu in 17 females. The distance from termination of the round wk old fetus showing increase in vascularity. ligament to caudal labium is found to increase with gestational age, 0.6cms in 8wks fetus to 1.5cms in 26wks Plenty of myoblasts and smooth muscle are observed in fetus. This is due to increase in the size of body wall. 17wks fetus. Mesenchymal cells are few in number. The myoblasts start arranging as a central longitudinal core Microscopic structure (Table 1) and oblique peripheral region and smooth muscle is also seen in the peripheral region. Vascularity is increased (Figure 6). In 22-26wks fetuses, large congested blood Uterine cornu vessels with mesenchymal cells, fibroblasts and myoblasts are seen. In one 22wk old fetus, central zone of In the smallest fetus (8-10wks), the round ligament is blood vessels (vascular core) is seen surrounded by seen as a collection of mesenchymal cells with fibroblasts fibroblasts, mesenchymal cells and peripheral myoblasts. (Figure 5). Very few blood vessels and myoblasts are In a 26wk old fetus, central zone of blood vessels, seen. Mesenchymal cells are stellate to fusiform, nucleus mesenchymal cells, myoblasts, smooth muscle and is large and pale with scanty cytoplasm and they form a peripheral fibroblasts are seen. syncytium. International Journal of Research in Medical Sciences | January 2018 | Vol 6 | Issue 1 Page 123 Shrivastava T et al.
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