Histotopographical Features of the Diaphragm in Normal Conditions and with its Metastatic Lesions

Abstract

The study of regional histotopographic features of the diaphragm in normal conditions and in various types of metastatic lesions is of practical importance in abdominal oncology when planning cytoreductive surgical interventions and diaphragmatic peritonectomy. The aim was to study the histotopographic structure of the diaphragm in normal and peritoneal carcinomatosis. Material and methods . 40 non-embalmed preparations of the cadaveric diaphragm were used to prepare histotopograms of their various parts. The surgical material of 77 patients who underwent cytoreductive intervention and diaphragmatic peritonectomy of various volumes was also studied and histological preparations were made. Regional histotopographic features of the diaphragm in normal and metastatic lesions were studied. A correlation analysis of the size of carcinomatous nodes and the depth of tumor invasion was carried out. Results. It was found that the histotopographic structure in various parts of the diaphragm is normally specific and has a number of differences. Metastatic damage to the diaphragm in peritoneal carcinomatosis differs in size of tumor nodes, in depth of tumor invasion, and in combined lesion of adjacent anatomical structures. In most cases, the size of carcinomatous lesions directly correlated with the depth of tumor invasion, however, it was found that a number of large tumor nodes do not have such a depth of germination, but affect only the superficial layers of the diaphragm (peritoneum and diaphragmatic fascia). Conclusion. The results of studying the depth of tumor invasion, which is often associated with the size of carcinomatous nodes, can be implemented in clinical practice when planning cytoreductive surgical interventions and performing diaphragmatic peritonectomy.