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Breast US > Anatomy > Flashcards

Anatomy Flashcards

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1
Q

The breasts initially develop from the?

A

ectoderm. As paired mammary ridges (or milk lines)

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2
Q

What week of gestation does the breasts develop?

A

4th

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3
Q

How many lobes of glandular tissue develop?

A

15-20

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4
Q

Cooper’s ligaments and fat develop from the?

A

mesoderm

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5
Q

Are the rudimentary mammary glands the same at birth in both males and females?

A

Yes

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6
Q

What makes the areolae thick?

A

Glands of Montgomery

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7
Q

Witch’s Milk:

A

Enlargement of newborns ductal system, which causes secretions similar to colostrum. This happens due to a decrease in maternal estrogen in the newborn’s bloodstream which stimulates the pituitary gland.

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8
Q

Corpus luteum secretes what after ovulation?

A

Progesterone

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9
Q

What causes breast fullness and tenderness after ovulation?

A

Proliferation of the epithelial cells within TDLU and subsequent enlargement of the lobules and terminal ductules.

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10
Q

If pregnancy occurs, the breasts reach functional maturity influenced by what hormones?

A

estrogen, progesterone, prolactin and placental lactogen

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11
Q

Acini become fully formed and functional once puberty is completed.

A

False – when pregnancy and lactation have occurred

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12
Q

What hormones causes lactation to begin?

A

drop in progesterone, alveolar epithelium begins to secrete milk. Then, in response to sucking or crying, oxytocin causes contractions to the epithelial cells which forces the alveoli to secrete milk

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13
Q

What part of the breast secretes milk?

A

Alveoli

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14
Q

When do the mammary glands begin to atrophy?

A

40yrs — after menopause the glands further involute and are replaced by fat and CT

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15
Q

What’s responsible for duct development and division and the deposition of fatty tissue?

A

Estrogen

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16
Q

What’s responsible for alveolar (acini) and lobular development?

A

Progesterone

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17
Q

List some changes that occur during pregnancy:

A

areola darkens and increases in size (color lightens after lactation is done, but never is the pre pregnancy state)

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18
Q

Colostrum

A

Little water or fat, but high in antibodies

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19
Q

What hormones have to be right in order for the alveoli to produce milk?

A

Prolactin (ant pituitary gland)- high

Estrogen/progesterone- low

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20
Q

What hormone inhibits milk production during pregnancy?

A

estrogen and progesterone from the placenta

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21
Q

Milk is produced how many days post partum?

A

1-3days

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22
Q

What continues the alveoli in producing milk?

A

Sucking motion stimulates the anterior pituitary gland to release prolactin

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23
Q

How does milk travel from the breast tissue through the nipple?

A

Collects in the alveolar cells in the clustered alveoli, then into the secondary tubules. These converge to form a lactiferous duct. Near the nipple, the ducts expand to form an ampulla (lactiferous sinus), where milk is stored

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24
Q

Oxytocin stimulates the milk ejection reflex, and also ?

A

the contraction of myoepithelial cells

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25
Q

As a woman ages, the breast tissue changes from glandular to fatty. What delays this?

A

HRT

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26
Q

The breast is classified as a modified and highly specialized type of what gland?

A

Apocrine

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27
Q

What’s the function of the apocrine gland?

A

To secrete milk during lactation.

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28
Q

What’s the purpose of the areola?

A

To lubricate the nipple during lactation through the action of sebaceous areolar glands or glands of Montgomery.

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29
Q

How many lactiferous duct openings are there?

A

20

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30
Q

The entire breast is enveloped in ?

A

Superficial pectoral fascia – or connective tissue

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31
Q

What supports the breast?

A

Cooper’s ligaments

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32
Q

What are the 3 layers of the breast?

A

Subcutaneous, mammary, retromammary

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33
Q

Describe the subcutaneous layer of the breast:

A

bounded by skin anterior and fascial plane posteriorly. Skin thickness <2mm. Mostly composed of fat lobules separated by Cooper’s ligaments

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34
Q

Describe the retromammary layer of the breast:

A

Primarily composed of fat. Bounded anteriorly by the mammary layer and posteriorly by the deep fascia covering the pec muscle

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35
Q

Are fat lobules smaller in the subcutaneous or retromammary layer?

A

Retromammary

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36
Q

The mammary layer is contained within?

A

the superficial and deep layers of the superficial pectoral fascia

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37
Q

What layer of the breast are we most concerned for disease and changes w advancing age and pregnancy?

A

Mammary layer

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38
Q

There is no what immediately beneath the nipple and central areola?

A

fat

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39
Q

Tail of Spence aka?

A

Axillary tail – extends from the UOQ to axilla

40
Q

The breast receives its arterial blood supply from which arteries?

A

Thoracic branch of the axillary and lateral thoracic arteries including: internal mammary, lateral thoracic, intercostal artery and perforating arteries (least important)

41
Q

What is the principle source of arterial blood supply to the breast?

A

Internal mammary artery (arising from the prox SCA)

42
Q

What are the landmarks for locating the internal mammary (parasternal) chain of LN’s?

A

IMA and IMV

43
Q

What supplies blood to the medial aspect of the breast?

A

Perforating branches of the IMA

44
Q

What supplies blood to the lateral aspect as well as the deep portions of the breast?

A

Branches of the lateral thoracic and intercostal arteries

45
Q

What is the circulus venosus?

A

Venous anastomotic circle around the base of the nipple

46
Q

What provides the majority of the sensory innervation to the breast?

A

Lateral and anterior cutaneous branches of the intercostal nerves. Also the supraclavicular nerve

47
Q

Lymphatic drainage begins within the lobules and drains?

A

intramammary LN’s

48
Q

Plexus of Sappey

A

when lactiferous ducts converge at the nipple at the subareolar plexus. Play an important role in LN mapping as all lymphatics of the breast communicate through this plexus

49
Q

What’s the primary route of lymphatic drainage?

A

Posterior intercostal nodes to the axillary lymph nodes (75%)

50
Q

What’s the secondary route of lymphatic drainage?

A

internal mammary chain (20-25%)

51
Q

What’s the least important role in lymphatic drainage?

A

Subcutaneous LN’s (5%)

52
Q

There are 8 LN groups, list them

A

external mammary, scapular, axillary, central, subclavicular, interpectoral, internal mammary, supraclavicular

53
Q

How are axillary LN’s subdivided ?

A

By their relationship to the pectoralis minor muscle

54
Q

Level 1 (low) nodes are located:

A

lateral to pec minor

55
Q

Level 2 (middle) nodes are located:

A

posterior to pec minor

56
Q

Level 3 (upper) nodes are located:

A

medial to pec minor (subcl, infracl, and apical nodes)

57
Q

What are Rotter’s nodes:

A

1-2 LN’s that are located between the pec minor and major muscles. Along the pectoral branch of the thoracoacromial artery

58
Q

Approximately 75% of the lymphatic vessels drain to the 30 or so regional LN’s through the nodes at

A

L1

59
Q

The lumen of each duct is lined with:

A

epithelial cells

60
Q

What lines the outside of a duct?

A

myoepithelial cells

61
Q

Epithelial and myoepithelial cells are composed of what? What does this aid in?

A

Contractile fibers – transport of milk

62
Q

What’s the functional unit of the breast?

A

Terminal duct lobular unit (TDLU)

63
Q

Intralobular terminal duct (ITD) drains the

A

multiple, small, blind ended ductules (acini)

64
Q

Extralobular terminal duct (ETD) drains the

A

lobule

65
Q

What is the target zone for a lobule:

A

Junction of the intra and extralobular terminal ducts, as it is the side of 50% of precancerous epithelial proliferations

66
Q

Each TDLU consists of ? Each lobule consists of?

A

lobule and extralobular terminal duct. Intralobular terminal duct and ductules

67
Q

Tissue types in the breast can be described as hyper or hypoechoic, when comparing it to the:

A

subcutaneous fat

68
Q

How does the skin layer appear on US

A

two, parallel, echogenic bands on either side of a hypoechoic central layer

69
Q

Skin layer thickness

A

<2mm

70
Q

Pectoralis minor lies how to the major?

A

Posterior, superior and lateral

71
Q

What muscle is located deep to the lateral third of the breast and forms the medial wall of the axilla?

A

Anterior serratus

72
Q

Normal ducts should not exceed

A

2mm (non lactating)

73
Q

Ductal ectasia often occurs in the presence of

A

fibrocystic disease and mastitis

74
Q

Ductal ectasia symptoms:

A

milky discharge, sometimes w pain in subareolar region

75
Q

What percentage of palpable breast cancers have LN involvement?

A

40-50%

76
Q

Cortical thickness of a LN cannot measure more than

A

4mm

77
Q

What’s the most significant difference between a normal and abnormal node?

A

Fatty hilum

78
Q

LN’s in the OUQ should measure less than

A

1.5-2cm

79
Q

Patients with ____________________ have a higher risk of cancer reccurence.

A

Extra-nodal extensions (ENE)

80
Q

What are signs of extra-nodal extensions (ENE)?

A

Perinodal edema and matted LN’s (2-3 nodes appear fixed in place during real time scanning)

81
Q

What is interval breast cancer?

A

Cancers that are present, but not caught on a woman’s last screening mammography exam. As well as those that developed after the exam

82
Q

What does the male breast lack?

A

Cooper’s ligaments and acini

83
Q

What’s the most common reason for a male breast US?

A

Gynecomastia or asymmetry

84
Q

What’s the most common benign male breast mass? Second most common?

A

Gynecomastia, lipoma

85
Q

What is thought to be the primary cause of gynecomastia? Secondary?

A

Primary - estrogen concentration

Secondary - proliferation of ductal and stromal elements

86
Q

Dendritic gynecomastia

A

presents in gynecomastia patients who have been symptomatic for over a year. Small, hypoechoic tissue extending into the subareolar tissue and sometimes UOQ

87
Q

Diffuse gynecomastia

A

appears similar to dense female breast tissue, hyperechoic

88
Q

What is pseduogynecomastia:

A

accumulation of pectoral fat stored behind and around the nipple area

89
Q

What’s the risk of breast cancer in males?

A

1%

90
Q

What are the symptoms of breast cancer in males?

A

Unilateral, painless, palpable mass (80-90%). People can also present w nipple discharge (10-15%)

91
Q

What’s the most common type of breast cancer in males?

A

Invasive or infiltrating ductal carcinoma, and then DCIS.

92
Q

Do transgender women have similar breast tissue to normal women?

A

Yes. They develop ducts, lobules and acini.

93
Q

Internal mammary artery is now known as:

A

internal thoracic artery

94
Q

Lactiferous duct system of the breast is best evaluated how?

A

radial and anti radial scan plans

95
Q

Risk factors of male breast cancer:

A

advanced age
radiation exposure to chest at a young age
occupational heat exposure
treatment of prostate cancer w estrogen based hormones leading to hyperestrogenism
family hx of a first degree male or female relative
BRCA1 or BRCA2 gene

Breast US (6 decks)

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