boobies

Question 1

nipple histology

Answer 1

highly pigmeneted keratinized stratified squamous epithelium
- core of dense irregular connective tissue mixed with bundles of smooth muscle

lots of lactiferous ducts that serve one lobe of the breast

Question 2

3 components of mammary glands

Answer 2

1. glandular tissue - tubule-alveolar type + arrange in lobes
2. fibrous tissue - support lobes + forms numerous septa
3. interlobar fatty tissue - makes organ round in contour

Question 3

terminal duct lobular unit (TDLU)

Answer 3

basic functional secretory unit of breast

Question 4

changes to breast in luteal phase

Answer 4

epithelial cells increase in height
lumina of ducts enlarge
small amounts of secretions appear in the ducts

Question 5

changes to breasts in pregnancy

Answer 5

1st trimester – elongation + branching of smaller ducts, combined with proliferation of epithelial cells of glands + myoepithelial cells

2nd – glandular tissue continue to develop with differention of secretory alveoli, plasma cells + lymphocytes infiltrate the nearby connective tissue

3rd – alveoli continue to mature, with development of extensive rER

-> These changes are accompanied by a reduction in amount of connective tissue + adipose tissue present

Question 6

composition of breast milk

Answer 6

• 88% water
• 1.5% protein
• 7% carbohydrate
• 3.5% lipid
• Bits of ions, vitamins + IgA antibodies

Question 7

changes to boob in menopause

Answer 7

secretory cells of TDLU’s degenerate leaving only ducts

in connective tissue there are fewer fibroblasts + reduced collagen + elastic fibres

Question 8

blood supply to lateral vs medial mammary branches

Answer 8

lateral = lateral thoracic artery

medial = internal thoracic artery

Question 9

venous drainage of mammmary

Answer 9

lateral = lateral mammary veins

medial = medial mammary veins

Question 10

lymph drainage of boobs

Answer 10

> 75% axillary nodes

• remainder parasternal nodes, some may also drain to abdominal nodes

Question 11

views in mammography

Answer 11

2 views
- mediolateral oblique
- craniocaudal

Question 12

strengths + weaknesses of mammography

Answer 12

Strengths
- Images whole of both breasts
- High sensitivity for detecting DCIS + invasive cancer
- Only screening modality proven to reduce population mortality
- Accessible + inexpensive
- Reproducible
Weakness
- Ionising radiation
- Breast pain/discomfort
- Challenging if limited mobility
- Low sensitivity in dense breasts
- No functional data

Question 13

oil cyst

Answer 13

“eggshell”

often happens following trauma

Question 14

plasma cell mastitis

Answer 14

coarse rod shape pointing towards nipple, bilateral + symmetrical

Question 15

benign vs malignant on grey scale US

Answer 15

benign
- wide, well defined
- anechoic (black) - cyst
- hypochoic (dark gray)

malignant
- tall, ill defined
- hypochoic + heterogenous (dark/mixed)

Question 16

indications for gray scale US

Answer 16

• Targeted assessment – clinical/mammography abnormality
• Problems during pregnancy
• Monitoring response to systemic treatment
• Follow up in mammographically occult lesions
• Image-guided procedures – biopsy, localisation, aspiration

Question 17

gray scle US strengths + weaknesses

Answer 17

Strengths
- No ionising radiation
- Inexpensive
- Comfort
- Good sensitivity + specificity for invasive cancer
- Image-guided procedures
Weaknesses
- Low specificity when used in screening
- Low sensitivity for DCIS
- Operator dependent
- No functional data

Question 18

tomosynthesis

Answer 18

3D imaging technique
reconstruction into multiple slices - removes overlap, shows margin better

additional radiation doses
may increase sensitivity in denser breasts - not much tho

Question 19

contrast enhanced spectral mammography (CESM)

Answer 19

mammogram technique with IV contrast agent
2 clinical images for each breast view
- low energy - equivalent to mammogram
- subtracted image - enhance, cancer have increased vascularity so enhance

super good for dense breasts, quick, inexpensve
radiation dose, reaction to contrast, breast pain/discomfort

Question 20

breast elastrography

Answer 20

a measure of breast “stiffness”
-> cancer tends to be stiffer than normal breast tissue