BRANT: Chapter 18: Normal Anatomy and Histopathology

Question 1

Normal skin thickness of the breast

Answer 1

2-3 mm

Question 2

The nipple–areolar complex (NAC) is usually located at the ____ in a nonpendulous breast.

Answer 2

4th intercostal space

Question 3

The areola consists of pigmented skin, rings of smooth muscle, and specialized apocrine glands called ____

Answer 3

Montgomery glands

These Montgomery glands open to the skin surface at the Morgagni tubercles which are 1- to 2-mm raised bumps around the periphery of the areola. There are approximately 10 to 15 ductal openings on the surface of each nipple.

Question 4

Identify the pointed structure

Answer 4

Cooper ligaments

Cooper ligaments are easily seen with mammography and MRI. Normally, they have a scalloped appearance with undulating curves that can resemble the waves of the ocean.

Question 5

T/F: After menopause, the stoma of the breast becomes more fatty.

Answer 5

True

Fat is the most compressible structure in the breast. The AP dimension of a fat lobule will decrease by 30% or more if compressed with the ultrasound transducer

The amount of fat in the breast is related to both age and body mass index

Question 6

Identify the structure pointed by the arrowheads

Answer 6

Nipple

Question 7

Functional unit of the breast and site of milk formation

Answer 7

Lobules

Question 8

There are approximately ____ milk ducts that extend to the surface of the nipple with a reported range between 5 and 20. Behind each nipple orifice, there is a slightly dilated portion known as the ____.

Answer 8

10 to 15
Lactiferous sinus

Question 9

Name the study and identify the pointed structures

Answer 9

Galactogram
Arrowhead: Lobules
Arrow: Milk duct

Question 10

Smallest functional units responsible for milk production

Answer 10

Alveoli

Each ductal system drains a lobe of the breast. Within each lobe there are 20 to 40 lobules. Within each lobule, there are 10 to 100 alveoli.

Question 11

Site where most ductal and lobular carcinomas are thought to arise

Answer 11

Terminal duct lobular unit (TDLU)

The terminal duct lobular unit (TDLU) is made up of the terminal duct and the lobule that it drains

Question 12

It is an important structural and functional unit of the breast.

Answer 12

Terminal duct lobular unit (TDLU)

Question 13

The lobules and milk ducts are interspersed with fat and fibrous stroma. Together this is call ____

Answer 13

Fibroglandular tissue

Question 14

The amount of fat relative to the amount of fibroglandular tissue can vary. When this is measured on mammography, it is called ____

Answer 14

Breast density

Question 15

T/F: Breast density is also an independent risk factor for breast cancer.

Answer 15

True

Question 16

In most women, the majority of fibroglandular tissue is in the ____

Answer 16

Upper outer quadrants

Question 17

2 areas with least breast tissue

Answer 17

Lower inner quadrant
Retromammary fat

Question 18

Pectoralis major is seen on the ____ view of the mammogram and is an important landmark when assessing image quality and positioning

Answer 18

Mediolateral oblique (MLO)

Question 19

Most common method of spread for breast cancers is via

Answer 19

Lymphatic system

Question 20

We use ____ as the maximum cortical thickness for a normal node in a patient with breast cancer

Answer 20

2.3 mm

The afferent lymphatic channels first pass through the cortex of a node. Thus, the immediate subcortical region is often the first place that a metastasis is deposited. Be suspicious of a ball-like projection from the cortex of a node. An indistinct or irregular margin of a node can be a sign of extra capsular extension of the metastasis into the surrounding fat

Lymph node metastasis can cause abundant extra hilar blood flow, or multiple feeding vessels around a node that do not pass through the hilum

Question 21

The normal cortical thickness of an axillary lymph node in women without breast cancer can be up to ____

Answer 21

3 mm

Question 22

There is a large lymphatic plexus under the NAC that is called the ____

Answer 22

Subareolar or Sappey plexus

Question 23

About 75% to 97% of the lymphatic drainage of the breast is to the lymph nodes in the ____.

Answer 23

Axilla

Question 24

The first lymph node encountered is called the ____

Answer 24

Sentinel lymph node

This node can be identified at the time of surgery by using mapping techniques that involve injection of a blue dye and/or a radioisotope ( 99mTc-sulfur colloid). These substances are then traceable to the sentinel node.

Question 25

Features of suspicious lymph node include:
a. Cortical thickness > 2.3 mm
b. Loss of fatty hilum
c. Focal cortical thickening
d. AOTA

Answer 25

d. AOTA

Question 26

Nodes that are located between the pectoralis major and pectoralis minor muscles are called

Answer 26

Rotter nodes

Question 27

Landmark that divides axillary nodes into Levels I through III

Answer 27

Pectoralis minor muscle

Level I: Lateral
Level II: Posterior
Level III: Medial

Level III nodes are sometimes called infaclavicular nodes

Question 28

What level?

Answer 28

Level II

Question 29

Identify the node pointed by the arrowhead

Answer 29

Rotter nodes

When nodes are located between the pectoralis major and pectoralis minor muscles, they are called Rotter nodes.

Question 30

T/F: Intramammary nodes do not occur in the fibroglandular breast tissue

Answer 30

True

Intramammary nodes are most often a normal incidental finding. They are almost always found in the fat, usually adjacent to a vessel.

Question 31

Identify

Answer 31

Normal intramammary node

They are almost always found in the fat, usually adjacent to a vessel.

Question 32

Identify the structure pointed by the arrow

Answer 32

Lateral thoracic artery and vein

Question 33

The blood supply to the breast is from the IM artery that supplies the ____ parts of the breast and the lateral thoracic artery which supplies the ____ portions of the breast.

Answer 33

Medial and central
Upper and outer

Question 34

Breast development begins during the ____ of development and is the same for both males and females.

Answer 34

5th week

The ventral ectoderm folds inward to form two symmetric lines known as the “milk streak.” The milk streak extends from the axilla to the groin

Question 35

Accessory breast tissue is most common in the ____, seen in 2% to 6% of women.

Answer 35

Axilla

Question 36

Identify

Answer 36

Breast bud

In young girls, the first sign of breast development is a nickel size lump directly behind the nipple called the breast bud.

Question 37

T/F: In contrast to DCIS, lobular carcinoma in situ (LCIS) is not considered breast cancer.

Answer 37

True

Question 38

The sign where the skin is seen as wrapping around the structure

Answer 38

“Claw sign”

Question 39

Name the pointed structures

Answer 39

Arrows: Pectoralis major
Arrowheads: Pectoralis minor

Question 40

T/F: After birth, the male breast remains rudimentary, consisting only of ductal structures and not lobules

Answer 40

True

Question 41

Site of milk production during pregnancy and lactation

Answer 41

Lobules

The female breast continues to develop during puberty.

Estrogen: Development of the milk ducts
Progesterone + Estrogen: TDLUs and lobules begin to form in later adolescence and in the early 20s

Question 42

Breast development is termed

Answer 42

Thelarche

In young girls, the first sign of breast development is a nickel size lump directly behind the nipple called the breast bud.

Question 43

During pregnancy, there is accelerated development of the lobules under the influence of ____

Answer 43

Progesterone

The effects are most pronounced in the second and third trimesters

In the late third trimester, the acini begin to secrete colostrum and then milk which will also increase the breast density.