Breast Flashcards
What is the blood supply to the breast?
Medially -** Internal thoracic (mammary) artery** which goes into perforating branches 2nd- 5th IC space
Laterally
- Posterior intercostal artery and it’s perforating branches
- Lateral thoracic (mammary) artery and it’s perforating branches
- Thoraco-acromial artery
- Anterior intercostal arteries 2-4 (branches of internal thoracic artery
Which 3 groups of lymph nodes receive lymph from the breast?
Axillary, parasternal and posterior intercostal lymph nodes
What nerves innervate the breast?
Anterior and lateral cutaneous branches of the 4-6th intercostal nerves
What ligaments hold the breasts up?
Suspensory ligaments of cooper
They attach the dermis to the pectoralis fascia
What muscles lie posterior to breasts?
Pectoralis major
Pectoralis minor
Serratus anterior
External oblique
What does halo sign mean on mammography?
Breast cyst
What drugs cause gynaecomastia?
D - digoxin
I - isoniazid
S - spironolactone
C - cemitidine
O - oestrogen
Metoclopramide
Methyldopa
Ethionamide
Chlorpromazine
What is the most important prognostic indicator in breast cancer?
Nodal status
Which type of breast cancer is characterised by a marked lymphocytic infiltrate?
Medullary breast cancer
Cause of nipple discharge, inverted nipple and invovlement of multiple ducts?
Duct ectasia
Widening of the lactiferous ducts, blockage and build up
Menopausal women >50, smokers
Thick, green nipple discharge
Can be from single or multiple ducts
What is the commonest cause of blood stained nipple discharge in younger women?
Intraductal papilloma
Most likely cause of a19 year old male presents with bilateral gynaecomastia, poor vision and nipple discharge?
Prolactinoma
Proliferation of lactotrophic cells in anterior pituitary gland. Can cause compression of the optic chiasm resulting in bi temporal hemianopia
What nerves are most likely to be damaged during axillary node clearnace?
Thoracodorsal nerve
Intercostalbrachial nerve
Infiltration of the malignancy to what structures causes skin dimpling and nipple retraction?
Skin dimpling - Suspensory ligaments of cooper
Nipple retraction - Lactiferous ducts
What type of breast ca is likely to show as linear, branching microcalcification with coarse granules on mammography?
Comedo DCIS
Which type of breast tumour is most commonly associated with a risk of metastasis to the contralateral breast?
Invasive lobular carcinoma
What breast condition is common in smokers and may present with recurrent infections?
Periductal mastitis
What are the symptoms of periductal mastitis?
periareolar or sub areolar infections
What is Mondors disease?
localised thrombophlebitis of a breast vein
What is the most common type of wound closure following implantation after mastectomy?
Pedicled latissimus dorsi myocutaneous flap
Which type of cancer forms as a result of chronic lymphoedema?
Lymphangiosarcoma
What is the nerve supply to pectoralis major and minor?
Pec major - clavicular head is lateral pectoral nerve and sternocostal head is medial pectoral nerve.
Pec minor - medical pectoral nerve
What is the nerve and blood supply to the latissimus dorsi?
Thoracodorsal artery - branch of subscapular artery
Thoracodorsal nerve - branch of posterior cord of brachial plexus
What is the nerve and blood supply of the serratus anterior?
Long thoracic nerve (C5-7)
Lateral thoracic artery, the superior thoracic artery and the thoracodorsal artery
What is the difference between nipple eczema and paget’s disease of the breast?
Most present with erythematous rashes.
Nipple eczema usually affects nipple only.
Paget’s disease spreads to areolar and periareaolar tissue. It is associated with undelying DCIS or invasive carcinoma. Diagnosis is made with punch biopsy.
Which subtype of breast cancer is likely to have linear branching microcalcifications?
Comedo DCIS
Cribiform are multifocal
Which biologic agent is useful for HER2 postitive breast cancer in young women?
Trastuzumab
