Breast Flashcards
Suspensory ligaments/bands of connective tissue that extend from the skin to the deep fascia and provide structural support to the breast
Suspensory ligament of Cooper
Anatomical part of the Breast tissue that extends to the Axilla
Tail of Spence
Inferior border of the Breast
Inframammary fold (6th or 7th rib)
Superior border of the Breast
2nd or 3rd rib
Medial border of the breast
Lateral border of the sternum
Lateral border of the breast
Anterior axillary line
Percentage of breast lymph drainage that drains to the axillary nodes
75%
Level of Breast lymph nodes found anterior or posterior to the pectoralis minor muscle
Level II
Level of breast lymph nodes above/medial to the upper border of the pectoralis minor muscle
Level III
Level of breast lymph nodes lateral or below the lower border of the pectoralis minor muscle
Level II
Axillary lymph node groups found in Level I
Scapular
External Mammary
Axillary vein
Axillary Lymph node groups found in Level II
Central
Interpectoral (Rotter nodes)
Axillary Lymph node groups found in Level III
Subclavicular
The first lymph node/s that drain breast cancer
Sentinel Lymph nodes
Muscle innervated by the long thoracic nerve
Serratus Anterior
(winging of the scapula)
Muscle innervated by the Thoracodorsal nerve
Latissimus dorsi
Absence of breast tissue, nipple, and areola
Amastia
Absence of breast tissue but nipple and areola remains
Amazia
Failure of the underlying mesenchymal tissue to proliferate and project the nipple papilla outward
Inverted nipple
Loss of the medial edge of the breast with resulting absence of cleavage
Symmastia
Enlargement of the male breast resulting from proliferation of glandular tissure caused by increased ratio of estrogen to androgenn
Gynecomastia
3 stages in a male’s life prone to Gynecomastia due to excess circulating estrogens relative to circulating testosteron
Neonatal
Adolescence
Senescence
Pathophysiology of Gynecomastia
Estrogen excess
Androgen deficiency
Estrogenic drugs/steroids
Systemic diseases
Imaging for Gynecomastia
Mammogram or Ultrasonography
Surgical techniques for Gynecomastia
Local excision
Liposuction
Subcutaneous Mastectomy
Pathogen seen in breast abscesses that are localized and deep
S. aureus
Pathogen seen in breast abscesses that are diffuse and superficial
Streptococcus pyogenes
Most common pathogen for Mastitis
Staph aureus
Variant of thrombophlebitis that
involves the superficial veins of the anterior chest wall and breast
Mondor Disease (Superficial Thrombophlebitis)
Mondor disease is a usual complication after what procedure
Breast augmentation
Benign breast neoplasm that mimics invasive ductal carcinoma on mammo: dense solid rodlike calcifications
Duct Ectasia
Benign breast neoplasm that mimics invasive ductal carcinoma on mammo: dense solid rodlike calcifications
Duct Ectasia
Benign breast tumor of fibrous and epithelial elements, most common solid mass found in women of all ages
Fibroadenoma
Management of Fibroadenoma for patients <25-30 years with a typical imaging appearance
Close clinical followup
Management of Fibroadenoma for patients >30 years without prior mammogram
Needle aspiration, Mammography: assess
borders of lesion
Proliferation of glandular and stromal elements in the breast resulting in enlargement and distortion of lobe units
Sclerosing Adenosis
Finding of Sclerosing Adenosis on Mammogram (mimics breast carcinoma)
Diffuse microcalcifications
Management of finding of Sclerosing Adenosis (Diffuse microcalcifications)
Excisional biopsy to exclude diagnosis of carcinoma
Characterized by central necrosis and varying degrees of epithelial proliferation, apocrine metaplasia and papilloma formation
Radial and Complex Sclerosing Lesions
Breast condition involving an Increased number of cells relative to that normally observed above base membrane
Ductal Epithelial Hyperplasia
Also called “Swiss cheese disease” it is a focal palpable mass that may be a marker for families at risk of breast cancer
Juvenile Papillomatosis
Architectural classification of DCIS that shows Large cells, nuclear pleomorphism, mitotic activity, often associated with microinvasion
Comedo
Architectural classification of DCIS that shows small cells, small hypochromatic nuclei, back-to-back glands
Cribriform
Architectural classification of DCIS that shows lntraluminal projection of cells, club shaped, that lack fibrovascular cores
Micropapillary
Architectural classification of DCIS that shows lntraluminal projection of cells, fibrovascular cores
Papillary
Multiple separate foci of disease occur within the same quadrant of the breast
Multifocal
The foci of disease present in different quadrants of the breast, arising
simultaneously in different, disconnected duct systems
Multicentric
Eczematous, scaly skin at the nipple and areolar complex associated with an underlying in situ or invasive breast cancer
Paget disease of the breast
Most common type of non-invasive breast neoplasm without invasion of the basement membrane
Ductal Carcinoma in Situ
Model that described a gradual histological, nonobligatory series of abnormal stages leading to cancer in the terminal duct-lobular unit (hyperplasia > atypia > in situ lesions > invasive cancer)
Wellings-Jensen Model
DCIS vs LCIS
Age in years
DCIS: older (54-58)
LCIS: younger (44-47)
DCIS vs LCIS
Presentation
DCIS: Incidental on mammo, nipple discharge, paget disease, palpable mass
LCIS: incidental on biopsy, usually no clinical signs
DCIS vs LCIS
Cell size
DCIS: Medium/Large
LCIS: Small
DCIS vs LCIS
Pattern
DCIS: Comedo, Cribriform, Micropapillary, Solid
LCIS: Solid
DCIS vs LCIS
Calcification
DCIS: Usually present (seen on mammo)
LCIS: Usually absent
DCIS vs LCIS
Relation to Breast cancer
DCIS: precursor lesion
LCIS: risk factor
DCIS vs LCIS
Risk of subsequent invasive cancer
DCIS: Higher
LCIS: Lower
DCIS vs LCIS
Location of subsequent cancers
DCIS: Ipsilateral
LCIS: Bilateral
Primary diagnostic tool for breast cancer detection and diagnosis
Mammogram
Mammographic hallmark in Breast cancer
Calcifications:
Pleomorphic, with linear, branching, irregular or granular forms
Diagnostic imaging tool used for detecting residual disease, occult breast cancers, or multicentric lesions
MRI
Indications for Breast conservation therapy (Segmental mastec, lumpectomy, quadrantectomy, wide local excision)
Low grade DCIS, no necrosis, non-comedo, multifocal
Indications for Total Mastectomy
> Multicentric disease
Diffuse microcalcifications on mammo
Unable to obtain histologically negative margins after multiple excision
Large tumor size with predictably bad cosmetic outcome
Patient preference
Indications for Sentinel LN Biopsy
> Mastectomy with diffuse disease
Presence of microinvasion
Extensive high grade disease or necrosis in core biopsy
Imaging studies suggestive of invasion
Hormonal therapy for patients with ER receptor (+) DCIS
Tamoxifen
LCIS Pathophysiology
Filling, distention, and distortion of over half the acini of a lobular unit by a homogenous population of characteristic cells
Biomolecular profile usually found in LCIS
HR (+)
HER2/neu (-)
Most common indication for a breast biopsy that leads to a diagnosis of LCIS:
Nonpalpable mammographic abnormality or microcalcification
Characteristic of calcifications (if any) seen in LCIS
Neighborhood calcification (occurs outside of the focus of LCIS)
Chemoprevention regimen for LCIS
Tamoxifen 20mg PO for 5 years.
Reduces risk of invasive cancer by 55%
Side effects of Chronic Tamoxifen use
> Hot flashes
Endometrial cancer
Venous thromboembolism
