Breast Flashcards by Andie Cajucom

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

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Anatomical part of the Breast tissue that extends to the Axilla

Tail of Spence

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Inferior border of the Breast

Inframammary fold (6th or 7th rib)

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Superior border of the Breast

2nd or 3rd rib

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Medial border of the breast

Lateral border of the sternum

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Lateral border of the breast

Anterior axillary line

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Percentage of breast lymph drainage that drains to the axillary nodes

75%

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Level of Breast lymph nodes found anterior or posterior to the pectoralis minor muscle

Level II

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Level of breast lymph nodes above/medial to the upper border of the pectoralis minor muscle

Level III

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Level of breast lymph nodes lateral or below the lower border of the pectoralis minor muscle

Level II

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Axillary lymph node groups found in Level I

Scapular
External Mammary
Axillary vein

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Axillary Lymph node groups found in Level II

Central
Interpectoral (Rotter nodes)

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Axillary Lymph node groups found in Level III

Subclavicular

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The first lymph node/s that drain breast cancer

Sentinel Lymph nodes

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Muscle innervated by the long thoracic nerve

Serratus Anterior

(winging of the scapula)

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Muscle innervated by the Thoracodorsal nerve

Latissimus dorsi

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Absence of breast tissue, nipple, and areola

Amastia

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Absence of breast tissue but nipple and areola remains

Amazia

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Failure of the underlying mesenchymal tissue to proliferate and project the nipple papilla outward

Inverted nipple

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Loss of the medial edge of the breast with resulting absence of cleavage

Symmastia

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Enlargement of the male breast resulting from proliferation of glandular tissure caused by increased ratio of estrogen to androgenn

Gynecomastia

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3 stages in a male’s life prone to Gynecomastia due to excess circulating estrogens relative to circulating testosteron

Neonatal
Adolescence
Senescence

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Pathophysiology of Gynecomastia

Estrogen excess
Androgen deficiency
Estrogenic drugs/steroids
Systemic diseases

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Imaging for Gynecomastia

Mammogram or Ultrasonography

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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