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Breast Flashcards

1
Q

What does the breast lie anterior to?

A

Thorax, rib cage, pectoralis major/minor

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2
Q

What is the superior border of the breast?

A

2nd/3rd ribs

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3
Q

What is the inferior border of the breast?

A

7th costal cartilage

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4
Q

What is the medial border of the breast?

A

The sternum

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5
Q

What is the lateral border of the breast?

A

Margin of the axilla

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6
Q

What are the parenchymal tissue elements?

A

Lobes, lobules, ducts, acini/alveoli

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7
Q

What are the stromal (supporting) tissue elements?

A

Fat, loose/dense connective tissue

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8
Q

Describe the dome shape of the breast.

A

Radial in design (internal/external)

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9
Q

What comprises the nipple?

A

Round, fibromuscular papilla projecting from the center of the breast

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10
Q

What are main variants?

A

Nipple inversion, fibrocystic and fatty breast

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11
Q

What type of skin is the areola?

A

Pigmented

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12
Q

What type of glands do the areola contains?

A

Sebaceous and Montgomery’s glands (small nodules beneath the skin)

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13
Q

How many lobes are on each breast?

A

15-20

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14
Q

What separates the lobes?

A

Adipose tissue

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15
Q

What is adipose tissue comprised of?

A

Adipocytes

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16
Q

What is the simplest functional unit of the breast?

A

Lobules (one gland, one duct)

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17
Q

How many lobules per lobe?

A

20-40

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18
Q

What are the microscopic saclike secretory glands within the lobules at the ends of the ducts called?

A

Acini/alveoli

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19
Q

What is the axillary tail of Spence?

A

A portion of the mammary tissue extending into the region of the axilla

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20
Q

What are the lactiferous ducts?

A

A network of ducts draining acini, lobules and lobes

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21
Q

How many ducts per lobe?

A

One major duct (converging radially toward nipple)

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22
Q

What are sinuses?

A

Enlarged duct segments beneath the areola

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23
Q

Where are the parenchyma/glandular tissue positioned?

A

Within the layers of the deep and superficial fascia

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24
Q

Stroma/supportive tissue consisting of fat and connective tissue is found where?

A

Subcutaneous (skin&sub fat), retromammary (fat/muscle), and interlobar/interlobular

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25
Q

Where is the retromammary layer positioned?

A

Posterior to parenchyma

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26
Q

What are Cooper’s Ligaments?

A

Thin, echogenic, curvilinear line within fat

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27
Q

Where do Cooper’s extend?

A

From deep fascia to skin

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28
Q

What are Cooper’s function?

A

To firmly attach mammary gland to the skin, enclose and separate fat, lobes, and lobules

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29
Q

What is blood supply?

A

Branches of internal mammary, lateral thoracic, and intercostal arteries

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30
Q

Where do mammary arteries derive?

A

1st branch of subclavian arteries

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31
Q

Where do mammary veins drain?

A

Into subclavian veins (superficial/deep)

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32
Q

Where do lymph vessels flow?

A

Toward axilla (follow venous drainage into subclavian veins)

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33
Q

When do the breasts (modified sweat glands) lactate?

A

During and after pregnancy

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34
Q

What happens when lactation ceases?

A

The acini/alveoli disappear

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35
Q

How is lactation controlled?

A

The hypothalamus/anterior pituitary gland secretes prolactin

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36
Q

What is the prolactin-inhibiting factor?

A

It prevents the release of prolactin before childbirth

37
Q

What does infant sucking stimulate?

A

The secretion of oxytocin from APG causing contraction of lactiferous ducts.

38
Q

How is the milk stored before suckling?

A

Acini produce / lactiferous ducts drain it into lactiferous sinus/ampulla beneath the areola

39
Q

How does subcutaneous layer appear on U/S?

A

Hypoechoic

40
Q

How does mammary layer appear on U/S?

A

Moderately echogenic

41
Q

How does retromammary layer appear on U/S?

A

Hypoechoic to the parenchyma

42
Q

What is the problem with dense parenchyma?

A

Difficult to visualize with mammography in younger patients

43
Q

How do breast ducts/ductules appear?

A

Anechoic tubular structures

44
Q

How does nipple appear and problems associated?

A

Gives posterior shadowing when over it so you must scan from the side

45
Q

How are Cooper’s Ligaments seen?

A

Thin, echogenic, curvilinear line within fat

46
Q

What frequency transducers are used?

A

Start with higher (15 MHz for best resolution) and use 5 MHz for large breast

47
Q

What does the radial method use?

A

Radial (clock) and antiradial (perp/90 deg counter) views

48
Q

What does sonography detect masses better in?

A

Dense breast (young/pregnant/lactating)

49
Q

What are some indications for breast sonography?

A

Cystic/solid masses, trauma, inflammation, implants, post-radiation, gynecomastia, needle/biopsy assist

50
Q

What strength does x-ray have over sonography?

A

Sonography cannot detect microcalcifications (1mm) lying outside a mass

51
Q

How are simple cysts formed?

A

Intraductal hyperplasia/fibrosis may obstruct the duct causing secretions to gather and form a palpable mass

52
Q

Who commonly gets simple cysts?

A

Premenopausal women (35-50) and subside w/menopause

53
Q

What are sonographic appearances of simple cysts?

A

Anechoic, well-defined round with smooth thin margins, lateral refractive edge shadowing with posterior/distal acoustic enhancement

54
Q

What causes complex cysts?

A

Infections, trauma (hematoma), galactocele (accumulation of milk)

55
Q

What are clinical signs of mastitis?

A

Swollen breast, pain/tenderness, cracked nipple/discharge, dilated ducts, fever, and potential abscess

56
Q

What are sonographic appearances of a complex cyst?

A

Well-defined margins/round with internal echoes

57
Q

What causes fluid-fat internal echoes?

A

Galactocele (glandular tissue/ductal enlargement)

58
Q

What causes thrombus internal echoes?

A

Hematoma

59
Q

What causes internal echoes from debris?

A

Abscess (Cooper’s/skin thickened ligament/tissue edema)

60
Q

What is fibrocystic breast disease?

A

Diffuse interspersed small cysts in parenchyma (30-60 years)

61
Q

How does fibrocystic breast disease appear on U/S?

A

Basket-weave glandular tissue, echogenic parenchyma and dilated ducts

62
Q

What is fibroadenoma?

A

Most common benign breast tumore developing from estrogen in black women 15-35

63
Q

What are clinical signs of fibroadenoma?

A

A painless, palpable, moveable firm mass

64
Q

What is the sonographic appearance of fibroadenoma?

A

Homogenous, hypoechoic mass w/smooth borders (shadowing is not common)

65
Q

What variations can occur with fibroadenoma U/S appearance?

A

Lobulations and internal echoes

66
Q

What sonographic findings raise suspicion for malignancy?

A

Star-like pattern (spiculations) taller than wider, angular margins, hypoechoic, shadowing, thick Cooper’s, calcifications, duct extension, hypervascularity, lymphadenopathy

67
Q

What do malignant breast masses do?

A

Invade rather than displace

68
Q

What are sonographic features of benign breast masses?

A

More hyperechoic to fat, ellipsoid shape (base wider than tall), thin echogenic capsule

69
Q

What is medullary carcinoma?

A

Cellular tumor containing epithelial tissue more likely to happen in younger women comprising 5-10% of breast cancers

70
Q

What are clinical signs of medullary carcinoma?

A

Palpable mass and skin discoloration (mammogram anomaly)

71
Q

What is the U/S appearance of medullary carcinoma?

A

Bulk, smooth tumor (mildly irregular)

72
Q

What is invasive ductal carcinoma?

A

Most common breast cancer originating from lactiferous ducts

73
Q

What are clinical signs of ductal carcinoma?

A

Hard, fixed and painless if palpable, skin/nipple changes (mammogram anomaly)

74
Q

What are U/S appearance of ductal carcinoma?

A

Ducts are traced to the mass

75
Q

What are acute complications of implants?

A

Months/Years after surgery: bleeding, infection, asymmetry, loss of nipple sensation, and pain/tenderness

76
Q

What are chronic complications of implants?

A

Capsular contracture, rupture, hematoma, herniation, migration and chronic infection

77
Q

What are the 2 types of implant rupture?

A

Intracapsular and extracapsular

78
Q

What problems occur with an intracapsular rupture?

A

80% of the time, the breach in the elastomer membrane will cause the silicone to leak, but it will remain in the fibrous capsule around the ruptured implant

79
Q

What problems occur with an extracapsular rupture?

A

Silicone leaks into the surrounding tissues through a defect in both the implant shell and the fibrous capsule

80
Q

What are sonographic features for an implant rupture?

A

Stepladder parallel-line sign, low-med internal echoes in silicone, snowstorm (echogenic noise) hypoechoic mass outside implant capsule, implant deformity, having peri-implant fluid collection or not

81
Q

What has the FDA restricted since 1992?

A

Silicone implants

82
Q

What are the prosthetics of choice since 1992?

A

Saline implants

83
Q

What comprises silicone implants?

A

Single-lumen containing silicone gel bag w/elastomer or polyurethane shell

84
Q

How does silicone appear on U/S?

A

Large, oval echo-free structure behind the glandular tissue and in front of the pectoral muscle (subglandular) or beneath the muscle (subpectoral)

85
Q

How do saline implants appear?

A

Double-lumen containing silicone surround by a saline bag

86
Q

What is prolactin?

A

A hormone produced by the anterior pituitary (adenohypophysis) and binds to mammary epithelial cell receptors which stimulate creation of mRNA of milk proteins

87
Q

What is oxytocin?

A

A hormone produced by the posterior pituitary (neurohypophysis) which releases intermittently from suckling for the breast to produce milk ejection

88
Q

What’s the difference between oxytocin and prolactin?

A

Oxytocin is responsible for milk ejection whereas prolactin is responsible for milk production

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