Breast Flashcards
Cooper ligaments
Suspensory ligaments extending from the connective tissue layer through the breast and attaching to the underlying muscle fascia
Acini cells
Milk-producing celss
Greatest amount of glandular tissue
Upper outer quadrant extending to tail of Spence
Thelarche
Breast development
Tanner system
Stages of breast development
Pregnancy
Colostrum produced, accumulates in the acinus cells
Areolae become deeply pigmented and increase
Montgomery tubercles develop as sebaceous glands hypertrophy
Colostrum
Replaced by milk after 2-4 days
Supernumery nipples may arise
Along the milk line, an embryonic ridge
Inspect the breasts in the following positions
Arms overhead
Hands on hips pressing hands together
Leaning forward from the waist
Patient seated
Chest wall sweep from clavicle to nipple, feeling for superficial lumps
Bimanual digital palpation - walk across with one hand to flatten
Lymph node palpation - axillae, supraclavicular, infraclavicular
Sentinal nodes
Virchow nodes
Indicators of invasion of lymphatics by CA
Witch’s milk
Sometimes expressed 2 weeks-3 months of age infants
Telangiectasias
Spider angiomas or vascular spiders - may develop on upper chest, arms, neck, face as a result of circulating estrogen
Montgomery tubercles
Raised sebaceous glands
Fibrocystic changes
20-49 y/o Usually bilateral Multiple or single Round Soft to firm; tense Mobile No retraction Tender Well delineated Vary with menses (long follicular or luteal phase) = Benign fluid-filled cysts caused by ductal enlargement
Fibroadenoma
15-55 y/o Usually bilateral Multiple or single Round or discoid Firm or rubbery Mobile No retraction NOT tender Well delineated Do NOT vary with menses = Benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process in single terminal ductal unit
Cancer
30-80 y/o Usually unilateral Single Irregular or stellate Hard, stone-like Fixed, non-mobile Often have retraction Usually non-tender Poorly delineated, irregular borders Do NOT vary with menses = Ductal carcinoma arises from epithelial lining of ducts; lobular carcinoma originates in glandular tissue of lobules
Fat necrosis
Benign breast lump occurs as inflammatory response to local injury
History of trauma, painless lump
Firm irregular mass, discolored; mimic breast CA
Intraductal papillomas and pappilomatosis
Benign tumors of the subareolar ducts that produce nipple discharge
Wartlike tumor in lactiferous duct; 2-3 cm
Single or multiple
Spontaneous nipple discharge; serous or bloody
Duct ectasia
Benign condition of subareolar ducts that produces nipple discharge
Subareolar ducts become dilated and blocked with desquamating secretory epitheolium, necrotic debris, chronic inflammatory cells
Green or brown discharge; sticky
Galactorrhea
Lactation not associated with childbearing
Elevated prolactin; disruption of pituitary and hypothalamus
Pituitary secreting tumors; hypothalamic-pituitary disorders, systemic diseases, medications, herbs, physiologic conditions
PMH: amenorrhea, pregnancy, postabortion, hypothyroid, Cushing, CRF
Medications: phenothiazines, tricyclics, antiHTN, estrogens, H2 receptor blockers, marijuana, amphetamines, opiates
Physiologic: suckling, stress, dehydration, exercise, nipple stimulation
Paget disease
Surface manifestation of underlying ductal carcinoma
Migration of malignant epithelial cells from underlying intraductal carcinoma via lactiferous sinuses into nipple skin
Tumor cells disrupt epithelial barrier allowing extracellular fluid to seep out
Crusty nipple, areola
Pruritis, red, scaling
Unilateral or bilateral
Mastitis
Inflammation and infection of the breast tissue; S. Aureus
Commonly lactating women after milk established
May result in abscess
Tenderness, redness, heat; chills, fever
Tender, hard mass, fluctuation
May discharge pus
Gynecomastia
Breast enlargement in men
Increased body fat; hormone imbalance d/t puberty, age, testicular, pituitary, hormone-secreting tumors; liver failure; medications (anabolic steroids); antiHTN, antipsychotics, estrogens, antiandrogens
