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Appendix > Breast > Flashcards

Breast Flashcards

1
Q

Fibrous bands that provide structural support and insert perpendicularly into the dermis?

A

suspensory ligaments of Cooper

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2
Q

What are the suspensory ligaments of Cooper?

A

fibrous bands

provides structural support

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3
Q

Milk-forming glandular unit of the breast?

A

breast lobule

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4
Q

Retromammary space is a thin layer between pec major and breast tissue, contains what?

A

lymphatics + small vessels

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5
Q

What m located deep to pec major?

A

minor

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6
Q

Axillary LN are described as three anatomic levels in relation to pec minor;

A

Level 1: lateral to the lateral border of pec minor

Level 2: posterior to pec minor

Level 3; medial to pec minor

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7
Q

Lymph nodes found between pec major and pec minor m are called?

A

Rotter’s nodes (interpectoral group of nodes)

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8
Q

Of lymphatic flow from the breast, 75% is directed into which LN group?

A

axillary LNs

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9
Q

What nerve courses along medial side of axilla innervating serratus anterior m?

A

long thoracic n

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10
Q

Division of this nerve leads to winged scapula;

A

long thoracic nerve–> innervates serratus anterior m

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11
Q

What m does long thoracic nerve innervate?

A

serratus anterior m

transection leads to winged scapula

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12
Q

Why is the long thoracic nerve preserved during surgery?

A

innervates serratus anterior m
fixes scapula to chest wall during adduction and extension of arm

transection leads to winged scapula

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13
Q

Thoracodorsal nerve innervates what m?

A

lattisimus dorsi

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14
Q

Lattisimus dorsi is innervated by what n?

A

thoracodorsal

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15
Q

Two nerves encountered during an axillary dissection?

A

long thoracic n

thoracodorsal n

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16
Q

Pec major innervated by what m?

A

medial pectoral nerve

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17
Q

Medial pectoral nerve innervates what m?

A

pec major

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18
Q

Mature breast tissue is made of three cell types;

A

glandular tissue

fibrous stroma/supporting structures

adipose tissue

**adolescents have mostly glandular tissue + fibrous tissue

**post-menopausal women have mostly fat

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19
Q

Function of Cooper’s ligaments?

A

provide structure and shape to the breast

courses from the skin to underlying deep fascia

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20
Q

What causes skin dimpling we sometimes see with breast Ca?

A

Cooper’s ligaments are attachments from skin to underlying deep fascia

sometimes Ca infiltrates these ligaments and causes dimpling

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21
Q

Milk-producing parts of the breast?

A

lobules

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22
Q

In the ductal system why is the basement membrane important?

A

important boundary between DCIS vs invasive carcinoma

invasive breast cancer penetrates this membrane

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23
Q

Hormone dependent maturation of breasts during puberty is termed?

A

thelarche

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24
Q

What’s thelarce?

A

hormone dependent maturation of breast during puberty

**initiated by pituitary gonadotropins releasing estradiol

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25
Q

After birth, principal trigger for lactation?

A

prolactin

with aid of oxytocin

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26
Q

Median age of menopause?

A

51

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27
Q

What is menopause?

A

cessation of menstrual flow for at least 1 year

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28
Q

How does menopause affect breast tissue?

A

increase fat deposition

decreased connective tissue

disappearance of lobular units

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29
Q

Is breast pain a symptom of breast Ca?

A

NO

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30
Q

What is fibrocystic disease of the breast?

A

common during 4-5th decades of life, lasts until menopause

an increased response of breast stroma to circulating hormones

women see breast pain, tenderness, nodules

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31
Q

MOst pts with a simple breast cyst do not require any further evaluation, unless;

A

it’s a complex cyst with solid intra-cystic components

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32
Q

Cysts commonly seen in pts with fibrocystic disease, however, they’re uncommon in women ages what?

A

older than 60

younger than 30

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33
Q

Aside from cysts, what do we see histologically in pts with fibrocystic disease of the breast?

A

see adenosis, sclerosis, apocrine metaplasia, stromal fibrosis, epithelial metaplasia/hyperplasia

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34
Q

In fibrocystic breast disease, histologically we can have typical epithelial hyperplasia and atypical epithelial hyperplasia, what do we worry about?

A

atypical epithelial hyperplasia (atypical ductal hyperplasia)

is a risk factor for breast Ca development

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35
Q

What is absence of breast tissue called?

A

amastia

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36
Q

Absence of nipple called?

A

athelia

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37
Q

Accessory breast tissue called?

A

polymastia

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38
Q

Accessory nipple called?

A

supernumerary

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39
Q

Extra nipples are common and occur via what line?

A

occur along the milk line from axilla to pubis

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40
Q

Accessory breast tissue commonly found where?

A

axilla

**commonly seen during pregnancy

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41
Q

Gynecomastia?

A

hypertrophy of breast tissue

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42
Q

Pubertal gynecomastia in boys is common, concerning?

A

NO

**regresses w/adulthood

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43
Q

When do we perform surgery for pubertal gynecomastia?

A

if enlargement is unilateral

fails to regress

cosmetically unappealing

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44
Q

Some causes of gynecomastia in men?

A

drugs; digoxin, thiazides, estrogens, theophylline

hepatic cirrhosis, renal failure, malnutrition

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45
Q

Nipple discharge? Concerning?

A

nipple discharge in non-lactating women very common

rarely linked to underlying Ca

46
Q

Galactorrhea?

A

milky discharge from both breasts

usually due to high prolactin

47
Q

What nipple discharge is concerning for Ca?

A

bloody

48
Q

MCC of spontaneous nipple discharge from a single duct is?

A

a solitary intraductal papilloma

49
Q

This is a milk-filled cyst that is round, well-circumscribed and easily movable within the breast;

A

galactocele

**seen after cessation of lactation or when feeding frequency has decreased

50
Q

Tx for galactocele?

A

aspiration of thick milky fluid, sometimes w/brown or dark green tinge

51
Q

What do we worry about w/paeu d’orange?

A

edema of the skin breast due to dependent nature of breast and pooling/blockage of lymphatics

lymphatics could be blocked from radiation, mastitis, or inflammatory breast Ca (malignant cells block dermal lymphatics)

52
Q

What’s Paget’s dx of the breast?

A

can appear as a dermatitis or eczema on the breast

but there is often an underlying intraductal carcinoma under the nipple

53
Q

Characteristics of benign breast masses?

A

usually fibroadenomas + cysts

distinct, well-circumscribed, movable

carcinoma is firm, less circumscribed, moving it causes drag on adjacent tissue

54
Q

FNA main usefulness is used to distinguish between what and what?

A

solid vs cystic lesions

55
Q

If an FNA shows a cystic breast lesions what do you do next?

A

if cyst is simple on imaging; no further imaging required

if cyst is complex on imaging; carcinoma needs to be ruled out

56
Q

Method of choice to sample non-palpable image detected breast abnormalities:

A

core need biopsy

57
Q

What’s a stereotactic core need biopsy?

A

pt lies on prone table
breast is compressed
needle takes samples

58
Q

What % of pts with diagnosis of DCIS from core needle biopsy will have invasive carcinoma at definitive surgery?

A

10-20%

59
Q

Primary imaging modality for screening asymptomatic women?

A

mammography

breast is squeezed between two plexi-glass to reduce thickness thru which radiation tissue must pass

mammography sensitivity is limited by breast density

60
Q

Why does sensitivity of mammography increase with iage?

A

younger females have denser breasts

as women age, fatty infiltration ensues, fat doesn’t pick up radiation very well, you get contrast, thus can see smaller lesions

61
Q

USPSTF recommendation for screening mammography?

A

recommended for women 50-74 every 2 years

recommended against screening women >75
recommended against screening women 40-49

62
Q

ACS recommendation for screening mammography?

A

yearly starting at age 40

continue as long as women is in good health

63
Q

What does Bi-RADS stand for?

A

breast imaging reporting and data system

64
Q

What do we use Bi-RADS for?

A

used to categorize degree of suspicion of malignancy for a mammographic abnormality

65
Q

Describe Bi-RADS classification;

A

0; incomplete; need more imaging

1; negative; annual screening

2; benign; annual screening

3; probably benign 6 month f/u

4; suspicious; bx recommended

5; highly suspicious; >95% malignancy potential

6; known bx proven malignancy

66
Q

Risk factors for breast cancer development?

A

age

family hx

hormonal factors

proliferative breast dx

breast/chest wall irradiation at an early age

personal hx of malignancy

lifestyle factors

67
Q

Most important risk factor for breast Ca development?

A

age

incidence increases with increasing age (1/8 women will get breast cancer by age 80)

breast cancer rare in pt’s less than 20

68
Q

Avg. risk of women developing breast cancer in their lifetime?

A

12.2%

69
Q

Personal hx of breast cancer in one breast increase what

A

increases likelihood of a second primary cancer in the contralateral breast

70
Q

Is LCIS considered breast cancer?

A

not considered a breast ca

BUT is a marker for increased breast cancer susceptability

71
Q

Someone has LCIS, and they want something done, what can we do?

A

close observation (LCIS is not cancer, but is a histological marker for increase breast ca susceptability)

chemoprevention w/tamoxifen/raloxifen

b/l mastectomy

72
Q

First degree relatives and risk of breast ca?

A

1st degree relatives; moms, daughters, sisters of pts w/breast cancer have a 2-3 fold increase risk of breast ca

73
Q

Women with BRC1, BRC2 mutations are at an increased risk of what?

A

breast + OVARIAN ca

74
Q

BRC1 is what type of gene?

A

tumor suppressor gene

with dx susceptability inherited in AD fashion

75
Q

Which BRC gene associated with increased breast ca risk in males?

A

BRC2

76
Q

Women with BRC2 mutation also have a 20-30% increased risk of what type of Ca?

A

ovarian

77
Q

Reproductive risk factors for breast cancer?

A

factors that increase a women’s lifetime estrogen exposure

menarche before 12
first child after 30
nulliparity
menopause after 55

78
Q

Do HRT increase a woman’s risk of developing breast cancer?

A

combination estrogen + progesterone for 5 years, increase risk of breast Ca by 20%

79
Q

What’s the Gail model?

A

tool used to assess risk of breast ca;

age
race
age at menarche
age at first live birth
number of previous breast biopsies
number of previous breast biopsies
first degree relative w/breast ca
presence of proliferative dx w/atypia
80
Q

Does the Gail model use genetic factors to assess breast ca risk?

A

NO

81
Q

Screening recs for a woman with a family hx of breast cancer or ovarian ca syndrome?

A

monthly self breast exams starting at 18-20

semi-annual CBE starting at 25

annual mammo starting at 25 or 10 years earlier than first diagnosed relative

82
Q

Drugs currently prescribed to reduce breast cancer risk are?

A

tamoxifen

raloxifen

83
Q

How does tamoxifen work?

A

estrogene antagonist

used in pt’s with ER+ breast cancer

84
Q

How does raloxifen work?

A

selective ER modulator

85
Q

Does prophylactic mastectomy reduce risk of developing breast Ca?

A

shown to reduce risk of breast ca by 90% in high risk pts

86
Q

WHat cuases breast cysts to form?

A

pathogenesis not well understood

arise from destruction and dilation of lobules and terminal ductules

87
Q

These are epithelial lined cavities containing fluid:

A

breast cysts

88
Q

Why do breast cysts vary with menstrual cycles?

A

they’re influenced by ovarian hormones

most cysts occur in women >35
incidence increases until menopause

then sharp decline

89
Q

Do breast cysts increase breast cancer risk?

A

no evidence of increase risk of breast Ca with cyst formation

90
Q

These are benign solid tumors made of stromal and epithelial elements:

A

fibroadenomas

91
Q

What’s a fibroadenoma?

A

benign solid tumor of breast

made of stromal and epithelial elements

92
Q

Most common tumor in women younger than 30?

A

fibroadenoma

93
Q

2nd most common tumor of breast after carcinoma?

A

fibroadenoma

94
Q

What age group do we see fibroadenomas?

A

women in late teens

early reproductive years

rare in women after 40-45

95
Q

On clinical exam, these breast masses are firm masses, easily movable, may increase in size of several months,, well encapsulated;

A

fibroadenomas

96
Q

Cancer development from fibroadenomas?

A

exceedingly rare

97
Q

Breast hamartoma?

A

indistinguishable from fibroadenoma on exam

a nodule that contains closely packed lobules and prominent extra-lobular ducts

98
Q

What is lactational mastitis?

A

bacteria enter breast via nipple into the duct system

caused by s. aureus

sx: fever, leukocytosis, erythema, tenderness
tx; frequent emptying, abx

99
Q

What’s periductal mastitis or ductal ectasia?

A

chronic relapsing form of breast infection
seen in women smokers/DM

aerobic/anaerobic flora involved

100
Q

What are intraductal papillomas?

A

true polyps of epithelial lined breast ducts

101
Q

Do intraductal papillomas increase risk of Ca?

A

NO

102
Q

What is sclerosing adenosis?

A

lesions that produce deposition of calcium

can be confused with Ca

has no Ca risk

103
Q

In pts undergoing bx for microcalcifications; what’s the most frequent diagnosis?

A

sclerosing adenosis

104
Q

What’s a radial scar?

A

group of abnormalities known as complex sclerosing lesions

appear similar to carcinomas on mammo bx they crease spliculated lesions

can even result in skin dimpling

105
Q

Why do we need to bx radial scars?

A

need to be excised to rule out underlying carcinoma

assc w/modestly increased risk of breast Ca

106
Q

This can mimic breast ca by producing a palpable mass on mammo that may contain microcalcifications, usually seen after trauma or surgery or post-radiation;

A

fat necrosis

107
Q

Does fat necrosis have any malignant potential?

A

NO

108
Q

Histologically how does fat necrosis present?

A

lipid laden macrophages
scar tissue
chronic inflammatory cells

109
Q

Risk of isosulfan blue dye?

A

anaphylactic shock 1%

110
Q

Risk of methylene blue?

A

skin necrosis

Appendix (39 decks)

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