Breast Flashcards
1
Q
Fibrous bands that provide structural support and insert perpendicularly into the dermis?
A
suspensory ligaments of Cooper
2
Q
What are the suspensory ligaments of Cooper?
A
fibrous bands
provides structural support
3
Q
Milk-forming glandular unit of the breast?
A
breast lobule
4
Q
Retromammary space is a thin layer between pec major and breast tissue, contains what?
A
lymphatics + small vessels
5
Q
What m located deep to pec major?
A
minor
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
7
Q
Lymph nodes found between pec major and pec minor m are called?
A
Rotter’s nodes (interpectoral group of nodes)
8
Q
Of lymphatic flow from the breast, 75% is directed into which LN group?
A
axillary LNs
9
Q
What nerve courses along medial side of axilla innervating serratus anterior m?
A
long thoracic n
10
Q
Division of this nerve leads to winged scapula;
A
long thoracic nerve–> innervates serratus anterior m
11
Q
What m does long thoracic nerve innervate?
A
serratus anterior m
transection leads to winged scapula
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
13
Q
Thoracodorsal nerve innervates what m?
A
lattisimus dorsi
14
Q
Lattisimus dorsi is innervated by what n?
A
thoracodorsal
15
Q
Two nerves encountered during an axillary dissection?
A
long thoracic n
thoracodorsal n
16
Q
Pec major innervated by what m?
A
medial pectoral nerve
17
Q
Medial pectoral nerve innervates what m?
A
pec major
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
19
Q
Function of Cooper’s ligaments?
A
provide structure and shape to the breast
courses from the skin to underlying deep fascia
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
21
Q
Milk-producing parts of the breast?
A
lobules
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
23
Q
Hormone dependent maturation of breasts during puberty is termed?
A
thelarche
24
Q
What’s thelarce?
A
hormone dependent maturation of breast during puberty
**initiated by pituitary gonadotropins releasing estradiol
25
After birth, principal trigger for lactation?
prolactin
| with aid of oxytocin
26
Median age of menopause?
51
27
What is menopause?
cessation of menstrual flow for at least 1 year
28
How does menopause affect breast tissue?
increase fat deposition
decreased connective tissue
disappearance of lobular units
29
Is breast pain a symptom of breast Ca?
NO
30
What is fibrocystic disease of the breast?
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
31
MOst pts with a simple breast cyst do not require any further evaluation, unless;
it's a complex cyst with solid intra-cystic components
32
Cysts commonly seen in pts with fibrocystic disease, however, they're uncommon in women ages what?
older than 60
younger than 30
33
Aside from cysts, what do we see histologically in pts with fibrocystic disease of the breast?
see adenosis, sclerosis, apocrine metaplasia, stromal fibrosis, epithelial metaplasia/hyperplasia
34
In fibrocystic breast disease, histologically we can have typical epithelial hyperplasia and atypical epithelial hyperplasia, what do we worry about?
atypical epithelial hyperplasia (atypical ductal hyperplasia)
is a risk factor for breast Ca development
35
What is absence of breast tissue called?
amastia
36
Absence of nipple called?
athelia
37
Accessory breast tissue called?
polymastia
38
Accessory nipple called?
supernumerary
39
Extra nipples are common and occur via what line?
occur along the milk line from axilla to pubis
40
Accessory breast tissue commonly found where?
axilla
**commonly seen during pregnancy
41
Gynecomastia?
hypertrophy of breast tissue
42
Pubertal gynecomastia in boys is common, concerning?
NO
**regresses w/adulthood
43
When do we perform surgery for pubertal gynecomastia?
if enlargement is unilateral
fails to regress
cosmetically unappealing
44
Some causes of gynecomastia in men?
drugs; digoxin, thiazides, estrogens, theophylline
hepatic cirrhosis, renal failure, malnutrition
45
Nipple discharge? Concerning?
nipple discharge in non-lactating women very common
rarely linked to underlying Ca
46
Galactorrhea?
milky discharge from both breasts
| usually due to high prolactin
47
What nipple discharge is concerning for Ca?
bloody
48
MCC of spontaneous nipple discharge from a single duct is?
a solitary intraductal papilloma
49
This is a milk-filled cyst that is round, well-circumscribed and easily movable within the breast;
galactocele
**seen after cessation of lactation or when feeding frequency has decreased
50
Tx for galactocele?
aspiration of thick milky fluid, sometimes w/brown or dark green tinge
51
What do we worry about w/paeu d'orange?
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
What's Paget's dx of the breast?
can appear as a dermatitis or eczema on the breast
but there is often an underlying intraductal carcinoma under the nipple
53
Characteristics of benign breast masses?
usually fibroadenomas + cysts
distinct, well-circumscribed, movable
carcinoma is firm, less circumscribed, moving it causes drag on adjacent tissue
54
FNA main usefulness is used to distinguish between what and what?
solid vs cystic lesions
55
If an FNA shows a cystic breast lesions what do you do next?
if cyst is simple on imaging; no further imaging required
if cyst is complex on imaging; carcinoma needs to be ruled out
56
Method of choice to sample non-palpable image detected breast abnormalities:
core need biopsy
57
What's a stereotactic core need biopsy?
pt lies on prone table
breast is compressed
needle takes samples
58
What % of pts with diagnosis of DCIS from core needle biopsy will have invasive carcinoma at definitive surgery?
10-20%
59
Primary imaging modality for screening asymptomatic women?
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
Why does sensitivity of mammography increase with iage?
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
USPSTF recommendation for screening mammography?
recommended for women 50-74 every 2 years
recommended against screening women >75
recommended against screening women 40-49
62
ACS recommendation for screening mammography?
yearly starting at age 40
continue as long as women is in good health
63
What does Bi-RADS stand for?
breast imaging reporting and data system
64
What do we use Bi-RADS for?
used to categorize degree of suspicion of malignancy for a mammographic abnormality
65
Describe Bi-RADS classification;
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
Risk factors for breast cancer development?
age
family hx
hormonal factors
proliferative breast dx
breast/chest wall irradiation at an early age
personal hx of malignancy
lifestyle factors
67
Most important risk factor for breast Ca development?
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
Avg. risk of women developing breast cancer in their lifetime?
12.2%
69
Personal hx of breast cancer in one breast increase what
increases likelihood of a second primary cancer in the contralateral breast
70
Is LCIS considered breast cancer?
not considered a breast ca
BUT is a marker for increased breast cancer susceptability
71
Someone has LCIS, and they want something done, what can we do?
close observation (LCIS is not cancer, but is a histological marker for increase breast ca susceptability)
chemoprevention w/tamoxifen/raloxifen
b/l mastectomy
72
First degree relatives and risk of breast ca?
1st degree relatives; moms, daughters, sisters of pts w/breast cancer have a 2-3 fold increase risk of breast ca
73
Women with BRC1, BRC2 mutations are at an increased risk of what?
breast + OVARIAN ca
74
BRC1 is what type of gene?
tumor suppressor gene
with dx susceptability inherited in AD fashion
75
Which BRC gene associated with increased breast ca risk in males?
BRC2
76
Women with BRC2 mutation also have a 20-30% increased risk of what type of Ca?
ovarian
77
Reproductive risk factors for breast cancer?
factors that increase a women's lifetime estrogen exposure
menarche before 12
first child after 30
nulliparity
menopause after 55
78
Do HRT increase a woman's risk of developing breast cancer?
combination estrogen + progesterone for 5 years, increase risk of breast Ca by 20%
79
What's the Gail model?
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
Does the Gail model use genetic factors to assess breast ca risk?
NO
81
Screening recs for a woman with a family hx of breast cancer or ovarian ca syndrome?
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
Drugs currently prescribed to reduce breast cancer risk are?
tamoxifen
raloxifen
83
How does tamoxifen work?
estrogene antagonist
used in pt's with ER+ breast cancer
84
How does raloxifen work?
selective ER modulator
85
Does prophylactic mastectomy reduce risk of developing breast Ca?
shown to reduce risk of breast ca by 90% in high risk pts
86
WHat cuases breast cysts to form?
pathogenesis not well understood
arise from destruction and dilation of lobules and terminal ductules
87
These are epithelial lined cavities containing fluid:
breast cysts
88
Why do breast cysts vary with menstrual cycles?
they're influenced by ovarian hormones
most cysts occur in women >35
incidence increases until menopause
then sharp decline
89
Do breast cysts increase breast cancer risk?
no evidence of increase risk of breast Ca with cyst formation
90
These are benign solid tumors made of stromal and epithelial elements:
fibroadenomas
91
What's a fibroadenoma?
benign solid tumor of breast
made of stromal and epithelial elements
92
Most common tumor in women younger than 30?
fibroadenoma
93
2nd most common tumor of breast after carcinoma?
fibroadenoma
94
What age group do we see fibroadenomas?
women in late teens
early reproductive years
rare in women after 40-45
95
On clinical exam, these breast masses are firm masses, easily movable, may increase in size of several months,, well encapsulated;
fibroadenomas
96
Cancer development from fibroadenomas?
exceedingly rare
97
Breast hamartoma?
indistinguishable from fibroadenoma on exam
a nodule that contains closely packed lobules and prominent extra-lobular ducts
98
What is lactational mastitis?
bacteria enter breast via nipple into the duct system
caused by s. aureus
sx: fever, leukocytosis, erythema, tenderness
tx; frequent emptying, abx
99
What's periductal mastitis or ductal ectasia?
chronic relapsing form of breast infection
seen in women smokers/DM
aerobic/anaerobic flora involved
100
What are intraductal papillomas?
true polyps of epithelial lined breast ducts
101
Do intraductal papillomas increase risk of Ca?
NO
102
What is sclerosing adenosis?
lesions that produce deposition of calcium
can be confused with Ca
has no Ca risk
103
In pts undergoing bx for microcalcifications; what's the most frequent diagnosis?
sclerosing adenosis
104
What's a radial scar?
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
Why do we need to bx radial scars?
need to be excised to rule out underlying carcinoma
assc w/modestly increased risk of breast Ca
106
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;
fat necrosis
107
Does fat necrosis have any malignant potential?
NO
108
Histologically how does fat necrosis present?
lipid laden macrophages
scar tissue
chronic inflammatory cells
109
Risk of isosulfan blue dye?
anaphylactic shock 1%
110
Risk of methylene blue?
skin necrosis
