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Reproductive-Week 1/2 > Breast Anatomy and Pathology > Flashcards

Breast Anatomy and Pathology Flashcards

1
Q
  1. The Breast tissue ranges vertically from rib ____ to ____.
  2. The breast tissue extends transversally from the _____ (medially) to _____ (laterally).
A
  1. 2 to 6

2. sternum to axilla

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2
Q

Lateral extension of the Breast tissue

A

Axillary Process (“tail of Spence”)

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3
Q

The nipple lies at the center of the heavily pigmented region called the ____ and is located at about _____ intercostal space.

A

Areola; 4th

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4
Q

Sebaceous glands that open onto the surface of the Areola; lubricate and protect the nipple area during lactation

A

Areolar Glands

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5
Q

Each glandular (mammary) tissue consists of 10-20 lobes, each with it’s own _______ that open onto the nipple

A

Lactiferous Duct

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6
Q

Dilated section of the Lactiferous Duct at the nipple

A

Lactiferous Sinus

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7
Q

Mammary glands are firmly attached to the overlying dermis by connective tissue called…

A

Suspensory Ligaments (aka ligaments of Cooper)

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8
Q

Layer of connective tissue that separates the breast from the Pectoralis Major; allows some degree of motion/movement; tumors that grow past this indicate advanced carcinoma

A

Retromammary space

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9
Q

3 main blood supplies for the breast

A

Internal Thoracic artery (medial side)
Axillary artery (lateral side)
Intercostal arteries

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10
Q

Sensory innervation of the Breast

A
  1. 2nd through 6th intercostal nerves

2. supraclavicular nerves (branches of cervical plexus)

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11
Q

The Majority of lymph from the breast drains into the ________ nodes

A

Axillary

*rest to parasternal nodes (lymph from medial portion of breast) and abdominal nodes (lymph from inferior portion of breast)

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12
Q

Which subgroup of Axillary Lymph nodes receives the majority of Breast lymph

A

Pectoral

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13
Q

Typical pattern of lymph flow from the Breast

A

Breast–> Axillary nodes (Pectoral)–> Central nodes–> Apical nodes–> Venous system

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14
Q
  1. Right side lymph eventually drains into ______ at the right venous angle.
  2. Left side lymph eventually drains into ______ at the left venous angle.
A
  1. Lymphatic duct
  2. Thoracic duct
    * both finally drains into right and left subclavian veins.
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15
Q
  1. Tumors of the breast can block lymphatic ducts, resulting in edema and a ____________ appearance.
  2. Tumors of the breast can pull and contract the suspensory ligaments (ligament of Cooper) of the breast, resulting in a ______ appearance.
A
  1. orange peel-like

2. Dimpling

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16
Q

A surgical procedure used to determine whether cancer has spread beyond a primary tumor into the lymphatic system

A

Sentinel node biopsy

  • sentinel nodes are the first lymph node into which a tumor drains.
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17
Q

What are two complications seen after Mastectomy

A
  1. Winged-Scapula (long thoracic nerve damage causing serratus anterior muscle paralysis)
  2. Chronic Lymph Edema of a limb (interruption of lymphatic vessel/nodes within axilla)
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18
Q

The Lactiferous ducts and lobular acini are composed of what three cell types?

A

Epithelial (secretory)
Myoepithelial (contractile)
Stem cell

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19
Q

What are the most important BENIGN Breast lesions (5 total)

A 
Fibrocystic changes
Fibroadenoma
Intraductal Papilloma
Fat Necrosis
Gynecomastia
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20
Q

BENIGN Breast lesion; MOST COMMON breast tumor of young women; MOBILE; can enlarge with pregnancy or menstrual cycle; CLEAN margins; glandular structures with ductal/stromal proliferation but NO cellular atypia; usually surgically excised

A

Fibroadenoma

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21
Q

Histologic findings for Fibroadenoma

A

Glandular
Ductal/Stromal Proliferation
NO Cellular Atypia

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22
Q

Fibroadenomas are (sessile/mobile)

A

Mobile (benign lesion)

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23
Q

RARE BENIGN breast lesion; BULKY, FIRM masses; more common in African American women; has numerous CYSTIC spaces in a leaf-like appearance; may recur after excision and metastasize; stromal mitosis

A

Phyllodes Tumor

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24
Q

Benign breast lesion; PAINFUL and unilateral; usually after trauma, breast surgery or radiation; can see induration (hardening), calcification, IRREGULAR contours and retraction of skin; biopsy needed for diagnosis but no management required; foamy histiocytes and muti-nucleated giant cells can be seen histologically

A

Fat Necrosis

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25
Q

Fat necrosis of the breast is usually (painful/painless) while cancer is usually (painful/painless)

A

Fat Necrosis: painful

Cancer: painless

26
Q

Inflammation of breast tissue that is due to an infection by skin flora (Staph. aureus, strep); almost always lactational (10% of breastfeeding women); results in breast pain, swelling and warmth; associated with engorgement and loss of nipple integrity; treat with Antibiotics and NSAIDs; untreated can result in abscess formation

A

Mastitis

27
Q

BENIGN breast lesion; fluid-filled cysts of various sizes surrounded by fibrotic tissue; caused by exaggerated physiologic response to a changing hormonal environment; usually PAINFUL and BILATERAL; pain is cyclic due to hormonal changes; aspiration of a SYMPTOMATIC cyst

A

Fibrocystic Changes

28
Q

Histologic findings for Fibrocystic Changes

A 
Non-proliferative:
- Cystically dilated ducts
- Stromal fibrosis
- Apocrine metaplasia
\+/- calcification

Proliferative:

  • Usual or florid ductal hyperplasia
  • Sclerosing adenosis (enlarged lobules are distorted by scar-like tissue)
29
Q

BENIGN breast lesion; epithelial papillary growth with fibrotic components WITHIN a lactiferous duct; most common cause of serous/serosanguineous (bloody) nipple discharge

A

Intraductal Papilloma

30
Q

Histologic findings for Intraductal Papilloma

A

Dilated ducts
Ductal fibrosis and obstruction
NO cellular atypia

31
Q

Nipple discharge is considered pathologic if…

A

Spontaneous
Comes from single duct
Grossly bloody

32
Q

BENIGN breast lesion; enlargement of male breast; often idiopathic, but can be due to increase in estrogen:androgen ratio (drugs, hormone secreting tumors, metabolic disorders like cirrhosis and hyperthyroidism); bilateral; proliferation of branching, intermediate-sized ducts; ductal epithelial hyperplasia; tapering tufts; loose periductal stroma

A

Gynecomastia

33
Q

Causes of Gynecomastia

A 
Idiopathic
Exogenous estrogens
Adrenal/Testicular tumors
Gonadotropin secreting tumors
Cirrhosis
Hyperthyroidism (androstenedione--> estrogen)
34
Q

Procedures for Breast Examination

A
  1. Mammogram (good for older women)
  2. Ultrasound (good for younger women)
  3. Breast Cyst Aspiration (for palpable mass even with negative imaging)
  4. Biopsy (Needle vs. Excisional)
35
Q

Examples of MALIGNANT Breast lesions

A 
Ductal Carcinoma in situ
Lobular Carcinioma in situ
Paget
Invasive Ductal Carcinoma
Invasive Lobular Carcinoma
36
Q

Breast Carcinoma; NO invasion (confined to ducts) through myoepithelial cell layer and duct and lobule basement membrane; PRECURSOR lesion to invasive carcinoma; NO MASSES; COMEDO-type DCIS shows high-grade nuclei, central necrosis, and microcalcifications within a duct

A

Ductal Carcinoma In Situ (DCIS)

37
Q

Difference between Ductal Carcinoma In Situ and Invasive Ductal Carcinoma

A

DCIS: no basement membrane invasion

*same for LCIS

38
Q

Breast Carcinoma; proliferation of tumor cells in ACINI; often BILATERAL and MULTICENTRIC; NO invasion of the basement membrane; monomorphic tumor cells distending the acini; regarded as a RISK FACTOR (rather than a true precursor) for invasive cancer

A

Lobular Carcinoma In Situ (LCIS)

39
Q

MALIGNANT involvement of epidermal cells at the Nipple or Areola; small nests with PALE cytoplasm; localized erythema, scaling and ulceration involving NIPPLE; almost ALWAYS associated with underlying in situ or invasive carcinoma; can be mimicked by eczematous dermatitis

A

Paget Disease

40
Q

Histologic findings for Paget Disease of the breast

A

Small nests of tumor cells in Epidermis
Abundant PALE cytoplasm
Atypical nuclei

41
Q

Most common type of invasive (MALIGNANT) breast cancer; invasion of malignant cells past ductal basement membrane; firm, IRREGULAR mass; non-tender; can see calcifications and reactive fibrosis; has favorable vs. unfavorable histology findings

A

Invasive Ductal Carcinoma

Favorable: tubular or mucinous carcinoma
Unfavorable: metaplastic or inflammatory

42
Q

MALIGNANT Breast Cancer; invasion of malignant cells past acinar basement membrane; tend to be LARGE and metastasize to unusual sites (GI, gynecologic, etc.); most are hormone receptor positive and HER2/neu negative; often clinically and mammographically occult

A

Invasive Lobular Carcinoma

43
Q

Carcinoma associated with profound erythema and induration/dimpling of the skin (peau d’orange); due to involvement of dermal lymphatic spaces of skin; VERY POOR prognostic finding

A

Inflammatory Carcinoma

44
Q

The average age of incidence of Breast Cancer is…

A

61

45
Q

Risk factors for Breast Cancer

A 
Age (2/3 post-menopause)
Race
Family History
Reproductive factors
Chest Radiation
Postmenopausal Obesity
  • about 50% with breast cancer have NO risk factors! wow
46
Q

BRCA genes are (proto-oncogenic/tumor suppressor) genes

A

Tumor Suppressor (DNA repair)

47
Q

The most common type of male Breast Cancer is…

A

Invasive Ductal Carcinoma

48
Q

Why does male breast cancer tend to present at a more advanced stage

A

Less fat/breast tissue–> involvement of chest wall earlier

49
Q

MOST IMPORTANT prognostic factor for Breast Cancer staging (Tumor size, Nodes or Metastases)

A

Nodes (involvement of regional axillary nodes)

50
Q

Most Invasive Breast carcinomas are ________ receptor positive

A

Hormone (Estrogen and Progesterone)

51
Q

Prognostic/Predictive factors for Estrogen and Progesterone receptors in Breast Cancer

A

Longer disease-free survival

Response to Hormonal therapy (anti-estrogen, tamoxifen, etc.)

52
Q

Gene on chromosome 17; member of Growth Factor receptor family with tyrosine kinase activity; regulates cell growth, division and differentiation

A

HER2/neu

53
Q

Prognostic/Predictive factors for HER2/neu gene

A

Dec. survivial

Shorter disease-free interval

54
Q

Purpose of Axillary Lymph Node evaluation

A

Assess likelihood of distant spread and local recurrence

55
Q

Purpose of Radiation Therapy

A

Dec. local recurrence or palliation

56
Q

Purpose of Systemic Therapy

A

Treatment of or Dec. distant recurrence (“metastatic control”)

57
Q

Best preventatives for Breast Cancer

A

Healthy body weight
Exercise
Low fat diet
High risk: Selective Estrogen Receptor Modulators

58
Q

What are general recommendations for Screening in women at average risk for Breast Cancer

A

Screening every 1-2 years (Age 50-70)

59
Q

Axillary lymph nodes that are located lateral to the pectoralis minor is level

A

1

60
Q

Axillary lymph nodes that are located at the level of the pectoralis minor is level

A

2

61
Q

Axillary lymph nodes that are located medial to the pectoralis minor is level

A

3

62
Q

The survival rate of breast cancer patients decreases from axillary nodal level ___ (best) to level ___ (worse).

A

1 to 3

Reproductive-Week 1/2 (14 decks)

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