Breast disease Flashcards
1
Q
Function of the breast
A
- Secondary sexual feature of females
- Source of nutrition for neonates
- Modified and specialised sweat gland that produces milk
- Present in both males and female but better developed in females
2
Q
Location and extent of the breast
A
- Extent
- Vertical → 2nd to 6th rib
- Transverse → sternal edge to mid axillary line
- Lies on deep pectoral fascia
- Axillary tail → small part of breast that extends into axillary fossa
- ⅔ breast on pectorall fascia and covers pectorals major
- ⅓ breast on fascia covering serrates anterior
- Firmly attached to dermis by suspensory ligament of Cooper
3
Q
Main structures of the breast
A
- Nipples → prominence of the breast
- Areola → pigmented area around nipples
- Lobules → glandular tissue
- Lactiferous duct → drains each nipple
- Lactiferous sinus → dilated portion of each duct
4
Q
Nipple
A
- Position variable → 4th intercostal space
- Fissured with lactiferous ducts
5
Q
Areas of the breast
A
- 4 quadrants
6
Q
Embryological development of the breast
A
- Mammary crest cells/ ridge during week 4
- Crest extends from inguinal region to axillary region
- Disappears except in pectoral region
7
Q
Gynaecomastia
A
- Post-natal development of rudimentary lactiferous ducts in males
- Mid-puberty ⅔ boys develop breast hyperplasia
8
Q
Athelia and amastia
A
- Absent nipple or breast
9
Q
Supernumary breast and nipples
A
- Polymastia → extra breast
- Polythelia → extra nipple
10
Q
Blood supply to the breast
A
- Thoraco-acromial artery
- Lateral thoracic artery
- Internal mammary (thoracic) artery)
- All branches of axillary, internal thoracic and intercostal arteries
11
Q
Nerve supply of the breast
A
- Anterior and lateral cutaneous branches of intercostal nerves (4-6)
12
Q
Lymphatic drainage of the breast
A
- Axillary lymph nodes (75% drainage of breast from lateral quadrant)
- Supraclavicular or inferior cervical nodes (medial quadrant)
- Lymphatic system of breast do not contain valves
- Significant in metastatic malignancies
13
Q
Definition of sentinel lymph node
A
- First draining lymph node
- Clinical relevant in breast cancer
- Used for lymphatic mapping and staging of breast cancer
14
Q
Tissues that make up breast
A
- Parenchyma → glandular tissue made of lobes, lobules and ducts
- Mesenchyme → connective tissue surrounding lobules made of fibrocollagenous tsissue
15
Q
Histological changes in breast pre-puberty, puberty and post-menopausal
A
- Pre-puberty
- Lactiferous ducts without secretory alveoli
- Little branching
- Enlargement of fibrous stroma and fat
- Puberty
- Branching of lactiferous ducts
- Growth of alveoli (milk glands)
- Accumulation of lips in adopocytes
- Post-menopasual
- Progressive atrophy of lobules and cuts
- Fatty replacement of glandular tissue
16
Q
Definition of Paget’s disease of nipple
A
- Rare form of breast cancer
- Malignant cells collect around nipples
- Cancer affects ducts of nipples first before spreading to surface and areola
- Causes eczematous erosion of nipple
- Associated with ductal/ invasive carcinoma
17
Q
Presentation of breast cancer
A
- Skin dimpling
- Abnormal contouring
- Edema of skin (Peau d’orange sign)
- Nipple detraction and deviation
18
Q
Imagining modalities in breast cancer
A
- Mammography
- Ultrasound
- Image guided techniques
- MRI
- Nuclear medicine
19
Q
Define triple assessment
A
- Clinical examination
- Imaging
- FNA cytology
20
Q
Characteristics of mammography
A
- Two main views
- Mediolateral
- Craniocaudal
- Carried out in anyone aged 40 and over and under 40 for those with strong suspicion of cancer
- Presentation
- Dominant mass
- Asymmetry
- Distorted architecture
- Calcification
21
Q
Difference in presentation of malignant and benign masses
A
- Benign
- Smooth
- Lobulated
- Normal density
- Malignant
- Irregular
- Poorly defined
- Craggy
- Dense
- Distorted architecture
22
Q
Characteristics of ultrasound
A
- Differentiation between solid and cystic masses
- Differentiation between benign and malignant masses
- First-line under 40s age group
- No ionising radiation
*
23
Q
Characteristics of image guide fine needle biopsy
A
- Two types
- FNA
- Core biopsy
- Image guided or freehand
24
Q
Characteristics of MRI
A
- Poor specificity
- May require IV contrast
- Expensive
- Contraindication → noisy, lengthy
- Indication
- Recurrent disease
- Implants
- Indeterminate lesion post triple assessment
- High risk women
25
Breast screening program
* Woman 50-70 invited every 3 years
* 80% uptake
* 5-10% recall for further screening
* Aim to detect cancer in early DCIS stage or less
26
Modality of samples in cytology
* Fine needle aspiration
* Direct smear of nipple discharge
* Scrape of nipple with scalpel
27
Characteristics of fine needle aspiration
* Can be ultrasound guided → impalpable areas
* Axillary LN FNA → pre-operative planning
* Cysts → curative
* No contraindication
* Cannot be used for grading or assessment of invasion
* Complications → pain, haematoma, fainting, infection
28
Microscopic features of benign and malignant disease in cytology
* Benign
* Low/ moderate cellularity
* Cohesive
* Flat sheet of cells
* Bipolar nuclei
* Uniform cell size
* Uniform chromatic pattern
* Malignant
* High cellularity
* Loss of cohesion
* Crowding/ overlapping cells
* Nuclear pleomorphism
* Hyperchromasia
29
Cause of nipple discharge
* Duct ectasia → benign mass causing widening of milk ductss
* Introduit papilloma → benign mass of milk duct
* Intraduct carcinoma → malignant mass
30
Characteristics of core biopsy
* Indicated with radiological or cytological suspicious maSS
* Breast screening → architectural distortion and micro calcification
* Minimally invasive
31
Benign breast conditions
* Fibrocystic mass → fibrosis, adenosine, cysts, apocrine metaplasia, ductal epithelial hyperplasia
* Fibroadenoma
* Intraductal papilloma
* Fat necrosis
* Duct ectasia
* Phyllodes tumor
32
Fibroadenoma
* Growth of epithelial and stroll cells
* Most common type in adolescent/ young adult women
* Well circumscribed, freely-mobile, non-painful
33
Tubular adenoma
* Less common than fibroadenoma
* Benign mass of tubule
34
Lactating adenoma
* Enlarging mass during lactation/ pregnancy with secretory changes
35
Intraduct papilloma
* Middle aged women
* Nipple discharge
* Epithelial hyperplasia
36
Fat necrosis in breast
* Benign mass caused breakdown of adipocytes in breast mesenchyme
* History of trauma, post-surgical intervention
* Lipid-filled cysts, fibrosis and calcification on mammography
37
Phyllodes tumour
* Rare breast cancer affecting pre-menopasual women in 40s
* Fleshy tumour, leaf-pattern and cysts on surface
* Benign, borderline or malignant
38
Risk factors of breast carcinoma
* Female
* Increasing age
* Early menarche
* Late menopause
* Geriatric pregnancy
* Radiation exposure
* Family history
* Past medical history
* Hormonal treatment
* Genetic predisposition → BRCA1,
* Obesity
* Sedentary lifestyle
* Alcohol
39
Specific genes associated with breast carcinoma
* BRCA1
* BRCA3
* TP53
* PTEN
40
Histological types of breast carcinoma
* Non-invasive
* Ductal carcinoma in-situ (DCIS)
* Lobular carcinoma in-siut (LCIS)
* Invasive
* Invasive ductal carcinoma
* Invasive lobular carcinoma
41
Investigations in breast carcinoma
* Clinical examination
* Radiology
* Mammogram
* Ultrasound
* MRI
* Fine need aspiration cytology (FNAC)
* needle core bishop
* Wide local excision with adequate margins
42
Management of breast cancer
* Diagnosis and staging
* Surgery (mastectomy + lymph nodes)
* Radiotherapy
* Anti-hormonal therapy
* Chemotherapy
43
Gynaecomastia vs pseudogynaecomastia
* Gynaecomastia
* Increased sub-areolar tissue
* Associated with hyperthyroidism, liver cirrhosis, chronic renal failure, chronic pulmonary disease, hypogonadism, hormonal irregulars
* Pseuodo-gynaecomastia
* Non-glandular enlargement
* Not associated with hormonal changes
