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Reproductive > Breast disease > Flashcards

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
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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
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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
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4
Q

Nipple

A
  • Position variable → 4th intercostal space
  • Fissured with lactiferous ducts
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5
Q

Areas of the breast

A
  • 4 quadrants
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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
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7
Q

Gynaecomastia

A
  • Post-natal development of rudimentary lactiferous ducts in males
  • Mid-puberty ⅔ boys develop breast hyperplasia
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8
Q

Athelia and amastia

A
  • Absent nipple or breast
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9
Q

Supernumary breast and nipples

A
  • Polymastia → extra breast
  • Polythelia → extra nipple
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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
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11
Q

Nerve supply of the breast

A
  • Anterior and lateral cutaneous branches of intercostal nerves (4-6)
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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
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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
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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
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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
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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
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17
Q

Presentation of breast cancer

A
  • Skin dimpling
  • Abnormal contouring
  • Edema of skin (Peau d’orange sign)
  • Nipple detraction and deviation
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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
Q

Breast screening program

A
  • 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
Q

Modality of samples in cytology

A
  • Fine needle aspiration
  • Direct smear of nipple discharge
  • Scrape of nipple with scalpel
27
Q

Characteristics of fine needle aspiration

A
  • 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
Q

Microscopic features of benign and malignant disease in cytology

A
  • 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
Q

Cause of nipple discharge

A
  • Duct ectasia → benign mass causing widening of milk ductss
  • Introduit papilloma → benign mass of milk duct
  • Intraduct carcinoma → malignant mass
30
Q

Characteristics of core biopsy

A
  • Indicated with radiological or cytological suspicious maSS
  • Breast screening → architectural distortion and micro calcification
  • Minimally invasive
31
Q

Benign breast conditions

A
  • Fibrocystic mass → fibrosis, adenosine, cysts, apocrine metaplasia, ductal epithelial hyperplasia
  • Fibroadenoma
  • Intraductal papilloma
  • Fat necrosis
  • Duct ectasia
  • Phyllodes tumor
32
Q

Fibroadenoma

A
  • Growth of epithelial and stroll cells
  • Most common type in adolescent/ young adult women
  • Well circumscribed, freely-mobile, non-painful
33
Q

Tubular adenoma

A
  • Less common than fibroadenoma
  • Benign mass of tubule
34
Q

Lactating adenoma

A
  • Enlarging mass during lactation/ pregnancy with secretory changes
35
Q

Intraduct papilloma

A
  • Middle aged women
  • Nipple discharge
  • Epithelial hyperplasia
36
Q

Fat necrosis in breast

A
  • Benign mass caused breakdown of adipocytes in breast mesenchyme
  • History of trauma, post-surgical intervention
  • Lipid-filled cysts, fibrosis and calcification on mammography
37
Q

Phyllodes tumour

A
  • Rare breast cancer affecting pre-menopasual women in 40s
  • Fleshy tumour, leaf-pattern and cysts on surface
  • Benign, borderline or malignant
38
Q

Risk factors of breast carcinoma

A
  • 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
Q

Specific genes associated with breast carcinoma

A
  • BRCA1
  • BRCA3
  • TP53
  • PTEN
40
Q

Histological types of breast carcinoma

A
  • Non-invasive
    • Ductal carcinoma in-situ (DCIS)
    • Lobular carcinoma in-siut (LCIS)
  • Invasive
    • Invasive ductal carcinoma
    • Invasive lobular carcinoma
41
Q

Investigations in breast carcinoma

A
  • Clinical examination
  • Radiology
    • Mammogram
    • Ultrasound
    • MRI
  • Fine need aspiration cytology (FNAC)
  • needle core bishop
  • Wide local excision with adequate margins
42
Q

Management of breast cancer

A
  • Diagnosis and staging
  • Surgery (mastectomy + lymph nodes)
  • Radiotherapy
  • Anti-hormonal therapy
  • Chemotherapy
43
Q

Gynaecomastia vs pseudogynaecomastia

A
  • 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

Reproductive (25 decks)

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