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Reproductive > Breast disease > Flashcards

Breast disease Flashcards

1
Q

What is the surface anatomy of the breast?

A

2/3rd rib - 6th rib

Sternal edge to midaxillary line

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2
Q

What is the axillary tail?

A

Small part of breast extends towards axillary fossa

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3
Q

What muscles does the breast lie on?

A

2/3 Pectoral fascia covering pectoralis major

1/3 Serratus anterior

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4
Q

How is the breast attached to the dermis?

A

Suspensory ligament of cooper

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5
Q

What does the suspensory ligament of cooper do?

A

Attaches breast to dermis

Helps support the lobules of the gland

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6
Q

How many lobules does each breast contain?

A

15-20 lobules of glandular tissue

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7
Q

What is the glandular tissue of the breast called?

A

Parenchyma

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8
Q

What is the dilated portion of each lactiferous duct called?

A

Lactiferous sinus

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9
Q

What type of tissue is the nipple made from?

A

Collagenous dense connective tissue, elastic fibre and bands of smooth muscle

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10
Q

What are the tips of the nipples fissured with?

A

Lactiferous ducts

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11
Q

Where are the nipples typically located?

A

4th intercostal space

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12
Q

What does the areola contain?

A

Sweat and sebaceous glands

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13
Q

What is the areola?

A

Skin covering the nipple

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14
Q

What happens to the areola during pregnancy?

A

Enlarge

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15
Q

How many quadrants of the breast are there?

A

4

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16
Q

What are the 4 quadrants of the breast?

A

Superolateral
Superomedial
Inferolateral
Inferomedial

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17
Q

Which quadrant does the axillary tail extend into?

A

Superolateral

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18
Q

What is the male breast formed by?

A

Small ducts without lobules or alveoli

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19
Q

In the development of breast, when do mammary crests or ridges appear?

A

During 4th week

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20
Q

What is gynecomastia?

A

Postnatal development of rudimentary lacteriferous ducts in males

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21
Q

What is polymastia?

A

Extra breast

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22
Q

What is polythelia?

A

Extra nipple

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23
Q

What is aphelia or amastia?

A

Absence of nipple or breast

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24
Q

What is breast’s blood supply?

A

Branches of the axillary a., internal thoracic a. and some intercostal a.

Thoraco-acromial a.
Lateral thoracic a.
Internal mammary (thoracic) a.

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25
Q

What veins drain the breasts?

A

Axillary and internal thoracic veins

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26
Q

What nerves supply the breast?

A

Anterior and lateral cutaneous branches of 4-6th intercostal nerves

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27
Q

What is important about breast lymphatics that is of clinical significance?

A

Branch extensively and do not contain valves

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28
Q

Where does most lymph from the breast drain?

A

Axillary lymph nodes

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29
Q

Apart from the axillary nodes, where else does lymph drain from the breasts?

A

Supraclavicular nodes
Inferior cervical nodes
Parasternal nodes

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30
Q

What is the sentinel node?

A

First few lymph nodes into which tumour drains

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31
Q

What is used to locate the sentinel node?

A

Radiolabelled colloid

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32
Q

What lobe is the functional milk secretory component of the breast?

A

Terminal duct lobular unit

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33
Q

What is the histology of normal breast tissue?

A

Surrounded by dense fibrous interlobular tissue & adipose tissue

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34
Q

What are the ducts and acini of breast tissue lined by?

A

Luminal epithelial cells

Myoepithelial cells

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35
Q

What are changes that happen to breast tissue during puberty?

A

Branching of lactiferous ducts

Accumulation of lipids in adipocytes

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36
Q

What are changes that happen to breast tissue post-menopause?

A

Progressive atrophy of lobules and ducts

Fatty replacement of glandular tissue

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37
Q

What happens to breast tissue during pregnancy?

A

Enlarged lobules
Acini dilated
Epithelium vary from cuboidal to low columnar
Colostrum producted

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38
Q

What is colostrum?

A

Protein rich fluid, available few days after birth, rich in maternal antibodies

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39
Q

What happens to breast tissue during lactation?

A

Acini distended with milk

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40
Q

What are diagnostic methods used on breasts?

A 
Mammography
US
FNA cytology
Core biopsy
MRI
Nuclear medicine
Breast screening programme
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41
Q

What are signs of breast cancer?

A

Skin dimpling
Abnormal contours
Edema of skin
Nipple retraction/deviation

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42
Q

What are types of benign breast tumours?

A 
Fibroadenomeas
Duct papillomas
Adenomas
Connect tissue tumours
Paget's disease of nipple
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43
Q

How can cytology samples be gained for breast tissue?

A

FNA
Smear nipple discharge
Scrape of nipple with scalpel

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44
Q

What is the FNA of usually?

A

Axillary nodes

Satellite lesions

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45
Q

What are palpable symptoms of breast disease?

A 
Discrete mass: solid or cystic
Diffuse thickening
Nipple lesion
Discharge
Eczematous skin
46
Q

How can an area that is unpalatable have FNA?

A

US-guided FNA

47
Q

What are important considerations when doing FNA?

A

Patient: informed, comfortable, chaperone
Safety: PPA, dispose needle, care handle of material

48
Q

What are signs of benign cytology?

A 
Low/moderate cellularity
Cohesive groups of cells
Flat sheets of cells
Bipolar nuclei in background
Cells of uniform size
Uniform chromatin pattern
49
Q

What are signs of malignant cytology?

A 
High cellularity
Loss of cohesion
Crowding/overlapping of cells
Nuclear pleomorphism
Hyperchromasia
Absence of bipolar nuclei
50
Q

What is the cytology scoring system?

A 
C1-C5
C1: unsatisfactory
C2: benign
C3: atypic
C4: suspicious
C5: malignant
51
Q

How are cysts managed?

A

Aspiration is curative

52
Q

What are the advantages of FNA?

A

Simple - can be done at clinic
Well tolerated
Inexpensive
Immediate results

53
Q

What are the limitations of FNA?

A 
Accuracy not 100% - false negatives/positives
Invasion cannot be assessed
Grading cannot be done
Lesions missed
Technical - suboptimal smears
Interpretation
54
Q

What are the complications of FNA?

A

Pain
Haematoma
Fainting
Infection

55
Q

What are the contraindications of FNA?

A

None

56
Q

What is an indication of a nipple lesion?

A

Bloody discharge from single duct

57
Q

What could a nipple scrape determine between?

A

Paget’s disease (squamous cells + malignant cells)

Eczema (squamous cells only)

58
Q

What could a nipple discharge cytology sample tell the different between?

A

Duct ectasia
Intraduct papilloma
Intraduct carcinoma

59
Q

When is a core biopsy done?

A

All cases with clinical or radiological or cytological suspicion

60
Q

What can a core biopsy do?

A

Confirm invasion
Tumour typing and grading
Immunohistochemistry

61
Q

What is the main view on mammography?

A

ML oblique view and craniocaudal view

62
Q

When is mammography offered?

A

Over age 40

63
Q

When is mammography offered for <40yrs?

A

Strong suspicion cancer

FHx risk greater than 40%

64
Q

What is the radiation dose of mammography?

A

1mSv

65
Q

What are signs of malignant disease on mammography?

A

Irregular, illdefined
Spiculated
Dense
Distortion of architecture

66
Q

What are signs of benign disease on mammography?

A

Smooth or lobulated
Normal density
Halo

67
Q

What can an US differentiate between?

A

Solid from cystic mass

Solid benign from malignant

68
Q

What is first line of investigation of breast disease in <40yrs?

A

US

69
Q

What does a solid benign tumour look like on US?

A

Smooth outline
Oval shape
Acoustic enhancement

70
Q

What does a malignant tumour look like on US?

A

Irregular outline
Interrupting breast architecture
Acoustic shadowing and anterior halo

71
Q

What is the triple assessment in breast disease management?

A

Clinical examination
Imaging
FNA cytology

72
Q

What are the 2 types of image guided needle biopsy in breast disease?

A

FNA

Core biopsy

73
Q

What are the indications for MRI of the breast?

A

Recurrent disease
Implants
Indeterminate lesion following triple assessment
Screening high risk women

74
Q

What age is the breast screening programme aimed at?

A

50-70yrs

75
Q

What is duct ectasia?

A

A milk duct beneath the nipple widens, the duct walls thicken and the duct fills with fluid. This is the most common cause of greenish discharge.

76
Q

What is fibroadenoma?

A

Proliferation of epithelial and stromal elements

77
Q

What is the most common breast tumour in adolescent and young adult women?

A

Fibroadenoma

78
Q

How does fibroadenoma present?

A

Well-circumscribed
Freely mobile
Nonpainful mass
May regress with age if untreated

79
Q

What are other adenomas apart from fibroadenoma?

A

Tubular adenoma

Lactating adenoma

80
Q

What group of women usually get introducet papilloma?

A

Middle aged women

81
Q

How does introduction papilloma present?

A

Nipple discharge

82
Q

What can simulate carcinoma clinically and mammographically?

A

Fat necrosis

83
Q

What are causes of fat necrosis in breast tissue?

A

History of antecedent trauma

Prior surgical intervention

84
Q

What type of tumour is Phyllodes tumour: benign or malignant?

A

Can be either

85
Q

How is Phyllodes tumour described?

A

Fleshy
Leaf-like patterns
Cysts on cut surface
Circumscribed

86
Q

What is the metastatic route of Phyllodes tumour?

A

Hematogenous

87
Q

What is the commonest cause of female cancer death?

A

Breast Ca

88
Q

What are risk factors for breast cancer?

A 
Gender
Age
Menstrual Hx 
Age at first pregnancy
Radiation
FHx
Hormonal treatment
Genetics
Others: obesity, alcohol, lack activity
89
Q

What % of breast cancers attributed to inherited factors?

A

5-10%

90
Q

What are the most prominent genes that causes breast ca?

A

BRCA 1

BRCA 2

91
Q

What are the histological classifications of breast ca?

A

Non-invasive:

  • Ductal carcinoma in situ (DCIS)
  • Lobular carcinoma in situ (LCIS)

Invasive:

  • Invasive ductal carcinoma
  • Invasive lobular carcinoma and variants
  • Special types
92
Q

What are 2 types of non-invasive breast ca?

A
  • Ductal carcinoma in situ (DCIS)

- Lobular carcinoma in situ (LCIS)

93
Q

What are the features of in situ breast carcinoma?

A

Does not form palpable tumour
Not detected clinically - imaging needed
No metastatic spread
Risk invasion depending on grade

94
Q

Which type of non-invasive breast ca has a higher risk of progression?

A

DCIS

95
Q

What are the special types of breast ca?

A

Tubular carcinoma
Mucinous carcinoma
Carcinoma with medullary features
Metaplastic carcinoma

96
Q

How often is mammography screening?

A

Every 3yrs

97
Q

What are microcalcifications?

A

Tiny deposits of calcium can appear in breast and show on mammogram
Majority are harmless
Some precancerous/cancerous

98
Q

What are two of most important mammography indicators of breast ca?

A

Masses

Microcalcifications

99
Q

What is in a histology report from breast tissue sample?

A 
Invasive or non-invasive
Type: ductal or lobular
Grade
Size
Margins
Lymph nodes
Estrogen/progesterone receptor
100
Q

Where is the usual spread of breast ca?

A

Local - skin, pectoral muscles
Lymphatic - axillary, internal mammary nodes
Blood - bone, lungs, liver, brain

101
Q

What is the prognosis tool for breast ca?

A

Nottingham Prognostic Index (NPI)

102
Q

Which tumours don’t respond to hormonal therapies?

A

ER/PR negative tumours

103
Q

What does HER-2 status predict?

A

Response to trastuzumab (Herceptin)

20-30% are positive Her-2

104
Q

What are the 5 molecular subtypes of breast ca?

A 
Normal
Basal
Luminal A
Luminal B
Her-2
105
Q

What is the management of breast ca?

A 
Staging
Surgery
Radiotherapy
Antihormonal therapy
Chemotherapy
106
Q

What is the antihormonal therapy for breast ca?

A

Tamoxifen

107
Q

What are the surgery options for breast ca?

A

Mastectomy

Breast conserving surgery +/- lymph nodes

108
Q

What is Paget’s disease of the nipple a result of?

A

Intraepithelial spread of intraductal carcinoma

109
Q

What are signs of Paget’s disease of the nippled?

A 
Pain/itching
Scaling/redness
Mistaken for eczema
Ulceration
Crusting
Serous/bloody discharge
110
Q

What is gynecomastia associated with?

A 
Hyperthyroidism
Cirrhosis of liver
Chronic renal failure
Chronic pulmonary disease
Hypogonadism
Use of hormones

Reproductive (20 decks)

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