Breast Lectures Flashcards
Describe the location and relations of breasts
- 2nd/3rd rib to 6th rib
- Sternal edge to midaxillary line
- Lies on the deep pectoral fascia
- A small part (axillary tail) may extend towards the axillary fossa
- Retromammary space - helps some degree of movement
Describe the structure of the breast
- Nipple
- Areola
- 15-20 lobules of glandular tissue (parenchyma)
- Each lobule is drained by a lactiferous duct
- Each duct has a dilated portion (lactiferous sinus)
Describe the structure of the nipple
- No fat or hair
- Contains collagenous dense connective tissue, elastic fibres and bands of smooth muscle
- The tips of the nipples are fissured with lactiferous ducts opening into them
- Position: 4th intercostal space (roughly)
Describe the structure of the areola
- Skin covering the nipple and areola contains numerous sweat and sebaceous glands
- Oily secretion lubricates the nipple and areola
Name the four quadrants of the breast
- Superolateral
- Superomedial
- Interolateral
- Inferomedial
Describe the development of the breast
- Mammary crests or ridges appear during the 4th week
- These crests extend from the axillary region to inguinal region
- The crests usually disappear (except in the pectoral region)
- Primary mammary buds > secondary mammary buds > lactiferous ducts and their branches
What is the blood supply to the breasts?
- Branches of axillary, internal thoracic and some intercostal arteries
- Thoraco acromial a.
- Lateral thoracic a.
- Internal mammary a.
What is the innervation of the breasts?
- Anterior and lateral cutaneous branches of 4-6th intercostal nerves
- Sensory fibres and sumpathetic fibres to the blood vessels and smooth muscle
Which lymph nodes drain lymph from the breasts?
-Axillary lymph nodes
-Supraclavicular nodes
-Inferior cervical nodes
-Parasternal
(can drain to the opposite breast)
What is the function of the terminal duct lobular unit?
Milk secretory component of the breast
Describe the features of breast tissue prepuberty
- Neonatal breast contains lactiferous ducts but no alveoli
- Until puberty, little branching of the ducts occurs
- Slight breast enlargement reflects the growth of fibrous stroma and fat
Describe the features of breast tissue at puberty
- Branching of lactiferous ducts
- Solid, spheroidal masses of granular polyhedral cells
- Accumulation of lipids in the adipocytes
Describe the features of breast tissue post menopausal
- Progressive atrophy of lobules and ducts
- Fatty replacement of glandular tissue
Name the signs of breast cancer
- Skin dimpling
- Abnormal contours
- Oedema of the skin
- Nipple retraction or deviation
Name some of the benign breast tumours
- Fibroadenoma
- Duct papillomas
- Adenomas
- Corrective tissue tumours
What is cytology and how can samples be obtained?
- Miscroscopic examination of a thin layer of cells on a slide
- FNA
- Direct smear from nipple discharge
- Scrape of nipple with scalpel
Which groups of patients should get cytology?
- Symptomatic patients (discrete mass, diffuse thickening and nipple lesion)
- Breast screening
What would you see on a benign cytology?
- Low/moderate cellularity
- Cohesive groups of cells
- Flat sheets of cells
- Bipolar nuclei in the background
- Cells of uniform size
- Uniform chromatin pattern
What would be seen on a malignant cytology?
- High cellularity
- Loss of cohesion
- Crowding/ overlapping of cells
- Nuclear pleomorphism
- Hyperchromasia
- Absence of bipolar nuclei
Which features on a cytology would suggest a specific type of cancer?
- Cytoplasmic vacuoles: lobular carcinoma
- Cells arranged in tubes: tubular carcinoma
Describe the cytology scoring system
- C1: unsatisfactory
- C2: benign
- C3: atypia (probably benign)
- C4: suspicious
- C5: malignant
What is the treatment for cysts?
Aspiration: fluid is then discarded unless blood stained or there is residual mass