Breast/Lymph Flashcards
Describe and identify the following areas of breast anatomy: nipple; areola; Montgomery tubercles; Suspensory ligaments of Cooper; lobes; lobules; and lactiferous ductules, ducts and sinuses.
Lobe: radiate around nipple consist of lobules
Lobules: consist of milk producing acinar cells that empty into lactiferous ducts
Lactiferous ducts: drains milk from lobe onto surface of nipple
Suspensory ligaments: extend from connective tissue layer through the breast and attach to the underlying muscle fascia, providing further support
Montgomery tubercles: bumps forming from sebaceous glands around the nipple
Define the anatomical borders of the breast
The breasts are paired mammary glands located on the anterior chest wall, superficial to the pectoralis major and serratus anterior muscles. In female breasts, the breast extends from the second or third rib to the sixth or seventh rib and from the sternal margin to the midaxillary line.
Identify the four quadrants of the breast and the Tail of Spence.
Identify common descriptive terms used to describe breast shape on a physical examination write-up.
intact breasts vary in shape, from convex to pendulous or conical, and often one breast is somewhat smaller than the other.
Describe the lymphatic drainage pathways of the breast.
The axillary nodes are more superficial and are accessible to palpation when enlarged. The anterior axillary (pectoral) nodes are located along the lower border of the pectoralis major, inside the lateral axillary fold. The midaxillary (central) nodes are high in the axilla close to the ribs. The posterior axillary (subscapular) nodes lie along the lateral border of the scapula and deep in the posterior axillary fold, whereas the lateral axillary (brachial) nodes can be felt along the upper humerus
List expected changes that occur in the breast during pregnancy.
In response to luteal and placental hormones, the lactiferous ducts proliferate, and the alveoli increase extensively in size and number, which may cause the breasts to enlarge two to three times their prepregnancy size. The increase in glandular tissue displaces connective tissue, and the breasts become softer and looser. Toward the end of pregnancy, as epithelial secretory activity increases, colostrum is produced and accumulates in the acinar cells (alveoli). The areolae become more deeply pigmented and their diameter increases. The nipples become more prominent, darker, and more erectile. Montgomery tubercles often develop as sebaceous glands hypertrophy. Mammary vascularization increases, causing veins to engorge and become visible as a blue network beneath the surface of the skin.
Identify and describe changes in the appearance and/or texture of the breast suggestive of an underlying malignancy.
- Unilateral venous patterns
- Recent unilateral inversion of previously everted nipple
- Nipple discharge
- Painless lump
- Palpable mass – unilateral, poorly delineated border
- Dimpling breast
- peau d’orange or thickened appearance.
Describe how to thoroughly evaluate nipple discharge on physical exam.
Determine whether the discharge is bilateral or unilateral. Use a magnifying glass to look closely at the nipple to determine whether the discharge is from a single duct or multiple ducts. Characteristics of concern include spontaneous discharge that is unilateral and from a single duct
Describe how lymph fluid moves through the body.
Lymphatic capillaries -> Afferent lymph vessels -> Lymph node -> Efferent Lymph vessels -> Lymphatic trunk -> Collecting Duct (Right lymphatic duct for right thorax, head, neck, right arm; thoracic duct rest of body) -> Subclavian vv
Describe which parts of the body drain lymph into the right lymphatic duct and which parts drain lymph into the thoracic duct. Identify the blood vessels into which these lymph ducts empty.
The drainage point for the right upper body is a lymphatic trunk that empties into the right subclavian vein. The thoracic duct, the major vessel of the lymphatic system, drains lymph from the rest of the body into the left subclavian vein.
Identify the expected location of a Virchow lymph node and discuss its clinical significance.
Left supraclavicular, probing deeply in the angle formed by the clavicle and the sternocleidomastoid muscle — sign of gastric cancer
Matted lymph nodes:
Group of fused lymph nodes – may be a sign of certain conditions, such as infection, sarcoidosis, or lymphoma. They also may be a sign of cancer that has spread to the lymph nodes.
Shotty lymph nodes:
clusters of small lymph nodes < 1 cm common in children
Anterior cervical triangle
Midline, mandible, SCM
Posterior cervical triangle
SCM, clavicle, trapezius
