Breast path I Flashcards
how many lobes are in the breast
15-25
What is the terminal ducta lobular unit
basic functional unit of breast with acini and secretory units
what lines the breast duct system
inner epithelial cell layer is luminal cells
outer layer is basal cells or myoepithelial
both layers of the duct system are surrounded by what
basal lamina- BM
role of coopers ligaments
connect fascia to the dermis
suspensory support
where is the specialized stroma of the breast
the intralobular
which cell of the breast is equivalent to BM for invasion of cancer
myoepithelial “basal” cells
what stain to we use to see BM
S100
ductal carcinomas arise where and easily stained with what?
luminal cells
stain E Receptor +
when does milk production begin after delivery
3-5 days
end of P which allows dec hcg
what stimulates the let down of milk
prolactin
oxytocin- contraction
FIL- produced in distended breast
maternal milk is made up of what
lactose, milk fat, proteins, minerals, neutros, macros and lymphocytes
what is colostrum
early milk that is higher in protein and lipids
why do breasts become more radiolucent with age
more adipose, less stroma
what are supernumerary nipples
milk line remnants
ddx for accessory axillary breast
lymph node
lipoma
hidradenitis suppurative
epidermoid cyst
congenital inverted nipples are associated with higher risk for what
lactiferous sinus obstruction and inflammation
difficulty breast feeding
if patient presents with newly inverted nipple what must you consider
underlying pathology, maybe malignancy
Clinical presentation of breast disease in general
pain
nipple discharge
masses
what is mastodynia and mastalgia
pain in the breast
what can cause breast pain
obstruction, inflammation
cyclic through menses
10% breast Ca painful
what can cause galactorrhea
milky discharge assoc with prolactin and meds
what can cause serous and bloody nipple discharge
cysts and large duct papillomas
most common cause of bloody nipple discharge
benign intraductal papilloma
examination of breast masses involves what
PE
mammogram
patholgoy (FNA etc)
—- cancer has to be excluded—-
what are the gradings for a mammogram
1-5 5 being most severe
what can cause microcalcifications in the breast
form in secretions necrotic debris and involuting stroma
characteristics of malignant calcifications
small irregular, clustered, numerous
what can US tell you about a breast mass
cystic or solid
MRI is useful with breast Ca how
good for staging based on invasion of chest wall
does a negative FNA from breast rule out breast CA
no
what is the best type biobpsy for breast tissue
core because can see tissue and also allows DNA testing for ER PR Her2neu and etc
why are margins of breast tissue inked with different colors upon excision
so know if comes back not clear margins, know where to go in for more
what is needle localization of breast
go to radiology to have them stick a needle in mass that is not palpable, then surgeoun just follows needle into the area that needs to be taken out
what is a simple masectomy
breast tissue, skin and nipple
what is a modified radical mastectomy
breast tissue skin nipple
most axillary lymph nodes
spares pectoralis muscle
what lesions can occur in the terminal duct lobular unit
cyst sclerosing adenosis small duct papilloma hyperplasia atypical hyperplasia carcinoma
what type of lesions can occur in the lobular stroma of the breast
fibroadenoma
phyllodes tumor
what are the lesions of the large ducts and lactiferous sinuses
duct ectasia recurrent subareolar abscess solitary ductal papilloma pagets mastitis
what are the lesions of the interlobular stroma of breast
fat necrosis lipoma fibrous tumor PASH fibromatosis sarcoma peripheral mastitis
what is puerperal mastitis
post partum acute mastitis
what is lactational mastitis
segmental features of acute inflammation
starts at nipple fissure and milk stasis (skin bacteria)
common pathogens for lactational mastitis
staph aureus and strep sp.
what are the types of non-lactational mastitis
periareolar (mammary duct ectasia)
peripheral
what causes periareolar non lactational mastitis
obstructed lactiferous sinus at level of the nipple
what are associations with periareolar mastitis
inverted nipple, cigarette smoking– keratin plugging of the nipple
periductal mastitis
when the dilated sinuses form a mass which ruptures the duct causing redness, tenderness, heat and pain
if periductal mastitis is left untreated, what can happen
fistula
peripheral non-lactational mastitis associated with what conditions
DM, RA, steroids or trauma
what is a ductogram
radio opaque dye injected into the subareolar sinuses through openings in the nipple
