Introduction to Breast Pathology

Question 1

What is Poland syndrome?

Answer 1

• A disorder in which affected individuals are born with missing or underdeveloped muscles on one side of the body, resulting in abnormalities that affect the chest, shoulder, arm, and hand

Question 2

Who does Poland syndrome affect more?

Answer 2

• Occurs twice as often in males

Question 3

What hand abnormalities are seen in Poland syndrome?

Answer 3

• Underdeveloped hand with abnormally short fingers
• Small, underdeveloped fingers
• Or some fingers fused together

Question 4

Why may some cases of Poland syndrome go unnoticed until puberty?

Answer 4

• May be recognized until there is asymmetry in the chest

Question 5

What can be affected in Poland syndrome in rare cases?

Answer 5

• Internal organs like lungs and kidneys

- Sometimes, the heart is located in the right side of the chest

Question 6

What are milk line remnants also called?

Answer 6

• Supernumerary nipples

Question 7

What is polymastia?

Answer 7

• Supernumerary nipples that appear complete with breast tissue and ducts

Question 8

What is the path of milk lines?

Answer 8

• From axilla to pubis

Question 9

What is the predominance of supernumerary nipples in males and females?

Answer 9

• Almost 1:1 but there is some evidence saying it could be 1.7:1 in males

Question 10

How does the size of a supernumerary nipple compare to a normal nipple?

Answer 10

• Usually 30% of the diameter of normal

- In 25% of people, the supernumerary nipple is around half the size of a nipple

Question 11

What is needed to be done when examining a female patient in regards to a supernumerary nipple?

Answer 11

• Check under the breast tissue as it may hide them

Question 12

How do most supernumerary nipples present (numbers wise)?

Answer 12

• Most are single
• Occasionally bilateral
• Most are located below the actual nipples

Question 13

What is accessory axillary breast tissue?

Answer 13

• In some women, the normal ductal system extends into the subcutaneous tissue of the chest wall or the axillary fossa

Question 14

How is accessory axillary breast tissue clinically significant?

Answer 14

• Sometime this tissue is not removed in prophylactic mastectomies

Question 15

What is nipple inversion?

Answer 15

• The failure of the nipple to evert during development

Question 16

What is the clinical significance of developmental nipple inversion?

Answer 16

• Usually insignificant due to the spontaneous correction during pregnancy or simple traction

Question 17

What is the clinical significance of acquired nipple inversion?

Answer 17

• May indicate the presence of an invasive cance or other inflammatory nipple disease

Question 18

How much of the lymph is drained via the internal mammary nodes?

Answer 18

• 25%

Question 19

Where does a majority of the lymph drain from the breast?

Answer 19

• To the axilla

Question 20

When do males and females breasts start to differ? Why?

Answer 20

• Puberty is when they start to differ due to estrogen and other hormones that initiate breast development

Question 21

What happens to the duct system in the breast following puberty?

Answer 21

• Duct system expands and proliferates, giving rise to numerous terminal duct lobular units

Question 22

When does the breast become fully mature?

Answer 22

• With pregnancy

Question 23

What is the breast comprised of by the end of a full term pregnancy?

Answer 23

• Lobules separated by scant stroma

Question 24

What happens to the breast after the third decade?

Answer 24

• Lobules and their specialized stroma start to involute and the interlobular stroma is converted from radio dense fibrous stroma to radiolucent adipose tissue

Question 25

How is the myoepithelial cell layer identified due to it being very hard to see?

Answer 25

• Immuno markers like calponin, a-smooth muscle actin, p65, CD10

Question 26

What are the three important characteristics of breasts?

Answer 26

1. Major function is to provide for the nutritional support and survival of another individual, the infant
2. Undergoes dynamic structural changes throughout life: expansion of the lobular system after menarche; periodic remodeling during adulthood, especially during and after pregnancy; and ultimately involution and regression
3. Symbols of femininity, breasts have social, cultural, and personal importance that is unique from other organs

Question 27

What is done for male transitioning to females in terms of breast surgery?

Answer 27

• Inserting a saline or silicone implant behind each breast

Question 28

What is done for a female transition to male in terms of breast surgery?

Answer 28

• Reduce or remove the size of their chest tissue due to body dysmorphia or discomfort associated with their chest