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Reproduction Week 3 > Lecture 28: Development, Anatomy and Physiology of Breast > Flashcards

Lecture 28: Development, Anatomy and Physiology of Breast Flashcards

1
Q

What is the leading cause of cancer for women?

A

Breast cancer

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2
Q

What is mammogenesis?

A

Process by which breast develops

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3
Q

What is lactogenesis?

A

Process by which milk is produced

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4
Q

What is the primary function of the mammary gland?

A

Lactation

  • provides nourishment to dependent offspring
  • transfers passive immunity to the young
  • facilitates bonding between mother and offspring
  • promotes postpartum uterine involution
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5
Q

What lymph nodes do you biopsy for breast cancer?

A

Axillary lymph nodes

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6
Q

What are the components of breast tissue architecture?

A
  1. Epithelial component (ectoderm)
    • 20%
    • ducts
    • lobules (acini, alvelolar epithelial cells)
  2. Stromal/mesenchymal component (mesoderm)
    • fibrous connective tissue (fibroblast)
    • adipose tissue (adipocytes)
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7
Q

What is TDLU?

A

Terminal Ductal Lubular Unit

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8
Q

What are the two types of connective tissue in the breast?

A
  1. Intralobular stroma

2. INTERlobular stroma (extralobular stroma)

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9
Q

What are the stages of mammary gland development?

A
  1. fetal
  2. puberty
  3. pregnancy
  4. lactation
  5. post-lactational involution
  6. menopause
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10
Q

What are the multipotent progenitors that forms the cells of the mammary glands?

A
  1. Myoepithelial progenitor
  2. Ductal progenitor
  3. Alveolar progenitor
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11
Q

What are the hormonal requirements for breast development in puberty?

A 
Estrogen
Ductal morphogenesis (building the the tree)
Ductal elongation
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12
Q

What are the hormonal requirements in preganancy?

A

Lobuloalveolar development (expanding leaves of tree

  1. Progesterone
  2. Prolactin
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13
Q

What are the hormonal requirements in lactation?

A
  1. Prolactin (cortisol)

2. Insulin

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14
Q

What is colostrum?

A

The first secretion from the mammary glands after giving birth, rich in antibodies

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15
Q

What is the milk streak or a milk line?

A

Precursors to mammary glands and nipples

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16
Q

What are the characteristics of fetal mammary development?

A
  1. Hormone independent events
    Milk streak  mammary buds  primordial ductal tree
  2. Hormone dependent events
    -canalization of ducts
    -colostrum formation, parenchymal differentioation
  3. No sexual dimorphism prior to puberty
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17
Q

What is hormone independent in fetus?

A

Development of ductal tree

18
Q

What is hormone dependent in fetus?

A

Canalization of ducts

Colustrum formation

19
Q

When is the mitotic rate of glandular epithelial cells greatest?

A

During the luteal phase

Estrogen and progesterone are more mitogenic than E2 alone

20
Q

What are the changes in volume, nodularity and sensitivity in the breast in the luteal phase due to?

A

Due to tissue edema and hyperemia

Luteal phase

21
Q

What are the hormonal changes seen in pregnancy?

A

Progesterone, estrogen and prolactin
Progesterone and prolactin inhibit lactogenic action of prolactin
Lobuloalveolar development

22
Q

Are ovaries required for lactation?

A

No

23
Q

What is required for continued lactation?

A
  1. Regular removal of milk
  2. Intact HPA axis
  3. Adequate diet and nutrition
24
Q

What are the breast changes for lactation?

A
  1. Terminal differentiation of alveolar epithelial cells
  2. High prolactin levels in setting of LOW E2 AND P LEVELS
  3. Milk production/ejection controlled by neural reflex arcs
25
Q

What are the neural reflex arcs for milk production and ejection?

A
  1. Stimuli associated with nursing stimulates oxytocin release
    • oxytocin will lead to milk ejection (myoepithelial contraction)
  2. Suckling lead to prolactin release which leads to milk production
    • transcription of milk genes
    • induction of enzymes for lactose synthesis
    • induction of differentiation
26
Q

What do dopamine agonists like Bromocriptine do?

A

Inhibits lactogenesis

27
Q

Why do you have amenorrhea during lactation?

A

Hyperprolactinemia-induced inhibition of gonadotropin secretion

28
Q

What are the characteristics of postlactational involution?

A

At weaning
-prolactin and oxytocin release not stimulated
-unremoved milk leads to increased acinar pressure
Lactation ceases within 10 days
80% of epithelium dies
Involution takes 3-4 months and involves remodeling of tissues
-parity leads to permanent change in breast

29
Q

What is parity?

A

A technical term that refers to number of times a female has given birth

30
Q

What are the characteristics of breast devo during menopause?

A
  1. Decreased estrogen/progesterone secretion
  2. Progression involution of ductal and glandular elements of the breast
  3. Changes make aging breast more amenable to mammography
31
Q

What are potential disorders of breast development?

A
  1. Hypoplasia/Amastia

2. Supernumerary nipples polymastia

32
Q

What are the characteristics of hypoplasia/amastia?

A
  1. Asymmtery common
  2. Underdevelopment common
  3. Secondary to biopsy, chest wall trauma, thoracic radiation as a kid
33
Q

What is amastia?

A

When breast tissue, nipple and areola is absent

34
Q

What are the characteristics of supernumerary nipples/polymastia?

A

Secondary to incomplete regression of milk streak

35
Q

What is important about the endocrine pathophysiology of breast?

A 
Breast is hormonally responsive
Alterations in breast accompanied by endocrine disturbances
Indicative of 
	i. Turner
	ii. precocious puberty (PCOS?)
36
Q

What are the characteristics of galactorrhea?

A
  1. Persistent discharge of milk in the absence of parturition
    -discharge in the non-nursing mother over 6 months postpartum
  2. Associated with hyperprolactinemia, amenorrhea
    Caused by Prolactinoma and drugs
  3. Normoprolactinemia, regular menses can be present as well
    -this is caused by excess sensitivity of breast to prolactin
37
Q

What is Sheehan’s Syndrome?

A

Infarction of pituitary during labor and delivery
Pituitary particularly susceptible to decreased blood flow due to increased size during pregnancy
Lack of postpartum milk production

38
Q

What does lack of postpartum milk production make you think of?

A

Sheehan’s syndrome

Infarction of pituitary during labor

39
Q

What causes gynecomastia?

A

Decreased androgen:estrogen ratio

40
Q

What are the characteristics of gynecomastia?

A
  1. Excessive development of male mammary gland
  2. Physiological gynecomastia
    • transient gynecomastia of newborn
    • transient breast enlargement at puberty/elderly
  3. Pathological gynecomastia
    • reduced androgen/estrogen production or action

Reproduction Week 3 (8 decks)

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