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ESA 4 > Repro 11 > Flashcards

Repro 11 Flashcards

1
Q

why does breast enlarge at puberty in female?

A

under influence of oestrogens AT accumulates, and lactiferous ducts become much enlarged

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2
Q

what cells surround the lactiferous ducts in the breast?

A

myoepithelial cells

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3
Q

why can oedema and tenderness occur in the breasts within the week prior to the menses?

A

oestrogen peak stimulates mammary glands further in the menstrual cycle as it induces duct proliferation which causes ducts to enlarge and may cause oedema and tenderness

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4
Q

action of progesterone on breast in pregnancy?

A

influences development of secretory tissues

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5
Q

action of oestrogen on breast in pregnancy?

A

duct proliferation

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6
Q

where does base of mature breast extend?

A

from lateral border of sternum to mid-axillary line, and overlies 2nd to 6th ribs

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7
Q

major features of female breast?

A

nipple
areola
axillary tail

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8
Q

what does each lactiferous duct of each lobule of the breast comprise just prior to its opening onto the nipple?

A

a dilated lactiferous sinus

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9
Q

how is each lobule of glandular tissue in the breast delineated?

A

by CT septa extending from skin into deep fascia, known as suspensory ligaments

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10
Q

what does skin of areola comprise?

A

many tubercles produced by underlying alveolar glands

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11
Q

why is the breast mobile?

A

due to retromammary space between breast and fascia overlying the chest wall muscles

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12
Q

what changes to the breast may be visualised if a tumour is present?

A

distortion due to shortening of suspensory ligaments, and dimpling of skin due to oedema

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13
Q

blood supply to breast?

A

internal thoracic artery
intercostal artery
lateral thoracic
thoracoacromial

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14
Q

venous drainage of breast?

A

axillary vein
posterior IC veins
internal thoracic vein

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15
Q

lymphatic drainage of medial quadrants of breast?

A

parasternal nodes or opposite breast

most of lateral to axillary LNs

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16
Q

composition of lobes of breast?

A

lobules of alveoli- site of milk synthesis, and surrounded by myoepithelial cells
blood vessels
lactiferous ducts

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17
Q

what is secreted from the breast during the 1st week after birth?

A

colostrum: contains less H20 soluble vits, fat and sugar than later milk but more protein, fat-soluble vits and Igs
IgG and total protein declines over next 2-3wks, whilst fat and sugar rises to produce mature milk

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18
Q

where is milk fat synthesised?

A

smooth ER of alveolar cells and passes in membrane bound droplets towards lumen

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19
Q

where does milk protein pass through?

A

golgi apparatus and is released by exocytosis

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20
Q

what favours development of alveoli during preganancy?

A

a higher progesterone to oestrogen ratio

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21
Q

how do alveolar cells become responsive to prolactin at birth?

A

fall in progesterone levels, with fall in oestrogen less so

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22
Q

how does suckling maintain milk secretion?

A

neuro-endocrine reflex: suckling by infant stimulates receptors in nipple mechanically which results in impulses being sent up to brain stem and hypothalamus to reduce dopamine secretion and VIP so promoting prolactin secretion

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23
Q

what is milk ‘let down’

A

dramatic increase in oxytocin secretion when infant next suckles, which contracts myoepithelial cells which eject the milk

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24
Q

what doe maintenance of lactation depend on?

A

regular suckling to promote prolactin secretion, and tp remove accumulated milk

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25
what can a mother take to suppress milk production?
steroids= -ve feedback on anter.pituitary to inhibit prolactin release?
26
why will milk production cease if suckling stops?
decrease in prolactin and damage to breast due to turgor-induced damage
27
why is a new pregnancy unlikely during the time in which an infant is suckling?
fertility is reduced due to high prolactin
28
physiological breast changes in menarche?
increase in no. of lobules and increase in volume of interlobular stroma
29
physiological breast changes in menstrual cycle?
follicular phase: lobules quiescent after ovulation: cell proliferation and stromal oedema menses: decrease in size of lobules
30
physiological breast changes in pregnancy?
increase in size (hypertrophy) and number of lobules decrease in stroma secretory changes
31
clinical presentation of breast conditions?
``` Pain Palpable mass Nipple discharge Skin changes Lumpiness ```
32
cause of cyclical and diffuse pain in breast?
physiological e.g. in menstrual cycle
33
cause of non-cyclical and focal pain in breast?
ruptured cysts, injury, inflammation
34
triple approach to diagnosis and investigation of breast cancer?
clinical- history, FH, examination radiographic imaging- mammogram and USS pathology- fine needle aspiration and cytology and core biopsy
35
characteristics of an in situ breast carcinoma?
Neoplastic population of cells limited to ducts and lobules by BM, myoepithelial cells are preserved Does not invade into vessels so can't metastasise
36
how does a ductal carcinoma in situ most commonly present?
mammographic calcifications- clusters or linear and branching, but can present as a mass
37
histological appearance of a ductal carcinoma in situ?
central necrosis with calcification
38
how does invasive breast carcinoma commonly present?
mass or mammographic abnormality | over 50% will have metastasised to axillary LNs by time lump is found
39
why is breast turgor increased between feeds?
milk accumulates in alveoli and ducts as suckling at 1 feed promotes prolactin release which causes production of next feed
40
define physiological breast changes
changes or symptoms that come about due to normal breast physiology
41
physiological breast changes in menarche?
increase in lobule number, increase vol of interlobular stroma
42
describe cessation of lactation as a physiological breast change
atrophy of lobules but not to former levels
43
what happens to the breast with increasing age?
terminal duct lobular units decrease in no. and size, interlobular stroma replaced by AT- makes mammograms easier to interpret as less fibrous stroma which can make calcification more difficult to see
44
palpable breast mass most worrying if...?
hard, craggy, fixed
45
causes of palpable breast mass?
invasive carcinomas fibroadenomas cysts
46
when is nipple discharge most concerning?
spontaneous and unilateral | occasionally malignant lesions can cause bloody or serous discharge
47
why might nipple discharge be milky?
endocrine disorders e.g. pit adenoma, SE of med. e.g. OCP
48
when are women invited to screening by mammograms?
age 50-70 yrs every 3 yrs, but extending age to 47-73 yrs
49
most common benign tumour of breast?
fibroadenoma
50
aim of mammographic screening?
detect small invasive tumours and in situ carcinomas- not gone through BM, so therefore can treat before metastasis
51
does an in situ ductal cell carcinoma metastasise?
no, as doesn't go through BM so can't invade into blood vessels
52
only benign lesion to cause skin dimpling?
fat necrosis
53
how does fat necrosis usually result?
from skin trauma
54
common age of fibroadenoma occurrence?
<30yrs | but can occur at any age during repro. period
55
when do most phyllodes tumours present?
6th decade
56
average age of diagnosis of breast cancer?
64 yrs | incidence increases with age
57
pathological conditions of breast?
``` disorders of development inflammatory conditions benign epithelial lesions stromal tumours gyanecomastia breast carcinoma= malignant neoplasm of epithelial cells ```
58
examples of disorders of devleopment?
milk line remnants- polythelia= accessory nipple, accessory axillary breast tissue
59
inflammatory conditions of breast?
acute mastitis- almost always occurs during lactation duct ectasia fat necrosis
60
characteristics of breast affected by acute mastitis?
``` red warm painful often pyrexia may produce breast abscesses ```
61
common causative agent of acute mastitis?
staphylococcus aureus- infection from nipple cracks and fissures
62
how is acute mastitis usually treated?
by expressing milk- flush out infection, and antibiotics
63
what can duct ectasia mimic clinically?
carcinoma
64
characteristics of duct ectasia?
duct dilatation and inflammation- inflammatory cells seen under microscope may have periareolar mass and/or nipple discharge
65
presentation of fat necrosis?
mass, skin changes e.g. dimpling or mammpgraphic abnormality | can mimic carcinoma clinically and mammographically
66
commonest benign breast condition?
fibrocystic changes
67
presentation of fibrocystic change?
mass or mammographic abnormality | but mass often disappears after fine needle aspiration
68
histological fibrocystic change?
fibrosis- collagen deposition cyst formation apocrine metaplasia (mammary gland cells change from 1 differentiated cell type to another but the change is reversible) can mimic carcinoma clinically and mammographically
69
common site for distant metastases of breast cancer?
bone, liver, lung, brain
70
what might densities on a mammogram be due to?
invasive carcinomas fibroadenomas cysts
71
describe epithelial hyperplasia
proliferation of epithelial cells distending ducts and lobules assoc with slight increased risk of carcinoma if atypical, higher risk of carcinoma often detected as mammographic abnormality or incidental finding in biopsies
72
how might papillomas present?
nipple discharge as ductal epithelium irritated, may be bloody, small palpable mass, mammographic abnormality
73
histology of a papilloma?
intraduct lesion consisting of multiple branhcing fibrovascular cores covered by myoepithelial and epithelial cells
74
what cells should always be present on breast histology to indicate normal breast?
epithelial and myoepithelial cells
75
examples of stromal tumours?
``` fibroadenoma phyllodes tumour lipoma leimyoma hamartoma ```
76
how do fibroadenomas typically present?
mobile mass or mammographic abnormality can be multiple and bilateral can grow very largw and replace most of breast
77
macroscopic appearance of fibroadenoma?
well circumscribed, rubbery, greyinsh/white
78
histology of fibroadenoma?
mixture of stromal and epithelial elements
79
histology of phyllodes tumour?
nodules of proliferating stroma covered by epithelium | stroma more cellular and atypical than that in fibroadenomas
80
presentation of phyllodes tumour?
masses or mammographic abnormalities most benign, but can be borderline or malignant can be very large and involve entire breast malignant type aggressive, recur locally and metastasise via blood
81
why do phyllodes tumours need to be excised with a large margin?
to prevent recurrence
82
what is gynaecomastia caused by?
relative decrease in androgen effect or increase in oestrogen effect
83
why can liver cirrhosis cause gynaecomastia?
oestrogen not metabolised effectively so oestrogen excess
84
drugs that can cause gynaecomastia?
spironolactone cimetidine alcohol anabolic steroids
85
why might men with prostate cancer be more susceptible to breast cancer?
tment of prostate cancer with oestrogen, oestrogen stimulates ductal cell proliferation
86
what type of carcinoma are most breast cancers?
adenocarcinoma
87
whereabouts in the breast is breast cancer most common?
upper outer quadrant
88
RFs for breast cancer?
gender uninterrupted menses early menarche (<11yrs) late menopause, longer expos to oestrogens not many babies and old at first full term pregnancy brast-feeding obesity and high fat diet- peripheral oestrogen prod. HRT, LT users of OCP higher incidence in US and Europe- diet, exercise, breast-feeding, environ? atypical changes on prev. biopsy previous breast cacner radiation FH
89
what may carriers of BRCA mutations undergo to prevent breast cancer?
prophylactic mastectomies
90
why do BRCA1 and 2 gene mutations increase breast cancer risk?
tumour suppressor genes so their proteins repair damaged DNA hence mutations compromise this function and cells can continue proliferating with damaged DNA
91
what is Paget's disease of breast?
type of breast cancer that can result from DCIS cells extending to nipple skin without crossing BM unilateral red and crusting nipple eczematous or inflammat conditions of nipple suspicious, should perform biopsy
92
what does peau d'orange mean in reference to an invasive carcinoma of breast?
involvement of lymphatic drainage of skin, blocked so diffuse oedema ensues
93
name another gene other than BRCA that may be involved in hereditary breast cancer?
p53
94
characterisitcs of Invasive Ductal Carcinoma, no specific type (IDC-NST)?
o 70-80% of invasive carcinomas o Well-differentiated type – tubules lined by atypical cells o Poorly differentiated type – sheets of pleomorphic cells
95
characteristics of invasive lobular carcinoma?
Infiltrating cells in a single file, cells lack cohesion
96
how might invasive carcinoma appear macroscopically?
firm tissue | parenchymal deformity as tumour pulls inward on tissue
97
types of invasive carcinoma?
ductal lobular tubular mucinous
98
what sites might an invasive lobular carcinoma spread to?
``` peritoneum retroperitoneum GI tract ovaries uterus leptomeninges ```
99
factors determining prognosis in breast cancer?
in situ or invasive histologic subtype tumour grade and stage- size, locally advanced- into skin or skeletal muscle, LN metastses, distant metastases gene expression profile
100
aim of mammographic screening?
detect small impalapable cancers and pre-invasive cancer, look for asymmetric densities, parenchymal deformities and caclcifications, can then assess with further imaging, fine needle aspiration cytology and core biopsy
101
local and regional control of breast cancer?
o Breast Surgery Mastectomy or breast conserving surgery o Axillary Surgery  Extent depending on whether there are nodes involved o Post-operative radiotherapy to chest and axilla
102
function of sentinel LN biopsy?
can determine extent of axillary LN involvement in breast cancer and reduce risk of post op morbidity e.g. lymphoedema predisposing to arm malignancy e.g. sarcoma. Nodes are 1st draining LNs which are most likely to contain metastases and if not present, highly likely no other LNs involved so LN dissection can be avoided. intraoperative lymphatic mapping with dye and/or radioactivity of sentinel LNs
103
systemic control of breast cancer?
chemotherapy, can be neoadjuvant tamoxifen if oestrogen receptor +ve- nuclei stained brown herceptin if Her2 positive: encodes a transmembrane tyrosine kinase receptor, herceptin= antibodies against Her2 protein, brown stain on membrane if +ve. herceptin can also treat gastric cancer. gene is a protoncogene that controls cell growth.
104
how can survival from breast cancer be improved?
early detection- FH importance, self-exam, screening- 2 view mammograms every 3 yrs for women between 47 and 73 yrs neoadjuvant chemo- early tment of metastatic disease as these cells that cause death newer therapies e.g. herceptin gene expression profiles prevention in familial cases- genetic screening, prophylactic mastectomies

ESA 4 (24 decks)

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