Repro 11: Breast Flashcards by Bethany Fryar

How many lobules are in each breast?

15-20

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Where specifically within the breast is the site of milk synthesis?

The alveoli

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Which cells surround the alveoli?

Myoepithelial cells, responsible for milk let down

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How does the mammary tissue change during puberty?

Oestrogen causes ducts to sprout and alveoli to develop

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What is mammogenesis?

Preparation of breasts

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What is lactogenesis?

Synthesis and secretion from breast alveoli

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What is galactokinesis?

Ejection of milk

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What is galactopoiesis?

Maintenance of lactation

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How do the breasts change during pregnancy?

Hypertrophy of ductular lobular alveolar system
Alveolar cells differentiate to become capable of milk secretion from mid gestation (2nd trimester)
Nipples become erect
Breast becomes more sensitive
Alreola enlarges
Montgomery tubercles form

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What is the name of the secretion from breast in the first 3 days post birth?

Colostrum

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How much colostrum is produced per day?

40ml

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How does colostrum differ to mature milk?

More proteins, especially immunoglobulins

More fat soluble vitamins

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How does human milk compare to cows milk?

More lactose
Less protein
(“Sweet and semi skimmed”)

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How does the high progesterone:oestrogen ratio during pregnancy affect milk secretion?

Favours development of alveoli, but not secretion

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How is milk secretion controlled from birth?

At birth steroid hormone levels fall (esp progesterone) which allows the alveolar cells to become responsive to prolactin

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How does dopamine affect prolactin secretion?

Inhibits it

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Does prolactin have a positive or negative feedback effect on GnRH?

Negative

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How is milk production stimulated from the breast?

Suckling stimulates receptors in the nipple -> impulses to brainstem and hypothalamus -> reduces secretion of dopamine and promotes prolactin secretion

Suckling at one feed promote prolactin for production of the next feed

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How is milk let down?

Baby suckling causes oxytocin to be released from the PP, which stimulates the myoepithelial cells to contract and squeezes milk out of the breast

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What different mechanisms causes lactation to cease?

lost feedback (not enough suckling)
pain (increased turgor/ mastitis)
menstruation (lumpy changes in breast texture)
prolactin suppression (ergot, diuretics, retained placenta)
age (gradual shrinkage of mammary glands begins at ~35)

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Which hormone is responsible for milk synthesis?

Prolactin (from AP)

Which hormone is responsible for milk release?

Oxytocin (from PP)

What is hyperprolactinaemia?

Elevated prolactin levels

Usually due to prolactinoma (prolactin secreting tumour of pituitary gland), can be idiopathic/ due to hypothyroidism

How is hyperprolactinaemia treated?

Dopamine receptor agonist

What could be a physiological cause of milky breast discharge?

Pituitary prolactin secreting adenoma | Or side effect of OCP

What us acute mastitis?

Acute inflammation of the breasts Almost always during lactation due to staph aureus Red, painful breasts Can cause breast abscesses

How can acute mastitis be treated?

By expressing milk and antibiotics

How does fat necrosis present in the breast?

Can present as a mass/ skin changes/ mammographic abnormalities Usually history of surgery or trauma Can mimic carcinoma

What is the commonest breast lesion?

Fibrocystic change

What is fibrocystic change?

Benign epithelial lesion Presents as a firm, mobile mass or mammographic changes Histologically shows dilated cysts Disappears after find needle aspiration (but can reappear)

What does the term breast mouse refer to?

The mobile and elusive nature of fibroadenomas

Do fibroadenomas occur usually in older or younger women?

Younger women

What are fibroadenomas?

``` Benign stromal tumours Can mimic carcinoma but they are localised hyperplasia rather than neoplasia Breast mouse Commonly younger women Mobile mass or mammographic abnormality ```

How do fibroadenomas appear macroscopially?

Well circumcised, rubbery grey/ white

What is a Phyllodes tumour?

``` Rare before 40 Large masses which can involve entire breast Need to be excised with wide margin Leaf like histologically Mostly benign but can become malignant ```

What is enlargement of the male breast called?

Gynaecomastia

What are some possible causes of Gynaecomastia?

- oestrogen secreting tumour - drug related - liver cirrhosis (less oestrogen metabolised)

Why does Gynaecomastia occur?

Reduced androgen effect or increased oestrogen effect Often in puberty or elderly Can be uni or bilateral

What are some risk factors for breast cancer?

- gender - increasing age - previous breast cancer - exogenous oestrogens (OCP, HRT) - uninterrupted menses (early menarche and late menopause, or fewer pregnancies = more oestrogen over lifetime) - radiation - hereditary (BRCA 1/2) - obesity and high fat diet - breast feeding - geographical (Western, as we have fewer pregnancies)

What is the difference between in situ and invasive carcinoma?

In situ means it has not broke through the basement membrane so cannot metastasise Invasive means it has penetrated the basement membrane and it likely to have already metastasised by the time it is palpable

What is DCIS and how does it present histologically?

Ductal carcinoma in situ Presents as a mass or mammographic calcification and histologically as central necrosis with calcifications Often a pre cursor of invasive carcinoma Can spread throughout ducts and lobules

What is Paget's disease of the breast?

Caused by DCIS when cells extend into the nipple (without crossing BM) Red, crusting unilateral nipple

Where does invasive carcinoma of the breast usually metastasise to?

Axillary lymph nodes

How does invasive carcinoma of the breast present?

Hard, craggy and fixed mass or mammographic abnormalities

What is the difference between invasive ductal carcinoma and invasive lobular carcinoma?

IDS NST can be poorly or well differentiated | Invasive lobular carcinoma shows cells which lack cohesion and infiltrate in a single line

What is Peau D'orange?

The appearance of breast skin when cancer cells block lymphatic drainage so the skin is tethered and looks like an orange, with the nipple retracted inwards

Where do distant metastases of breasts usually go to?

Bone most frequently | Also lungs, liver and brain

What is the triple approach to investigate breast cancers?

1) history and examination 2) imaging (mammogram and USS) 3) biopsy and fine needle aspiration

What are treatments for breast cancer?

- surgery (mastectomy or wide local excision) - Axillary clearance - hormonal treatment (tamoxifen and herceptin) - sentinel lymph node biopsy - chemotherapy - post op radiotherapy

How does tamoxifen act?

Only possible of oestrogen receptor positive! (Will antagonise receptors to prevent action of oestrogen)

How does herceptin act?

Can only use of HER-2 receptor positive | Will antagonise them to prevent growth signals