Reproductive System (Breast Histo) Flashcards
BREAST
- Modified ____ sweat gland
- Runs from ____ to ____ intercostal space between ____ to ____ ribs
- Parasternal region =
BREAST
- Modified EXOCRINE sweat gland
- Runs from 2ND to 6TH intercostal space between 2ND to 7TH ribs
- Parasternal region = Area between breast and lateral border of sternum
Name the muscles deep to the breast
- pectoralis major
- serratus anterior
- external oblique muscle
State the layers of the breast from exterior to interior
Retromammary space (with lymphatics)
Pectoral fascia
Pectoralis major
Clavicle + subclavius muscle + pectoralis minor
Chest wall
State the blood supply of the breast
- axillary A –> SAL (superior, acromio, lateral throacic A)
- lateral branches of posterior intercostal A
- perforating branches of internal mammary/thoracic A (2nd-4th intercostal sapces)
State the 3 arteries that axillary artery gives rise to
- superior thoracic A
- acromio-thoracic A
- lateral thoracic A
MAMMARY GLANDS
- Modified ____ sweat glands
- Glandular elements = branched ____ glands consisting of multiple ____ lined by ____ cells which are surrounded by ____ cells
- Stroma of breast = ____ tissue + ____ tissue
- Nipple and areola have ____ epithelium
MAMMARY GLANDS
- Modified APOCRINE sweat glands
- Glandular elements = branched TUBULOACINAR glands consisting of multiple ACINI lined by EPITHELIAL cells which are surrounded by MYOEPITHELIAL cells
- Stroma of breast = CONNECTIVE tissue + ADIPOSE tissue
- Nipple and areola have STRATIFIED SQUAMOUS epithelium
Recall the epithelium that lines the nipple and areola
stratified squamous epithelium
Explain the process that occurs in mammary glands in old age
Collagen breaks down and suspensory ligaments of cooper which are supportive tissues with degrade –> breast will hang
State the 2 hormones that act at the breast and state their action.
PROGESTERONE and OESTROGEN promote acini and duct proliferation in the terminal duct lobular units (increased alveolar budding)
Label the histological slide for breast
State the features of a normal breast
hint: rule of 2s x 3
NORMAL BREAST
- 2 types of epithelial cells = luminal (line acini cells) + myoepithelial cells
- 2 types of stroma = interlobular + intralobular
- 2 structures = large ducts + terminal ductal lobular unit (TLDU)
State whether luminal cells or myoepithelial cells are more likely the PRECURSOR CELLS FOR MOST MALIGNANT CANCERS
LUMINAL CELLS (ductal carcinoma)
Regarding the LUMINAL CELLS, state
- Location in breast =
- Function =
Regarding the LUMINAL CELLS, state
- Location in breast = forms innermost layer lining the ducts and acini (alveoli)
- Function = luminal cells in TLDU produce milk + some cells have hormonal receptors (progesterone and estrogen)
HISTOLOGY OF LUMINAL CELLS
- ____ to ____ in type-transitional epithelium
- Nuclei are ____, ____ to oval and usually have ____ nuclei
- Cells have moderate amount of ____ cytoplasm
HISTOLOGY OF LUMINAL CELLS
- CUBOIDAL to COLUMNAR in type-transitional epithelium
- Nuclei are SMALL, ROUND to oval and usually have INCONSPICUOUS nuclei
- Cells have moderate amount of EOSINOPHILIC cytoplasm
Regarding the MYOEPITHELIAL CELLS, state
- Location in breast =
- Function =
Regarding the MYOEPITHELIAL CELLS, state
- Location in breast = forms outermost layer between luminal cells and basement membrane
- Function = contraction for milk ejection during lactation + produces basement membrane (oxytocin)
HISTOLOGY OF MYOEPITHELIAL CELLS
- ____ cells with small ____ nuclei
- Abundant and ____ cytoplasm
- Ageing results in ____ appearance
HISTOLOGY OF MYOEPITHELIAL CELLS
- FLATTENED cells with small ROUND nuclei
- Abundant and CLEAR cytoplasm
- Ageing results in SPINDLED appearance
State the roles of PROLACTIN and OXYTOCIN in hormonal control of lactation
prolactin = controls breast secretion of milk to environment
oxytocin = controls myoepithelial cells for milk secretion
Explain the milk ejection reflex starting from SUCKING
Stimulus - baby sucking mother’s nipple –> afferent impulse to hypothalamus
1. Stimulates hypothalamus to secrete thyrotropin-releasing hormone (TRH) to be transported via vascular link to ANTERIOR PITUITARY to stimulate production of PROLACTIN which stimulates milk secretion by the cuboidal cells in acini/alveoli of breast
2. Stimulates hypothalamus to secrete OXYTOCIN which is secreted by POSTERIOR PITUITARY to stimulate contraction of myoepithelial cells surrounding the alveoli deep in the breast
State the difference between INTRALOBULAR CONNECTIVE TISSUE and INTERLOBULAR CONNECTIVE TISSUE
intralobular - loose, more vascular, more cellular (fibroblast + plasma cells)
interlobular - dense, more collagen, less cellular
Explain the difference between the mammography results of a YOUNG WOMEN and OLDER WOMEN
YOUNG WOMEN - breast tissue is predominantly FIBROUS (radiodense - white)
- Mammography has LOW SENSITIVITY and HAS DIFFICULTY DETECTING LESIONS
OLDER WOMEN - breast tissue is REPLACED BY ADIPOSE TISSUE and is predominantly ADIPOSE (radiolucent - black)
- Mammography has HIGH SENSITIVITY and CALCIFICATIONS AND SMALL MASSES DETECTED MORE EASILY
State the cellular features of the breast in
1. Inactive phase
2. Early pregnancy
3. Lactation
Inactive phase - few acinar cells and ductal cells
Early pregnancy - proliferation of acinar cells
Lactation - enlarged breast tissue and milk produced
In INACTIVE PHASE,
- Dense irregular ____ connective tissue between quiescent lobules that have only very few ____ surrounded by less dense ____ connective tissue
- Ducts have 2 layers of epithelium
- Outer layer =
- Inner layer =
In INACTIVE PHASE,
- Dense irregular INTERLOBULAR connective tissue between quiescent lobules that have only very few DUCTS surrounded by less dense INTRALOBULAR connective tissue
- Ducts have 2 layers of epithelium
- Outer layer = MYOEPITHELIAL CELLS
- Inner layer = LUMINAL CELLS
In ACTIVE PHASE,
- More ____ tissue, less ____ tissue
- Intralobular connective tissue -> more ____ cells (secreting ____ into breast milk) to impart ____ into newborn
- Has increased ____ and ____ cells which proliferate to form secondary ____
- Epithelial (luminal) cells appear ____ and clear areas of ____ cytoplasm full of ____ and ____
In ACTIVE PHASE,
- More GLANDULAR tissue, less STROMAL tissue
- Intralobular connective tissue -> more PLASMA cells (secreting IgA into breast milk) to impart IMMUNITY into newborn
- Has increased EPITHELIAL and MYOEPITHELIAL cells which proliferate to form secondary ALVEOLI
- Epithelial (luminal) cells appear LARGE and clear areas of APICAL cytoplasm full of GLYCOGEN and LIPIDS
In EARLY PREGNANCY
- Excessive proliferation of ____ and ____
- Plasma cells secrete ____ into the breast milk
In EARLY PREGNANCY
- Excessive proliferation of ACINI and DUCTS
- Plasma cells secrete IgA Ab into the breast milk
State the parts of the mammary gland (compound tuboalveolar gland)
parenchyma - non-lactating and lactating gland
ducts - lactiferous, interlobular, intralobular, alveolar
stroma
State the two ways cancer can spread from breast
- haematogenous spread
- lymphatic spread
State the functions of the SUPERFICIAL LYMPHATICS and DEEP LYMPHATICS in breast
superficial lymphatics - drains skin of breast (except nipple and areola)
deep lymphatics - drains parenchyma of breast + skin of nipple and areola
Lymph drains across ____ space and ____ fascia and ____ fascia to reach apical group of axillary nodes
Lymph drains across RETROMMARY space and PECTORALIS fascia and CLAVIPECTORAL fascia to reach apical group of axillary nodes
State the lymphatic spread of cancer from
- Upper medial breast
- Lower medial breast
Upper medial breast - ipsilateral + contralateral internal mammary LN
Lower medial breast - ipsilateral + contralateral internal mammary LN + subperitoneal LN (krunkenberg’s tumour - to ovaries)
State the lymphatic spread of cancer from
- Upper lateral breast
- Lower lateral breast
Upper lateral breast - anterior axillary –> central –> deltopectoral –> apical axillary LN
Lower lateral breast - posterior intercostal LN + anterior/posterior axillary –> central –> deltopectoral –> apical axillary LN
State the abnormal signs of breast cancer
- lumps
- nipple change
- nipple retraction
- peau d orange breast (blockage of drainage of lymphatics + retraction of ligaments of cooper - pitting)
