Breast Flashcards
(88 cards)
1
Q
What does the breast lie anterior to?
A
Thorax, rib cage, pectoralis major/minor
2
Q
What is the superior border of the breast?
A
2nd/3rd ribs
3
Q
What is the inferior border of the breast?
A
7th costal cartilage
4
Q
What is the medial border of the breast?
A
The sternum
5
Q
What is the lateral border of the breast?
A
Margin of the axilla
6
Q
What are the parenchymal tissue elements?
A
Lobes, lobules, ducts, acini/alveoli
7
Q
What are the stromal (supporting) tissue elements?
A
Fat, loose/dense connective tissue
8
Q
Describe the dome shape of the breast.
A
Radial in design (internal/external)
9
Q
What comprises the nipple?
A
Round, fibromuscular papilla projecting from the center of the breast
10
Q
What are main variants?
A
Nipple inversion, fibrocystic and fatty breast
11
Q
What type of skin is the areola?
A
Pigmented
12
Q
What type of glands do the areola contains?
A
Sebaceous and Montgomery’s glands (small nodules beneath the skin)
13
Q
How many lobes are on each breast?
A
15-20
14
Q
What separates the lobes?
A
Adipose tissue
15
Q
What is adipose tissue comprised of?
A
Adipocytes
16
Q
What is the simplest functional unit of the breast?
A
Lobules (one gland, one duct)
17
Q
How many lobules per lobe?
A
20-40
18
Q
What are the microscopic saclike secretory glands within the lobules at the ends of the ducts called?
A
Acini/alveoli
19
Q
What is the axillary tail of Spence?
A
A portion of the mammary tissue extending into the region of the axilla
20
Q
What are the lactiferous ducts?
A
A network of ducts draining acini, lobules and lobes
21
Q
How many ducts per lobe?
A
One major duct (converging radially toward nipple)
22
Q
What are sinuses?
A
Enlarged duct segments beneath the areola
23
Q
Where are the parenchyma/glandular tissue positioned?
A
Within the layers of the deep and superficial fascia
24
Q
Stroma/supportive tissue consisting of fat and connective tissue is found where?
A
Subcutaneous (skin&sub fat), retromammary (fat/muscle), and interlobar/interlobular
25
Where is the retromammary layer positioned?
Posterior to parenchyma
26
What are Cooper's Ligaments?
Thin, echogenic, curvilinear line within fat
27
Where do Cooper's extend?
From deep fascia to skin
28
What are Cooper's function?
To firmly attach mammary gland to the skin, enclose and separate fat, lobes, and lobules
29
What is blood supply?
Branches of internal mammary, lateral thoracic, and intercostal arteries
30
Where do mammary arteries derive?
1st branch of subclavian arteries
31
Where do mammary veins drain?
Into subclavian veins (superficial/deep)
32
Where do lymph vessels flow?
Toward axilla (follow venous drainage into subclavian veins)
33
When do the breasts (modified sweat glands) lactate?
During and after pregnancy
34
What happens when lactation ceases?
The acini/alveoli disappear
35
How is lactation controlled?
The hypothalamus/anterior pituitary gland secretes prolactin
36
What is the prolactin-inhibiting factor?
It prevents the release of prolactin before childbirth
37
What does infant sucking stimulate?
The secretion of oxytocin from APG causing contraction of lactiferous ducts.
38
How is the milk stored before suckling?
Acini produce / lactiferous ducts drain it into lactiferous sinus/ampulla beneath the areola
39
How does subcutaneous layer appear on U/S?
Hypoechoic
40
How does mammary layer appear on U/S?
Moderately echogenic
41
How does retromammary layer appear on U/S?
Hypoechoic to the parenchyma
42
What is the problem with dense parenchyma?
Difficult to visualize with mammography in younger patients
43
How do breast ducts/ductules appear?
Anechoic tubular structures
44
How does nipple appear and problems associated?
Gives posterior shadowing when over it so you must scan from the side
45
How are Cooper's Ligaments seen?
Thin, echogenic, curvilinear line within fat
46
What frequency transducers are used?
Start with higher (15 MHz for best resolution) and use 5 MHz for large breast
47
What does the radial method use?
Radial (clock) and antiradial (perp/90 deg counter) views
48
What does sonography detect masses better in?
Dense breast (young/pregnant/lactating)
49
What are some indications for breast sonography?
Cystic/solid masses, trauma, inflammation, implants, post-radiation, gynecomastia, needle/biopsy assist
50
What strength does x-ray have over sonography?
Sonography cannot detect microcalcifications (1mm) lying outside a mass
51
How are simple cysts formed?
Intraductal hyperplasia/fibrosis may obstruct the duct causing secretions to gather and form a palpable mass
52
Who commonly gets simple cysts?
Premenopausal women (35-50) and subside w/menopause
53
What are sonographic appearances of simple cysts?
Anechoic, well-defined round with smooth thin margins, lateral refractive edge shadowing with posterior/distal acoustic enhancement
54
What causes complex cysts?
Infections, trauma (hematoma), galactocele (accumulation of milk)
55
What are clinical signs of mastitis?
Swollen breast, pain/tenderness, cracked nipple/discharge, dilated ducts, fever, and potential abscess
56
What are sonographic appearances of a complex cyst?
Well-defined margins/round with internal echoes
57
What causes fluid-fat internal echoes?
Galactocele (glandular tissue/ductal enlargement)
58
What causes thrombus internal echoes?
Hematoma
59
What causes internal echoes from debris?
Abscess (Cooper's/skin thickened ligament/tissue edema)
60
What is fibrocystic breast disease?
Diffuse interspersed small cysts in parenchyma (30-60 years)
61
How does fibrocystic breast disease appear on U/S?
Basket-weave glandular tissue, echogenic parenchyma and dilated ducts
62
What is fibroadenoma?
Most common benign breast tumore developing from estrogen in black women 15-35
63
What are clinical signs of fibroadenoma?
A painless, palpable, moveable firm mass
64
What is the sonographic appearance of fibroadenoma?
Homogenous, hypoechoic mass w/smooth borders (shadowing is not common)
65
What variations can occur with fibroadenoma U/S appearance?
Lobulations and internal echoes
66
What sonographic findings raise suspicion for malignancy?
Star-like pattern (spiculations) taller than wider, angular margins, hypoechoic, shadowing, thick Cooper's, calcifications, duct extension, hypervascularity, lymphadenopathy
67
What do malignant breast masses do?
Invade rather than displace
68
What are sonographic features of benign breast masses?
More hyperechoic to fat, ellipsoid shape (base wider than tall), thin echogenic capsule
69
What is medullary carcinoma?
Cellular tumor containing epithelial tissue more likely to happen in younger women comprising 5-10% of breast cancers
70
What are clinical signs of medullary carcinoma?
Palpable mass and skin discoloration (mammogram anomaly)
71
What is the U/S appearance of medullary carcinoma?
Bulk, smooth tumor (mildly irregular)
72
What is invasive ductal carcinoma?
Most common breast cancer originating from lactiferous ducts
73
What are clinical signs of ductal carcinoma?
Hard, fixed and painless if palpable, skin/nipple changes (mammogram anomaly)
74
What are U/S appearance of ductal carcinoma?
Ducts are traced to the mass
75
What are acute complications of implants?
Months/Years after surgery: bleeding, infection, asymmetry, loss of nipple sensation, and pain/tenderness
76
What are chronic complications of implants?
Capsular contracture, rupture, hematoma, herniation, migration and chronic infection
77
What are the 2 types of implant rupture?
Intracapsular and extracapsular
78
What problems occur with an intracapsular rupture?
80% of the time, the breach in the elastomer membrane will cause the silicone to leak, but it will remain in the fibrous capsule around the ruptured implant
79
What problems occur with an extracapsular rupture?
Silicone leaks into the surrounding tissues through a defect in both the implant shell and the fibrous capsule
80
What are sonographic features for an implant rupture?
Stepladder parallel-line sign, low-med internal echoes in silicone, snowstorm (echogenic noise) hypoechoic mass outside implant capsule, implant deformity, having peri-implant fluid collection or not
81
What has the FDA restricted since 1992?
Silicone implants
82
What are the prosthetics of choice since 1992?
Saline implants
83
What comprises silicone implants?
Single-lumen containing silicone gel bag w/elastomer or polyurethane shell
84
How does silicone appear on U/S?
Large, oval echo-free structure behind the glandular tissue and in front of the pectoral muscle (subglandular) or beneath the muscle (subpectoral)
85
How do saline implants appear?
Double-lumen containing silicone surround by a saline bag
86
What is prolactin?
A hormone produced by the anterior pituitary (adenohypophysis) and binds to mammary epithelial cell receptors which stimulate creation of mRNA of milk proteins
87
What is oxytocin?
A hormone produced by the posterior pituitary (neurohypophysis) which releases intermittently from suckling for the breast to produce milk ejection
88
What's the difference between oxytocin and prolactin?
Oxytocin is responsible for milk ejection whereas prolactin is responsible for milk production
