Breast Flashcards
(18 cards)
Normal breast anatomy
- The tail of spence extends laterally across the anterior axillary
- 15 to 20 lobes
- cooper suspensory ligaments (fibrous bands of connective tissue)
- insert perpendicularly into the dermis and provide structural support
- 2nd to 3rd rib to the inframmamary fold at the 6th or 7th rib
- deep or posterior surface = fascia of the pectoralis majpr, serratus anterior, and external oblique, upper extent of the rectus sheath
- retromammary bursa = posterior aspect of the breast between the investing fascia of the breast and fascia of the pectoralis major
Changes in the breast associated with pregnancy
- Accumulation of lymphocytes, plasma cells, and eosinophils within the breast
- Enlargement of breast alveoli
- Accumulation of secretory products in minor ducts
two distinct substances are produced by the alveolar epithelium
- Protein component of milk (merocrine secretion)
- Lipid component (apocrine secretion)
Blood supp;y of the breast
The breast receives its principal blood supply form
- perforating branches of the internal mammary artery
- Lateral branches of the posterior intercostal arteries
- branches from the axillary arterues
- highest thoracic
- lateral thoraic
- pectoral branches of the thoracoacromial artery
- The 2nd , 3rd, and 4th anterior intercostal perforators and branches of the internal mammary asrtery arborize in the breast as the medial mammary arteries
Lymph node levels
- Level I lymph nodes are those that are lateral to the pectoralis minor muscle
- Level II lymph nodes are lcoated deep to the pectoralis minor muscle
- LEvel III lymph nodes are located medial to the pectoralis muscle
Breast development before and during pregnancy (hormonal pairing)
- Estrogen: Initiates ductal development
- Progesterone: differentiation of epithelium and for lobular development
- Porlactin: lactogenesis
- LH and FSH: regulates release of estrogen and progesterone from the ovaries
Gynecomastia
Classified as per a three grade system
- Grade I: mild breast enlargemnt without skin redundancy
- Grade IIa : moderate breast enlargement without skin redundancy
- Grade IIb: moderate breats enlargement with skin redundancy
- Grade III: marked breast enlargement with skin redundancy and ptosis
During puberty: unilateral (12 to 15 years old)
During senscent: bilateral
Does not predispose to breast cancer except in case of Klinefelter syndrome
Inflammatory conditions of the the breast
- Zuska disease (Recurrent preductal mastitis)
- recurrent retroareolar infections and abscesses
- Hiradenitis suppurativa
- chronic inflamamtory condition taht originates within the accessory areolar glands of montgomery or within the axilalry sebaceous glands
- Mondor disease
- variant of thrombophlebitis that involves the superficial veins of the anterior chest wall and breast
Lesions with malignant potential
- Intraductal papilloma
- Atypical ductal hyperplasia
- Atypical lobular hyperplasia
Sclerosing adenosis - prevalent during the childbearing and perimenopausal years and has no malignant potential
Risk factors for the development of breast cancer
Early menarche
Nulliiparity
late menopause
Drugs usuful in breast cancer prevention
Raloxifene
Tamoxifen
Aromatase inhibitors
Metastasis of breast cancer
- Metastases occur after breast cancers acquire their own blood sypply
- Batson plexus facilitates metastasin to the vertebral column
- cells are scavenged by natural killer lymphocytes and macrophages
- 60% of the women who develop distant metastases will do so within 60 months of treatment
Breast LCIS
- LCIS originates from the terminal duct lobular units and develops only in the female breast
- Cytoplasmic mucoid globules are a distinctive cellular feature
- The frequency of LCIS in the genreal popualtion cannot be reliably determined
- incidental finding
- The average age of diagnosis is 45 years, which is approximately 15 to 25 years younger than the age at diagnosis for invasive breast cancer
Breast cancer staging
Inflamamtory carcinoma is considered _______
T4 disease
Factors that determine the type of therapy offered to patients after the diagnosis of breast cancer
- Stage of disease
- General health of patient
- Biologic subtype
Management of DCIS
- DCIS is treated with mastectomy has a local recurrence rate of 2%
- for nonpalpable DCIS
- needle localization or other image guided techniques
- Adjuvant tamoxifen considered for DCIS patients with ER-positive disaese
- Specimen mammography is performed to ensure that all visible evidence of cancer is excised
Accelerated partial breast irradiation
- delivered in abbreviated fashion (twice daily for 5 days) and at a lower dose compared with the standard course of 5 to 6 weeks
- Suitable patients for ABPU includes
- women older than 60 years with a unifocal T1, ER (+) tumor with no lymphovascular invsion
- margins for at least 2mm
Contraindications for Sentinel lymph node biopsy
Inflammatory breast cancer
palpable axilalry lymphadenopathy
biopsy proven metastasis
DCIS without mastectomy
prior axillary surgery
Breast cancer during pregnancy
- occurs in 1 of every 3000 pergant women
- axilalry lymph node metastasis are up to 75%
- fewer than 25% of the breast nodules developing during pregnancy and lactation will be cancerous
- Mammography is rarely indicated because of its decreased sensitivity
- Chemotherapy
- 1st trimester : risk of spontaneous abortion and a 12% risks of birth defects
- 2nd and 3rd trimester : mo evidence of teratogenicity
