breast - normal anatomy

Question 1

at which point of fetal development do mammary crests/ridges appear

Answer 1

week 4

Question 2

location of mammary crests

Answer 2

extend from axillary region to inguinal region
crests usually disappear except in the pectoral region

Question 3

stages of breast development

Answer 3

1y mammary buds
2y buds
lactiferous ducts and their branches

Question 4

function of breasts

Answer 4

2y sexual feature of F
source of nutrition for neonates
present in a rudimentary form in M
site of malignant change - up to 1/10 women

Question 5

general features of breasts

Answer 5

modified and highly specialised sweat glands - tubuloacinar
no special capsule or sheath
present in M and F, well developed in F
breast size and shape result from genetic, racial and dietary factors

Question 6

breast - vertical and transverse location

Answer 6

vertical - 2nd/3rd rib - 6th rib
transverse - sternal edge to midaxillary line

Question 7

what is the axillary tail of spence

Answer 7

small part of breast may extend towards axillary fossa

Question 8

what is the function of the retromammary space (bursa)

Answer 8

helps some degree of movement

Question 9

breast relations

Answer 9

2/3 of breast rests on pectoral fascia covering pec. maj
1/3 rests on the fascia covering serratus anterior

Question 10

how is the breast attached to the dermis

Answer 10

firmly attached by suspensory ligament of cooper - helps support the lobules of the gland

Question 11

breast structure - nipple

Answer 11

nipple - prominence of the breast

Question 12

breast structure - areola

Answer 12

pigmented area around the nipple
rich in sebaceous glands - not associated with the hair follicle as in other regions

Question 13

breast structure - lobules

Answer 13

each breast contains 15-20 lobules of glandular tissue (parenchyma)
each lobule is drained by a lactiferous duct - opens independently on the nipple
each duct has a dilated portion - lactiferous sinus

Question 14

does the nipple contain any fat or hair

Answer 14

no fat or hair

Question 15

what tissue makes up the nipple

Answer 15

collagenous dense connective tissue
elastic fibres
bands of smooth muscle

Question 16

lactiferous ducts and the nipple

Answer 16

the tips of the nipples are fissured with lactiferous ducts opening into them

Question 17

position of the nipple

Answer 17

variable or 4th IC space

Question 18

glands on the surface of the areola

Answer 18

skin covering the nipple and areola contains numerous sweat and sebaceous glands

Question 19

changes to the areola during pregnancy

Answer 19

enlarges

Question 20

secretions from the areola

Answer 20

oily material secreted by the sebaceous gland provides a protective lubricant for the nipple and areola

Question 21

breast quadrants

Answer 21

divided into 4 quadrants for anatomical location and description of pathology
superomedial, inferomedial, inferolateral, superolateral

axillary tail is an extension of the breast tissue in the superolateral quadrant

Question 22

describe the male breast

Answer 22

rudimentary throughout life
formed by small ducts w/o lobules or alveoli
little supporting fibroadipose tissue
temporary enlargement in newborn and during puberty

Question 23

define gynaecomastia

Answer 23

postnatal development of rudimentary lactiferous ducts in males
during midpuberty ~2/3 of boys develop varying degrees of hyperplasia of the breasts

Question 24

define polymastia

Answer 24

an extra breast

Question 25

define polythelia

Answer 25

extra nipple

Question 26

define athelia/amastia

Answer 26

absence of nipple/breast

Question 27

what arteries supply the breasts

Answer 27

branches of axillary a., internal thoracic a., and some IC a. thoraco-acromial a. lateral thoracic a. internal mammary (thoracic) a.

Question 28

nerves of the breast

Answer 28

anterior and lateral cutaneous branches of 4-6th IC n. - convey sensory fibres to the skin of the breast also carry sympathetic fibres to the blood vessels and smooth muscle around the nipple

Question 29

lymphatic drainage of the breast - clinical significance

Answer 29

great clinical significance - metastatic dissemination occurs primarily by the lymphatic routes breast lymphatics branch extensively and don't contain valves

Question 30

lymphatic drainage of the breast

Answer 30

\>75% of lymph from lateral quadrants --\> axillary LNs some lymph may drain directly to supraclavicular or inferior cervical nodes lymph from medial quadrants - parasternal or to opposite breast

Question 31

what is a sentinal lymph node

Answer 31

first draining node

Question 32

role of sentinal lymph node biopsy in breast cancer

Answer 32

lymphatic mapping and staging of patients radiolabelled colloid is used to locate the sentinal node blue dye is injected at the time of surgery combination of radioisotope and dye provides most accurate means of localising the node

Question 33

describe the breast soft tissue

Answer 33

lobes which contain a network of glandular tissue consisting of branching ducts and secretory lobules in a connective tissue stroma connective tissue stroma = dense and fibrocollagenous intralobular tissue = loose texture

Question 34

what is the functional secretory component of the breast

Answer 34

terminal duct lobular unit is the functional milk secretory component

Question 35

what breast tissue is shown here describe the histology features

Answer 35

normal breast histology extensive branching duct system surrounded by dense fibrous interlobular tissue (F) and adipose tissue (A) ducts and acini are lined by 2 layers of cells - luminal epithelial cells (E) and myoepithelial cells (M)

Question 36

age related changes in breasts - prepuberty

Answer 36

neonatal breasts contain lactiferous ducts but no alveoli (acini) until puberty, little branching of the ducts occurs slight breast enlargement reflects the growth of fibrous stroma and fat

Question 37

age related changes in breasts - puberty

Answer 37

branching of lactiferous ducts solid, spheroidal masses of granular polyhedral cells (alveoli) accumulation of lipids in the adipocytes

Question 38

age related changes in breasts - postmenopausal

Answer 38

progressive atrophy of lobules and ducts fatty replacement of glandular tissue

Question 39

what breast histology is shown here - label the letters

Answer 39

during pregnancy Lo - lobules S - septa A - acini E - epithelial cells enlarged lobules, acini are dilated, epithelium vary from cuboidal to low columnar

Question 40

what is colostrum

Answer 40

protein rich fluid, available a few days after birth rich in maternal antibodies

Question 41

what breast histology is shown here - identify the labels

Answer 41

lactating breast acini distended with milk thin speta (S) between the lobules image b - higher power, acini with eosinophilic material containing clear vacuoles milk production - suckling - neurohormonal reflex - prolactin and oxytocin

Question 42

diagnostic methods for breast cancer

Answer 42

mammography and US fine needle aspiration cytology core biopsy

Question 43

how common is breast cancer

Answer 43

20% of all cancers in women commonest cause of death in women aged 35-55y/o in UK any women has 1/9 chance of developing breast cancer

Question 44

what is shown here

Answer 44

CIS - carcinoma in situ Ca - cluster of malignant epithelial cells invade into the normal stroma (S)

Question 45

what are some signs of breast cancer

Answer 45

skin dimpling abnormal contours edema of skin (peau d'orange sign) nipple retraction and deviation

Question 46

benign breast tumours

Answer 46

fibroadenomas duct papillomas adenomas connective tissue tumours Paget's disease of the nipple

Question 47

what is Paget's disease of the nipple

Answer 47

erosion of the nipple resembling eczema associated with ductal or invasive carcinom