Chapter 19: The Breasts

Question 1

prepubertal. no breast tissue

Answer 1

tanner stage 1

Question 2

areolar enlargement with breast bud

Answer 2

tanner stage 2

Question 3

enlargement of breast and areola as a single mound

Answer 3

tanner stage 3

Question 4

projection of areola above breast as double mound

Answer 4

tanner stage 4

Question 5

adult; papilla projects out of areola that is part of breast contour

Answer 5

tanner stage 5

Question 6

most commonly found in the armpits or on the lower chest ______ and ______ to the normal breasts

Answer 6

accessory breasts and nipples
below
medial

Question 7

fully developed breasts are usually similar in size but not identical, and sometimes one fails to develop as much as its counterpart

Answer 7

unequal development

Question 8

sometimes at puberty, one or both breasts over-respond to hormonal stimulation; the hypertrophy is caused by overgrowth of ______, not glandular or fat

Answer 8

breast hypertrophy

fibrous

Question 9

caused by pus producing bacteria like ______ or ______. complication during ______.

• symptoms usually deal with pain and ______ (pus/blood).
• treatment: ______

Answer 9

acute mastitis 
strep or staph
lactation
discharge 
antibiotics

Question 10

unknown cause that affects premenopausal women and produce nonspecific symptoms. sometimes from ______

Answer 10

chronic mastitis

secondary tuberculosis

Question 11

in post menopausal women. dilation of ______ due to inflammation.
-symptoms: ______ with green brown nipple discharge

Answer 11

ductal ectasia
milk ducts
periareolar mass

Question 12

necrosis of fat tissue in breast due to trauma

Answer 12

fat necrosis

Question 13

• benign breast tumors
• tumors of ______ tissue and glands
• most common benign neoplasm of the breast; usually seen in ______ women
• presents as a well-circumscribed, ______ marble-like mass
• ______ sensitive- grows during pregnancy and may be painful during the menstrual cycle
• benign, with no increased risk of ______

Answer 13

fibroadenoma 
fibrous
premenopausal 
mobile
estrogen/progesterone
carcinoma

Question 14

-it is a very common benign condition also called fibrocystic disease: premenopausal women
-they are proliferation of ______ and ______ tissue (lump). Cysts have a ______ appearance on gross exam
-it is an ______ response of the breast to hormones during phases of the ______
-______ examination is very helpful in distuinguishing a ______ from a ______ mass int the breast
-Treatment: ______ of cyst
______ if no aspirate

Answer 14

benign cystic breast disease
glandular
fibrous 
blue-dome
irregular cyclic 
menstrual cycle
ultrasound
cystic
solid
aspiration
surgical excision

Question 15

due to temporary imbalance of female and male hormones (increase in estrogen), a distinct nodule of tissue develops under the nipple of the male breast

• usually presents as a sub areolar mass in older males
• highest density of breast tissues in males is ______
• may produce nipple ______
• associated with BRCA2 mutations and klinefelter syndrome

Answer 15

gynecomastia
underneath the nipple
discharge

Question 16

-the most common malignant tumor in women. 1 in 9 women will have it during her lifespan

Answer 16

carcinoma of the breast

Question 17

risk factors of carcinoma of the breast

• sex:
• early ______
• birth of first child after age ______
• genetic factors- family history, BRCA-1, 2, 3
• Race:
• age- tumor rare before ______
• hormones- ______ estrogen
• ______ (dehydroepiandrosterone)- steroid pro-hormone. present in high quantity in western diet and linked to breast cancer

Answer 17

female>male whose breast are not subject to stimulation by ovarian hormones 
menarche
30
white>africans>east asians 
puberty
exogenous
DHEAS

Question 18

begins in the cells lining of the milk ducts, which supply milk to the nipple and accounts for more than 3/4 of the breast cancer. this type includes 20-30% of breast cancer

Answer 18

ductal carcinoma in situ

Question 19

begins in the milk ducts but breaks through the walls of the ducts, invading the surrounding breast tissue. it can also spread to other other parts of the body. it accounts for 65-80% of breast cancers

Answer 19

invasive ductal carcinoma

Question 20

characterized by well differentiated tubule- good prognosis

Answer 20

tubular carcinoma

Question 21

characterized by extracellular mucin

Answer 21

mucinous carcinoma

Question 22

characterized by large, high-grade cells growing in sheets with associated lymphocytes and plasma cells
-linked to BRCA 1

Answer 22

medullary carcinoma

Question 23

characterized by carcinoma in dermal lymphatics. poor prognosis

Answer 23

inflammatory carcinoma

Question 24

begins in milk-secreting glands of the breasts. it often occurs in several areas of both breasts

Answer 24

lobular carcinoma in situ

Question 25

begins in the milk- producing glands of the breast but invades surrounding breast tissue and spreads to other parts of the body. It is more likely than other types of breast cancer to occur in both breasts. It accounts for 10 to 15% of breast cancers.

Answer 25

invasive lobular carcinoma

Question 26

Represents 10% of breast cancer cases. Clinical features that suggest hereditary breast cancer include multiple first- degree relatives with breast cancer, tumor at an early age (premenopausal), and multiple tumors in a single patient. -______ mutations are the most important single gene mutations associated with heredity breast cancer

Answer 26

hereditary breast cancer | BRCA 1, 2, 3

Question 27

Women with a genetic predisposition of developing breast cancer may choose to undergo removal of both breasts (______) to decrease the risk of cancer. -Cancer risk may remains due to breast tissue sometimes extends into the ______ of the chest wall.

Answer 27

bilateral mastectomy | subcutaneous tissue

Question 28

Invasive breast cancer that originates in the ducts of the breast and spread to the skin of the nipple area. Prognosis is often not good due to misdiagnosis since the disorder resembles as eczema near the nipple area.

Answer 28

pagets disease of the breast

Question 29

* Rare in comparison to breast carcinoma * Arises from ______ tissue or ______ * Large bulky tumor * May ______ widely * Treatment is by ______ of the involved breast

Answer 29

``` breast sarcoma fibrous blood vessels metastasize surgical resection ```

Question 30

clinical manifestations breast carcinoma • ______ in the breast • Nipple or skin may be ______ • Skin ______ (orange peel sign) • Tumor infiltrates breast and becomes fixed to chest wall • ______

Answer 30

Lump retracted edema Metastasis

Question 31

Inspection, palpation, examination of ______, first with arms at the sides, then arms are ______ and ______, and finally with hands on ______, begun at the periphery, all parts of breast palpated in a ______ direction, and finally the tissues under the nipples are examined

Answer 31

``` clinical examination axillary tissues elevated lowered hips clockwise ```

Question 32

May identify lesions not detected on clinical examination; recommendations are for a baseline at age 35–40, followed by annually or biannually up to age 50, followed by annually thereafter

Answer 32

mammogram

Question 33

The ______ is most useful for examining the breasts of ______ women because they contain more fat and less glandular tissue than the breasts of younger women.

Answer 33

mammogram | postmenopausal

Question 34

* Breast size (compression) * Breast density * Motion * Deodorants, talcum. Lotions * The technician

Answer 34

variables that can influence radiographic readings of mammograms

Question 35

treatment of breast carcinoma

Answer 35

-Modified radical mastectomy, also called total mastectomy with axillary lymph node dissection: -Partial mastectomy / lumpectomy with lymph node dissection and radiotherapy

Question 36

resecting the entire breast along with the axillary tissue but leaving the pectoral muscles overlying the chest wall

Answer 36

Modified radical mastectomy, also called total | mastectomy with axillary lymph node dissection

Question 37

removing only part of the breast with the tumor or only the tumor along with a small amount of adjacent breast tissue

Answer 37

Partial mastectomy / lumpectomy with lymph node dissection and radiotherapy

Question 38

- Prognosis in breast cancer is based on ______. - ______ is the most important factor, but most patients present before metastasis occurs. - Spread to ______ is the most useful prognostic factor (given that metastasis is not common at presentation). - Most important factors are ______, ______, and HER2/neu gene amplification (overexpression) status.

Answer 38

``` TNM staging Metastasis axillary lymph nodes estrogen receptor (ER) progesterone receptor (PR) ```

Question 39

Presence of ER and PR is associated with response to ______ (e.g., tamoxifen, ICI\Faslodex) or ______ (RU486); both receptors are located in the ______.

Answer 39

anti-estrogenic agents anti-progesterone nucleus

Question 40

HER2/neu amplification is associated with response to ______, a designer antibody directed against the HER2 receptor; HER2/neu is a ______ receptor present on the cell surface.

Answer 40

Herceptin (trastuzumab) | growth factor

Question 41

'Triple-negative' tumors are negative for ______ and have a poor prognosis; African American women have an increased propensity to develop triple-negative carcinoma.

Answer 41

ER, PR, and HER2/neu

Question 42

'Triple-negative' tumors are negative for ______ and have a poor prognosis; African American women have an increased propensity to develop triple-negative carcinoma.

Answer 42

ER, PR, and HER2/neu

Question 43

cells have receptors called ______ receptors that help them grow. Breast cancer cells with too many HER-2/neu receptors tend to be very ______.

Answer 43

HER-2/neu | fast growing