Superficial structures Flashcards
1
Q
breast tissue aka
A
mammary gland
2
Q
the mammary gland is a
A
modified sweat gland
3
Q
3 tissue types in the breast
A
fatty, glandular, fibrous
4
Q
3 zones of breast
A
subcutaneous/premammary
mammary/fibroglandular
retromammary
5
Q
the premammary zone contains
A
subcutaneous fat, Cooper’s ligaments, mammry fascia,
6
Q
no true breast lesions can occur in which zone
A
the premammary zone/ subcutaneous
7
Q
what is mammary fascia
A
connective tissue enveloping mammary zone, continuous with Cooper’s ligaments,
8
Q
function of mammary fascia
A
support and shape breast
9
Q
mammary zone is made of
A
fibroglandular tissue (parenchyma)
10
Q
mammary zone is in what area mainly
A
UOQ, areola
11
Q
size of mammary zone depends on
A
functional state (cycle, age), inherited tissue pattern (genetics)
12
Q
mammary zone contains
A
lobes -> lobules -> ducts, sinuses -> TDLU
13
Q
number of lobes per breast
A
15-20
14
Q
lobes are arranged
A
radially
15
Q
lobes contain
A
ducts, stroma, acinus
16
Q
acinus
A
milk-producing glands
17
Q
number of lobules per lobe
A
20-40
18
Q
lobules contain
A
individual milk producing glands
19
Q
acini
A
individual milk producing glands
20
Q
drain acini, lobules, lobes
A
ducts and sinuses
21
Q
lactiferous ducts converge to form
A
lactiferous sinus
22
Q
TDLU
A
terminal ductal-lobular unit
23
Q
functional unit of breast
A
TDLU
24
Q
TDLU consists of
A
lobule + extralobular terminal duct
25
undergoes monthly hormone-induced changes
TDLU
26
TDLU are in which layer
mammary zone, fibroglandular tissue
27
TDLU is surrounded by
connective tissue
28
size of TDLU
1-2 mm
29
site of most major breast pathology
TDLU
30
lobule + duct =
TDLU
31
tail of Spence
mammary tissue extending into axilla region
32
deepest layer
retromammary layer
33
retromammary layer contains
fat, blood, lymph
34
nipple
fibromuscular papilla, projecting from center of breast
35
normal variant of nipple
inverted nipple
36
multiple openings in nipple
lactiferous sinuses
37
pigmented area
areola
38
areola contains
many sebaceous glands
39
muscle posterior to retromammary layer
pectoralis major
40
covered by pectoralis major
pectoralis minor
41
breast vascular supply
lateral thoracic artery, internal mammary artery, intercostal arteries
42
blood vessel harvested for CABG
internal mammary artery
43
lymphatic drainage
axillary nodes, also pectoral, parasternal, subcutaneous nodes
44
breast cancer often cause what in LN
invasion
45
mammary glands are found in males, females or both
both
46
function of mammary glands
produce and secrete milk
47
mammary glands function is affected by
monthly hormonal changes, pregnancy, lactation
48
development of mammary glands starts
before menarche
49
age, stage of breast function affect
amount of parenchyma and stroma
50
estrogen effect
proliferates duct system
51
progesterone effect
stimulates development of lobular cells
52
prolactin effect
stimulates milk production
53
oxytocin
causes milk ejection from lactating breast
54
pre-pubescent breast
rudimentary ducts, tissue dev under nipple, little fat tissue
55
young adult breast
mostly dense fibroglandular tissue, minimal fat
56
adult breast tissue
equal fibroglandular and fat
57
pregnant/lactating breast
glandular tissue, prominent ducts
58
older/multiparous breast
increased subcutaneous/retromammary fat, +/- isolated fat areas
59
menopause breast
parenchyma mainly under nipple and outer quadrant
60
post-menopausal breast
lobules and ducts atrophy, fatty replacement, Cooper's ligaments easily id'd
61
sono appearance of nipple
homogeneous, mid level echoes, post shadowing
62
subcutaneous fat lobules do not extend
post to nipple
63
sono appearance of subcutaneous fat lobules
hypoechoic, echogenic strands
64
parenchyma appears ___ compared to fat
echogenic
65
sono appearance of parenchyma
hypoechoic ducts tracking towards nipple, interspersed with hypo areas of fat
66
sono appearance of lactiferous ductules
hypoechoic tubes, track towards nipple, increasing in size, up to 8 mm, radial pattern
67
sono appearance of Cooper's ligaments
curved echogenic striations, surround fat lobules
68
sono appearance of retromammary layer
hypoechoic, ant to pec major
69
sono appearance of muscles
striated, med - low level echoes, immediately post to breast
70
normal LN
< 1 cm, oval, hypoechoic, echogenic hilum, minimal flow
71
birads
system of lesion classification, categorizing according to degree of suspicion
72
birads 1
sonographically normal
73
birads 2
benign finding
74
birads 3
probably benign
75
birads 4a
low suspicion, requires biopsy
76
birads 4b
intermediate suspicion
77
birads 4c
moderate suspicion
78
birads 5
highly suggestive of malignancy (> 95%)
79
birads 6
known cancer
80
pseudo mass can be due to
retroareolar ducts, costal cartilage, prominent tissue, acoustic shadow at nipple, surgical scar
81
breast cyst is a ___ abnormality
benign
82
cause of breast cyst
obstruction in terminal portion of duct
83
cyst is more/less mobile than fibroadenoma>
less
84
are breast cysts palpable?
yes
85
sono features of breast cyst
strong back wall, round/oval, post enhancement, anechoic
86
origin of sebaceous cyst
skin, in premammary zone
87
sono features of complex cyst
low level internal echoes, septations, post enhancement
88
cyst formation in post-meno women is linked to
HRT
89
foam cyst
cyst filled with low level echoes -> PAM, protein, fat
90
PAM
papillary apocrine metaplasia: altered acini cells, clustered overgrowth of tissue
91
acorn cyst
cyst displaying non-dependent echogenic layer -> overgrowth of cells, won't move, benign overgrowth
92
most common benign tumour in women of child bearing years
fibroadenoma
93
benign tumour stimulated by estrogen
fibroadenoma
94
benign tumour formed in adolescence
fibroadenoma
95
what causes a fibroadenoma to increase in size
pregancy, HRT
96
fibroadenomas are
painless, palpable, mobile
97
sono features of fibroadenoma
lobulated contour, elliptical, well defined, thin echogenic capsule, hypoechoic, homogeneous, wider than tall, solid, no change with comp
98
fibroadenoma compressible?
no
99
fibroadenoma can be mistaken for
fat lobule
100
giant fibroadenoma
cystosarcoma phylloides
101
prominent feature of cystosarcoma phylloides
very fast growing
102
cystosarcoma phylloides occurs in which age group
40-50 yrs
103
cystosarcoma phylloides is uni/bilateral
unilateral
104
sono features of cystosarcoma phylloides
low level internal echoes, hypoechoic, irregular edges, borders defined, lobulated
105
fatty benign tumour
lipoma
106
lipomas occur in
middle aged or post meno women
107
sono features of lipomas
hypoechoic,- depending on surrounding tissue, defined margins, thin capsule
108
hemorrhage or liquefaction of fatty area
fat necrosis
109
fat necrosis is due to
trauma, surgery, inflammation
110
fat necrosis forms a
dense scar, or lipid cyst, may calcify, skin retraction, nipple inversion
111
sono features of fat necrosis
irregular, hypoechoic, complex mass, may shadow
112
benign solid mass in lining of ducts
papilloma
113
symptoms of papilloma
bloody discharge, tender breast
114
papillomas are found usually
near nipple
115
sono features of papilloma
solid lesion in a cyst, or dilated duct, ductal ectasia near mass
116
exaggerated cyclic changes in breast tissue
fibrocystic changes
117
fibrocystic changes
cells in breast ducts proliferate and retain water
118
fibrocystic changes usually occur
in UOQ
119
fibrocystic changes tissue processes
apocrine metaplasia, fibrosis, sclerosing adenosis
120
fibrocystic changes can be seen as
lumpy, swollen, painful breasts, nodular, nipple discharge, mammo changes mimicking cancer
121
fibrocystic changes on U/S
multiple cysts, echogenic fibrous tissue, small nodules ( < 1 cm) in parenchyma
122
fibrocystic changes treatment
eliminate caffeine, hormone therapy, vitamin E
123
obstruction of a lactiferous duct in pregnant or lactating woman
galactocele
124
location of galactocele
retro-areolar
125
galactoceles can lead to
mastitis
126
mastitis
inflammation of breast
127
sono features of galactocele
well-defined cystic mass, less post enhancement than regular cyst, internal debris; lipid-fluid layers
128
tubular hypoechoic structure converging towards nipple
ductal ectasia
129
size of ductal ectasia
> 8 mm
130
ductal ectasia occurs in
lactating pts, > 50 yrs
131
ductal ectasia can lead to
mastitis
132
breast inflammation
mastitis
133
mastitis can be __ or ___
focal; diffuse
134
mastitis usually occurs in
lactating patients
135
mastitis is caused by
obstruction of duct by milk, bacteria enters through nipple, trauma, radiation, diabetes, immune compromised
136
mastitis can lead to
abcess formation
137
S/S of mastitis
hot, red, tender (very painful), fever, palpable mass, nipple discharge
138
U/S features of mastitis
irregular fluid collection with debris, edema, loss of tissue definition, complex collection, shaggy wall, septations, post enhancement
139
low risk nipple discharge
bilateral, multiple orifices, milky/greenish, fibrocystic changes or duct ectasia
140
high risk nipple discharge
unilateral, spontaneous, clear, bloody, serous
141
malignancy location categories
ductal, lobular
142
non-invasive
in situ
143
invasive
infiltrating
144
sonographic characteristics of malignancy
taller > wide; angled, irregular borders, spiculated, heterogeneous, post shadowing, thick echogenic rim, hypo halo, ductal extension, branch pattern, microlobulations, microcalcs
145
secondary findings of malignancy
skin changes: skin thickening, flattening, retraction, inverted nipple, LN invasion, dilated ducts, surrounding tissue highly echogenic, thickened Cooper's ligaments
146
15 % of all breast cancers
non-invasive (in situ) carcinoma
147
most common non-invasive carcinoma
ductal carcinoma in situ
148
ductal carcinoma in situ usually occurs in
post-menopausal women
149
features of ductal carcinoma in situ
nipple discharge, microcalcs, +/- palpable lump
150
25 % of all breast cancers
lobular carcinoma in situ
151
lobular carcinoma in situ occurs in
reproductive years
152
not considered a true cancer
lobular carcinoma in situ
153
characteristics of intracystic papillary carcinoma in situ
rare, middle aged, well-defined, mobile, palpable - cyst is palpated, with cancer growing inside
154
most common invasive ca
infiltrating ductal carcinoma
155
infiltrating ductal carcinoma accounts for ___% of all ca
65%
156
characteristics of infiltrating ductal carcinoma
hard, stationary, painless, palpable mass, microcalcs, spiculations, taller > wide, hyperechoic rim, shadowing
157
most common location of infiltrating ductal carcinoma
UOQ
158
10-15 % of all breast ca
infiltrating lobular carcinoma
159
most frequently missed ca
infiltrating lobular carcinoma
160
infiltrating lobular carcinoma has increased risk of
occurence in contralateral breast
161
infiltrating lobular carcinoma is often associated with
nipple retraction
162
infiltrating ductal carcinoma is more common on the ___ side
left
163
infiltrating lobular carcinoma is found in which zone
pre-mammry zone
164
fastest growing ca
medullary carcinoma
165
looks like fibroadenoma or phylloides
medullary carcinoma
166
phylloides tumour is
benign
167
fastest growing breast CA
medullary carcinoma
168
difficult to distinguish from fibroadenoma
medullary carcinoma
169
rare, older women, slow growth
mucinous carcinoma
170
this type of breast CA needs biopsy to determine what type
mucinous carcinoma
171
breast ca typically affecting post-meno women
papillary carcinoma
172
associated with intraductal papilloma
papillary carcinoma
173
commonly has bloody nipple discharge
papillary carcinoma
174
typically located in central breast area
papillary carcinoma
175
favourable prognosis
papillary carcinoma
176
intraductal papilloma can turn into
papillary carcinoma
177
all solid breast lesion should be considered
malignant
178
augmented breast
breast implant
179
2 types of breast implants
silicone, saline
180
reconstructive breast augmentation
post- mastectomy
181
problem with ALL silicone implants
leakage
182
cosmetic implants are place ___ to pec major
anterior
183
reconstructive implants are place ___ to pec major, _____ to pec minor
posterior; anterior
184
problems with implants
leakage, rupture, contraction
185
implant contracture is associated with
immune and connective disorders
186
U/S appearance of implant
anechoic, anterior reverberation, anterior capsule formed by body, radial folds- anterior
187
silicone leak occurs
outside envelope
188
"step-ladder" sign
intra-capsular rupture
189
"snowstorm" sign
extra-capsular rupture
190
tear in sell of implant, silicone between shell and fibrous capsule
intra-capsular rupture
191
numerous linear echogenic structures
intra-capsular rupture
192
low level homogenoeous echoes beyond ant third of implant
intra-capsular rupture
193
tear in fibrous capsule
extra-capsular rupture
194
extravasion of silicone into breast parenchyma or LN
extra-capsular rupture
195
implant rupture
change in breast shape or consistency, chronic burning
196
occurs in ALL silicone implants
silicone bleeds
197
microscopic leakage thorugh an intact implant, contained in fibrous capsule
silicone bleeds
198
snowstorm appearance in LN
silicone bleeds
199
contracture can occur in
all implant types
200
normal body response to implant
fibrous capsule
201
fibrous capsule is normally
larger than implant, flexible
202
fibrous capsule in contracture
contracts, constricts, hard, disfiguring
203
lower risk of contracture in
posteriorly placed implants
204
palpable lump in saline implants
fill valve, directly posterior to nipple
205
male breast enlargement
gynecomastia
206
abnormal growth of retroareolar glandular tissue and increase in subcutaneous fat
gynecomastia
207
most common breast abn in men
gynecomastia
208
gynecomastia is linked to
estrogen and androgen use, HTN drugs, depression meds, estrogenic neoplasms
209
S/S of gynecomastia
enlarged breast, palpable mass at nipple, firm, pain, tenderness
210
U/S features of gynecomastia
triangular area of hypoechoic glandular tissue under nipple, ducts seen tracking to nipple, increased fat, can be unilateral
