[08.40] Benign and Malignant Lesions of the Breast V2.pdf

5th or 6th week

When do the two ventral bands of thickened ectoderm appear in the embryo?

Paired breasts

What structures develop along the ventral ridges of ectoderm in the embryo?

Polymastia

What is the term for the presence of accessory breasts?

Polythelia

What is the term for the presence of accessory nipples?

Less than 1 percent

What is the incidence rate of polymastia or polythelia in infants?

Urinary and cardiovascular

Abnormalities of which two systems may be associated with milkline accessory tissue?

Inverted nipple

What occurs when a pit fails to elevate above skin level during fetal development?

4 percent

What percentage of infants are affected by inverted nipples?

Amastia

What is the term for the complete absence of the breast?

6th fetal week

At what week of development does an arrest in the mammary ridge result in amastia?

Poland s syndrome

Which syndrome consists of amastia, costal cartilage defects, and rib defects?

Brachysyndactyly

What finger abnormality is associated with Poland s syndrome?

Symmastia

What is the rare condition of webbing between the breasts across the midline?

Turner s syndrome

Which syndrome involves ovarian agenesis and is associated with polymastia?

Fleischer s syndrome

Which syndrome involves nipple displacement and bilateral renal hypoplasia?

15 to 20

How many lobes is the human breast typically composed of?

Lobules

What structures compose the individual lobes of the breast?

Cooper s suspensory ligaments

What structures provide support and suspension to the breast tissue?

2nd or 3rd rib

At what rib level does the breast typically begin superiorly?

6th or 7th rib

At what rib level does the breast typically end at the inframammary fold?

Sternum

The breast extends transversely from the lateral border of which bone?

Anterior axillary line

What is the lateral transverse boundary of the breast extension?

Pectoralis major

On which major muscle fascia does the posterior part of the breast rest?

Serratus anterior and external oblique

Besides the pectoralis major, name two other muscles the breast fascia rests upon.

Posterior intercostal arteries

Which arteries provide blood supply to the breast via their lateral branches?

Internal thoracic artery

From which artery do perforating branches arise to supply the breast?

Axillary artery

Besides the internal thoracic and intercostal, which artery provides blood supply to the breast?

Internal thoracic vein

Which vein receives perforating branches for venous drainage of the breast?

Axillary vein

Which major vein receives tributaries for breast drainage?

Level 1

Which axillary lymph node group is located lateral to the pectoralis minor muscle?

Level 2

Which axillary lymph node group is located deep to the pectoralis minor muscle?

Level 3

Which axillary lymph node group is located medial to the pectoralis minor muscle?

Apical

What is another name for the Level 3 axillary lymph nodes?

Estrogen

Which hormone initiates ductal development in the breast?

Progesterone

Which hormone is responsible for the differentiation of epithelium and lobular development?

Prolactin

Along with estrogen and progesterone, which hormone is essential for normal development and function?

Oxytocin

Which hormone is part of the neuroendocrine control of breast function and let down?

GnRH

What hormone from the hypothalamus regulates the release of LH and FSH?

Anterior pituitary

In which gland are the basophilic cells that release LH and FSH located?

Adolescence, pregnancy, lactation, and senescence

What are the four different physiological stages of the breast?

Gynecomastia

What is the term for an enlarged breast in the male?

Neonatal, adolescence, and senescence

What are the three phases of life when gynecomastia usually occurs?

Estrogen

Gynecomastia results from an excess of what hormone in relation to testosterone?

Testicles

When a patient has gynecomastia, which organ besides the breast must be examined to rule out tumors?

True hermaphroditism

What gonadal condition can cause an estrogen excess state leading to gynecomastia?

Leydig cell and Sertoli cell

Name two types of non germinal testicular neoplasms that cause gynecomastia.

Choriocarcinoma

Which germ cell tumor is a known cause of gynecomastia?

Adrenal cortical neoplasms

Name a non testicular tumor type that can cause estrogen excess.

Liver disease

Hepatocellular carcinoma or cirrhosis of which organ causes gynecomastia?

Klinefelter s syndrome

Which XXY syndrome is a major cause of hypogonadism and gynecomastia?

Kallmann syndrome

Which syndrome involves hypogonadism and associated anosmia?

Congenital anorchia

What is the eunuchoid state of androgen deficiency?

Renal failure

Which organ failure is a non gonadal cause of gynecomastia?

Grade 1

Which gynecomastia grade involves small enlargement with no skin excess?

Grade 2a

Which gynecomastia grade involves moderate enlargement with no skin excess?

Grade 2b

Which gynecomastia grade involves moderate enlargement with extra skin?

Grade 3

Which gynecomastia grade involves marked enlargement with significant extra skin?

Inframammary fold

In gynecomastia grading, the nipple position is compared to which anatomical structure?

Breast ptosis

What is the medical term for breast sagging or redundancy?

Bacterial or mycotic

What are the two primary origins of infectious breast disorders?

Staphylococcus aureus

What is the most common bacterial cause of breast infections?

Streptococcus species

Which bacterial species, along with S aureus, is a common culprit for breast abscesses?

Point tenderness, erythema, and hyperthermia

Name three symptoms of a breast abscess.

Ultrasound guided aspiration

What diagnostic and therapeutic procedure uses sound waves to guide a needle into an abscess?

Incision and drainage

What is the operative treatment for a breast abscess?

Zuska s disease

What is the name for recurrent periductal mastitis?

Retroareolar

In Zuska s disease, infections and abscesses are recurrent in which area?

Blastomycosis or sporotrichosis

Name a rare focal mycotic infection of the breast.

Candida albicans

Which fungus causes erythematous, scaly lesions of the inframammary fold?

Hidradenitis suppurativa

What chronic inflammatory condition originates in the accessory areolar glands of Montgomery?

Paget s disease or invasive cancer

Hidradenitis suppurativa can mimic the appearance of which two serious conditions?

Mondor s disease

What is the variant of thrombophlebitis involving the superficial veins of the anterior chest wall?

Lateral thoracic and thoracoepigastric

Which two veins are most frequently involved in Mondor s disease?

ANDI

What is the classification system for aberrations of normal development and involution?

Fibroadenoma

According to the ANDI system, what is a common disorder of the early reproductive years?

Gigantomastia

What is the ANDI disease state for adolescent hypertrophy?

Cyclical mastalgia

What is a common breast disorder during the later reproductive years?

Involution

Which life stage (age 35 to 55) is associated with macrocysts and sclerosing lesions?

Duct ectasia

Which involutional disorder is related to duct dilatation and sclerosis?

Epithelial hyperplasia with atypia

What is the disease state of epithelial turnover in the involution phase?

Nonproliferative

What category of benign disorders includes cysts, calcifications, and fibroadenomas?

Apocrine metaplasia

What histological change is often seen in nonproliferative cysts?

Proliferative without atypia

What category includes sclerosing adenosis and radial scars?

Intraductal papilloma

Which benign lesion may present with nipple discharge?

Atypical proliferative lesions

What category includes atypical lobular and ductal hyperplasia?

No increased risk

What is the relative cancer risk for nonproliferative lesions of the breast?

1 5 to 2 fold

What is the relative cancer risk for florid hyperplasia?

4 fold

What is the relative cancer risk for atypical ductal hyperplasia?

10 fold

What is the relative cancer risk for ductal carcinoma in situ?

Lobular carcinoma in situ

Which in situ carcinoma, along with DCIS, carries a 10 fold relative risk?

Age at menarche

In the Gail model, which menstrual factor affects relative risk?

Age at first live birth

In the Gail model, which obstetric factor affects relative risk?

Number of biopsy specimens

What history of benign breast disease is a variable in the Gail model?

Inspection and palpation

What are the two primary components of a physical breast exam?

Percussion and auscultation

Which two common physical exam techniques are not used for the breast?

Upper inner, lower inner, upper outer, lower outer

Name the four quadrants of the breast.

Lift both arms

What should a patient be asked to do during inspection to check for breast symmetry?

Upright and supine

In which two positions should the patient be during breast palpation?

Axillary lymphadenopathy

What does the presence of enlarged or palpable axillary nodes suggest?

Breast ultrasound

What is the most common imaging study used once a suspicious lesion is identified?