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36 Cards in this Set

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when we speak of the "normal" breast, what are we referring to?
breast from menarche to menopause
describe the breast in one sentence
is a dynamic, endocrine, cyclic structure that responds to estrogen and progesterone and who's physiological role is lactation
how is the breast cyclic?
mimics endometrium
prepares to produce milk each month
how is the breast organized?
large secretory gland organized into units (lobules)
each lobule consists of glands that end in the terminal duct
terminal duct conn to collecting duct
6-7 collecting ducts to lactiferous ducts that empty as lactiferous sinuses ->areola
what happens with cystic change in the breast?
cysts occur in the lobules, which are expansile
cause a back up of secretions
what happens during each cycle?
during proliferative phase, breast prepares to prod milk
secretions are prod every month with the onset of ovulation
w/o fertilization, secretions are reabsorbed by duct epithelium
when are secretions produced? what does it cause?
prod by glandular epithelium only during secretory/luteal phase (after ovulation)
can result in tender, swollen breasts
where do most tumors arise from?
what is the most common example?
DUCTAL epithelium (not glandular)
infiltrating ductal carcinoma most common
defn duct
epithelial lines structure that empties a gland
describe the histology of an early pubertal breast
has ducts but few glands
when might it be difficult to distinguish b/w epithelial and myoepithelial cells?
early follicular phase
what would you see in histo in gynecomastia?
no lobules(glands); WITH ducts
what portion of the breast tissue is expansile?
the glands/lobules
expansile, specialied CT
ductal ectasia- inflamm, destroys duct wall->expansile (abnormal)
describe the histo of the glands of the lobule
TWO epithelial layers
1. inner glandular
2. outer myoepithelial (rounded, basilar cells)
descibe the mode of secretion
apocrine; pinching off
how do you discern b/w a malignant and benign tumor based on cell type?
benign- still see 2 cell types
malignant- only 1 cell type
what happens during the proliferative phase?
incr number and size of glands
what happens to the amount of muscle as the duct approaches the nipple?
more sm. muscle for contraction
what are glands of montgomery?
sebaceous glands in subareolar tissue close to tissue
important for lubrication
what might the acinii look like in the luteal/secretory phase?
apocrine secretions into wide, expanded lumens of the glands
what composes the secretions of the breast?
mainly protein. more fat during pregnancy
what normally happens to breast tissue with age?
involution of GLANDULAR epithelium
involution accelerated with pregnancy
interlobular stroma replaced with adipose
describe the appearance of mammograms in young women
dense (white) b/c less fat and glandular tissue, more fibrous interlobular stroma
difficult to detect masses or calcifications
why is it easier to detect masses in breasts of older women?
they appear more radiolucent (dark) b/c of increased fat
when does involution occur?
begins ~30
ends ~55
lose breast MASS unless replaced by adipose
what is meant by loss of parenchyma?
replace specialized CT and lobular glands with structural collagen (1,2)
more fibrotic
what remains after involution?
only terminal duct and collecting duct systems
what would estrogen supplements do to the aging of the breast?
may delay or prolong involution
what are milkline remnants?
regions where supernumerary nipples/breasts are seen
how does breast cancer spread?
hematogenous (to brain, lung, vertebrae)
spread to LN is indication of degree of spread but removing LN doesnt help
what are the most common breast symptoms reported by women?
pain (mastodynia, mastalgia)- assoc with menstrual cycle (decr with age); almost always benign sign
palpable mass- abt 2 cm diameter; usually cysts; less with age
nipple discharge- rarely malignant
what has been the main influence of mammograms?
detection of ductal carcinoma in situ
how does adenocarcinoma of the breast primarily spread?
early on, spread via lymphatics that mainly drain into the axilla
what is the least invasive way to sample breast tissue/fluid?
fine needle aspiration breast biopsy; used with palpable lesions
cysts- contain fluid
solid lesions- cellular material taken for cytology
what are some less commonly used methods of breast biopsy?
core needle breast biopsy
(needle localization) open breast biopsy
what is used to biopsy when an area of density is found but is not easily palpable?
stereotactic breast biopsy- fixes breast in place; density identified with coordinates and needle inserted