The Breast Week I

Front 1

Supernumerary nipples or breasts

Back 1

persistence of epidermal thickening along the milk line

Front 2

accessory axillary breast tissue

Back 2

extension of the normal ductal system over the entire anterolateral chest wall and into the axillary fosa.

Front 3

Congenital inversion of the nipples

Back 3

occurs in women with large or pendulous breasts, and frustrates attempts at nursing.

Front 4

Macromastia

Back 4

very large breasts that may cause severe back pain and disability.

Front 5

acute mastitis

Back 5

inflammation of the breasts ususally during the early weeks of nursing due to cracks and fissures in the nipples.
E: Staph. aureus or Strep
M: ususally unilateral, localized area of acute inflammation that may progress to the formation of single or multiple abscesses

Front 6

periductal mastitis

Back 6

painful erythematous subareolar mass that resembles an infectious process. A fistula is formed from under the nipple on the skin at the edge of the areola.
E: 90% smokers
M: secondary infections are common

Front 7

Mammary duct ectasia

Back 7

happens in multiparous women
clinically one finds a poorly defined periareolar mass, thick, cheesy nipple secretion
M: dilation of the ducts, inspissation (thickening) of breast secretions; granulomatous inflammatory reaction

Front 8

fat necrosis

Back 8

It is an unusual lesion produced by injury or trauma, surgical intervention, or radiation to the breast. It produces tumoral masses that clinically can stimulate carcinomas
M: adipose tissue is inflamed and necrotic with areas of calcification; chronic inflammtory cells
E: trauma, surgery, and radiation therapy

Front 9

Fibrocystic changes

Back 9

most common lesion of the breast; peak ages before menopause
E: excess estrogen, functioning ovarian tumors, deficiency of progesterone; oral contraceptives decrease the risk
M: cysts, fibrosis, adenosis
clincally one sees: pain, palpable lumps, nipple discharge, mammographic calcifications; do not elevate risk of cancer.

Front 10

Epithelial Hyperplasia

Back 10

a proliferative breast disease
It is an increase in the layers of the moyepithelial and epithelial cells (normally two) above the basement membrane of the ducts. If four layers are present there is increased risk of developing carcinoma
M: the lumen is filled with round and spindle cells that obliterate it, but irregular lumens (fenestrations) are peripherally located; atypia may be present
No increased risk for carcinoma

Front 11

Atypical ductal hyperplasia

Back 11

a type of proliferative breast disease
intraductal cell population is homogenous and fenestrations are regular in shape and evenly spaced

Front 12

Atypical lobular hyperplasia

Back 12

a type of proliferative breast disease
proliferation of acinar cells that can extend to the ducts increasing the risk of developing invasive carcinoma
excess proliferation of lobular unit

Front 13

Sclerosing adenosis

Back 13

Increased numbers of distorted and compressed acini. Mammographic examination reveals calcifications or densities, but rarely palpable masses are present

Front 14

fibroadenoma

Back 14

this type of stromal tumor is the most common benign tumor of the breast; these are usually multiple and bilateral
C: Palpable mass in young women, and a mammographic density in older women. There is a mild increased risk in developing breast cancer.
M: Sharply circumscribed and freely movable masses, from 1-10 cm in size, usually 2-4 cm; microscopically there is a fibrous capsule and calcifications may be present; response to hormones

Front 15

Carcinoma of the breast

Back 15

The most common cancer affecting women
E: rare before the age of 25 increases by the fourth decade
Nulliparous, Delayed childbearing, family history, uterine cancer, whites, early menarche, late menopause
P: there are genetic factors; endogenous excess estrogen, functioning ovarian tumors

Front 16

enviornmental factors of carcinoma of the breast

Back 16

radiation for Hodkin's; dietary fat, moderate to heavy alcohol consumption, viruses, organochlorine pesiticides.

Front 17

carcinoma is most common in the __

Back 17

left breast. 60% arise in the upper outer quadrant; thought to arise from terminal duct lobular unit

Front 18

Invading ductal carcinoma

Back 18

represents the majority of carcinomas

Front 19

Invasive lobular carcinoma

Back 19

bilateral, multicentric within the same breast, 20% chance to develop in the opposite breast
"Indian file" strands

Front 20

Medullary carcinoma

Back 20

accounts for 1-5% of all breast cancers, and occurs in younger women

Front 21

Colloid (mucinous) carcinoma

Back 21

1-6% of all carcinomas, older women

Front 22

Tubular carcinoma

Back 22

10% of all carcinomas less than 1 cm in size, younger women, tumors are multifocal or bilateral, excellent prognosis

Front 23

Invasive papillary carcinoma

Back 23

1% of all breast cancers, prognosis is better

Front 24

mammographic appearance of breast cancer

Back 24

Densities
Architectural distortion
Calcifications
Changes over time

Front 25

Clinical features of carcinoma of the breast

Back 25

1. Lump
2. Pain
3. Nipple discharge.
4. Dimpling of skin
5. Lymphedema
6. Thickening of skin (peau d’orange)
7. Retraction of nipple
8. Inflammatory carcinoma
9. Axillary masses

Front 26

how is carcinoma of the breast spread?

Back 26

lymphatic axillary; internal mammary artery; hematogenous (lungs);

Front 27

___ is the most important prognostic factor

Back 27

axillary lymph node metasteses

Front 28

Paget disease of the nipple

Back 28

it is an uncommon variant of Ductal Carcinoma, either in situ or invasive, that extends to involve the epidermis of the nipple and areola
Clinically: An erythematous, scaly, and weeping “eczema” that involves the nipple
M: Epidermis contains clusters of ductal cell carcinoma, which are larger and have more abundant pale cytoplasm (Paget cells) than the surrounding keratinocytes