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Last moment revision about Breast for Competitive Exams

Tuesday, 24 January 2017

Breast

A modified sweat gland (glands of Montgomery are sebaceous glands)

Mammary ridge or milk line appears in 6th week of intrauterine life

Young female breast extends from 2nd to 6th rib from sternum to anterior axillary line

Average number of internal mammary lymph nodes is 5 and that of 20 axillary nodes is

Witch’s milk is the milk like secretion from breasts of infants after 3rd or 4th day of life

Best position of self-palpation of breast is lying down

Gynaecomastia

Enlargement of male breast

Caused by excess oestrogen action

Discharge per nipple

Serous discharge – fibrocystic disease

Greenish discharge – fibrocystic disease, duct ectasia

Yellowish discharge – breast abcess

Bloody discharge – duct papilloma, duct carcinoma

Milky discharge – galactocele, hypothyroidism, pituitary tumours

Paste-like material – duct ectasia

Fibroadenoma (breast mouse)

Most common tumour below 30yrs

An aberration of normal development of a single lobule

Microscopically 2 types – peri canalicular(more fibrosis and more hard) intercanalicular(less fibrosis)

Shows popcorn calcification on mammography

Duct papilloma

Benign lesion, usually single and unilateral

Present in one of the large lactiferous ducts

Cause bloody discharge from the nipples

Phylloides tumor

Also called Serocystic disease of Brodie

Shows cut cabbage or tear drop configuration

Carcinoma breast

Most common malignancy in females in developed countries

Infiltrating ductal adenocarcinoma is the most common type of breast carcinoma

—Mastitis carcinomatosa (inflammatory carcinoma) is usually ductal carcinoma involving dermal lymphatics and presenting as peau-d-orange. It is most malignant with worst prognosis

Colloid carcinoma occurring in old age shows lakes of mucin on section

Paget's disease is a manifestation of ductal carcinoma that invades nipples

Lobular carcinoma arises in terminal duct epithelium and spread invasive pattern in a sheet like

Ductal carcinoma

Most common site is upper quadrant

Most reliable diagnostic test is open excisional biopsy

Mammography is the most useful technique for detection of early cancer

Usual mammographic finding is clustered polymorphic micro calcification

Most common tumour marker for evaluation of metastasis and recurrence are CA 15-3 and CEA

Average time for a breast cancer foci to attain 1 cm size is 10yrs

Most common site of metastasis is axillary lymph node, first group to be involved is pectoral 

Common site of systemic spread is bone most commonly lumbar vertebrae

Phenomena due to lymphatic obstruction

Peau d’ orange appearance

Elephantiasis chirurgeons – also called late oedema of arms, seen after radical mastectomy 

—Brawny arm – non-pitting oedema of arm due to advanced neoplastic infiltration 

—Lymphangio sarcoma – a complication of post-mastectomy lymphoedema 

Cancer en cuirasse – appears as coat of armour as the thoracic wall is full of nodules and skin is infiltrated 

Paget’s disease of nipple

—Clin features are red, eczematous like lesion of the nipple which eventually erodes the nipple. 

—DD is eczema of the nipple. The later is usually bilateral, itchy and does not destroy the nipple 

—Inv- mammography and biopsy

Dr.Reshmi RS MD(Hom)
MO Govt of Kerala


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