Post on 12-Jan-2016
transcript
ANATOMYANATOMYANATOMYANATOMY
FETAL DEVELOPMENT• Mammary Glands• Mammary Line• Buds• Lobes• Lobules• Lactiferous Ducts
• Interlobar and Connective Tissue
• Fatty Tissue• Nipple
http://sprojects.mmi.mcgill.ca/dir/mammography.html
PUBERTY DEVELOPMENT
• Estrogen production begins growth of mammary ducts.
• Fat increases and fibrous tissue elastic• Adolescent period 9-13 years.• Complete development after ovulation
with the effect of progesterone. (Age 17)• Mammographic appearance: dense and
homogeneous
MENSTRUAL CYCLE• Changes in size and firmness due
to hormone balance.• Breasts enlarge • Certain areas more tender• BSE 7-10 days after menstruation
begins
PREGNANCY• PROLIFERATION• Acini grow • Estrogen• Progesterone• Prolactin• Oxytocin
MENOPAUSE• INVOLUTION• Loss of lobules• Breast replaced largely with fat• Takes 3-5 years
DISTRIBUTION OF GLANDULAR TISSUE
• Majority of glandular tissue lies centrally and laterally.
• Atrophy of glandular tissue begins medially and posteriorly working toward nipple.
Estrogen Replacement Therapy
• Benefits:– Decrease in symptoms– Decrease risk of heart problems– Decrease risk of osteoporosis
• Contraindications:– Increased risk of breast CA– Can influence growth of CA
Estrogen Replacement Therapy
• Hysterectomy: estrogen only• Menopause with uterus:
estrogen/progesterone to prevent proliferation of uterine lining
• Pills, skin patches, vaginal creams• Side effects: breast enlargement,
cysts, fibrocystic changes
DEVELOPMENTAL ABNORMALITIES
CONGENITAL• Supernumerary
Nipples (Polymastia)
• Accessory Breast Tissue (2-6%)
• Amastia/Amazia
ACQUIRED• Trauma• Radiotherapy• Breast Biopsy
Supernummerary nipples, when present, follow a predictable line
down the thorax
• A supernumerary nipple is the aborted beginning of an additional nipple along the mid-clavicular line of the thorax.
Supernumerary on Adolescent boy
Supernumerary on Shoulder
Case 2: A 22-year-old white woman presented three days following spontaneous vaginal delivery with painless swelling of her right axilla. She had an unremarkable
medical history, and her prenatal course was unremarkable. She denied any fever or signs of systemic
infection. On physical examination, a 3 x 3 cm mobile, painless swelling was noted in the right axilla. A small
amount of cloudy fluid was expressed through a central punctum within the swelling.
AMASTIA
EXTERNAL ANATOMY• Breast• Nipple• Areola• Areolar Muscle• Montgomery Glands• Inframammary Fold• Axillary Tail of Spence
INTERNAL ANATOMY• Fascia• Retromammary/
glandular Fat Space• Connective Tissue• Blood Supply• Veins (Circulus
Venosus)• Lobes• Lactiferous Ducts• Ampulla
• Lobules• TDLU• Extralobular
Terminal Duct• Intralobular Terminal
Duct• Ductules (Acini)• Lymphatics
Breast profile:A - ductsB - lobesC - ampullaD - nippleE - fatF - pectoralis major
muscleG - chest wall/rib
cage
Enlargement:A - normal duct
cellsB - basement
membraneC - lumen (center of
duct)
TDLU• Intralobular
terminal duct (dots)
• Extralobular terminal duct (dashes)
http://sprojects.mmi.mcgill.ca/dir/mammography.html
Lymph node areas adjacent to breast area.
A - pectoralis major muscle
B - axillary lymph nodes: levels I
C - axillary lymph nodes: levels II
D - axillary lymph nodes: levels III
E - supraclavicular lymph nodes
F - internal mammary lymph nodes
MALE BREAST• Similar to female breast until
puberty• Male breasts stay in rudimentary
state• Gynecomastia
BREAST CLASSIFICATIONS
• Dense/GLANDULAR • Average/FIBRO-FATTY or
FIBRO-GLANDULAR • Adipose/FATTY
WOLFE BREAST CLASSIFICATIONS
• N1• P1• P2• DY
DEFINITIONS• Nulliparity• Proliferation• Involution• Epithelial Cells• Myoepithelial Cells
MAMMOGRAPHIC ANATOMY
• Convex Pectoralis Muscle• Cooper’s Ligaments• Blood Vessels• Ducts• IMF• Skin Pores• Nipple in profile
MAMMOGRAPHIC CHANGES
• Pregnancy/lactation• Menstruation• Menopausal• Estrogen Replacement Therapy
(ERT)
Viewing A Mammogram• Right and Left opposite each other
for CC and MLO• Place comparison films either to the
sides or above or below current films• Hang anatomically• Axillary region always up• Marker always in Axillary region
1. ID and Date2. Marker3. Whole breast
imaged4. Skin Pores5. Nipple in
profile6. Pectoralis
muscle7. IMF
http://sprojects.mmi.mcgill.ca/dir/mammography.html
ASSIGNMENT• Log in to www.thehungersite.com• www.thebreastcancersite.com
Friday Assignment• Post a summary of an article related
to some sort of breast specialty exam in the Discussions section of WebCT. You must then respond to two other postings to show you have read their summaries. Your summary is due Friday night at midnight. Responses are due Monday night.