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This is the homepage for the Breast sitegroup.
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General Anatomy and Radiology
EMBRYOLOGY OF BREAST
Develops from mammary ridge / milk line
4th week of intrauterine life
Gland is ectodermal & stroma is mesodermal in origin
Secondary buds ( 15-20 ) divides & subdivides to form lobes of gland
Growth of mammary gland , at puberty is caused by oestrogen
Till puberty, male & female breasts are morphologically alike & characterized by ducts lined by cuboidal epithelium
In females at puberty Formation of lobules,branching ducts & deposition of fat & connective tissue
Male breast remains rudimentary with no lobules & scanty intervening substance
ANATOMY OF BREAST
SITUATION
Lies in the superficial fascia of pectoral region
Small extention called axillary tail (of Spence) pierces deep fascia and lies in axilla
EXTENT
Vertically : From 2th to 6th rib
Horizontally : from lateral border of sternum
to mid axillary line.
DEEP RELATIONS
Lies on deep fascia (Pectoral fascia) covering Pectoralis Major
Still deeper : Pectoralis Major Muscle
: Pectoralis Minor Muscle
: Serratus Anterior Muscle
: Ext. Oblique Muscle of
Abdomen & upper ¼ of
anterior rectus sheath
Retromammary space : Loose areolar tissue seperating breast from Pectoral fascia
THE CHEST WALL :
Includes ribs , intercostal muscles &
serratus anterior muscle but not the pectoralis
muscle
STRUCTURE OF THE BREAST
THE SKIN :1) Nipple –A conical projection just below centre of the breast
at level of 4th intercostal space
- pierced by 15-20 lactiferous ducts
- contains circular & longitudinal smooth muscle fibres
- rich in nerve supply
2) Areola – Skin surrounding base of nipple is pigmented
- Rich in Mod.sebaceous glands(Montgomery tubercles
in pregnancy )
THE PARENCHYMA - made up of glandular tissue which secretes milk
-15 – 20 lobes
- Each lobe is a cluster of alveoli & drained by a
lactiferous duct
- Lactiferous duct converge towards nipple &open
on it
- Dilatation at termination called Lactiferous sinus
( infiltration of Lact.duct –Nipple retraction)
THE STROMA
Forms supporting framework of the gland
Fibrous stroma form septa called Ligament of Cooper which anchor the skin & gland to Pectoral fascia
Fatty stroma forms main bulk of the gland
Clinical significance
Dimpling & puckering occurs due to
involvement of Cooper’s ligaments by
disease (Can be seen well on a
mammogram as spiculations)
BLOOD SUPPLY
ARTERIAL SUPPLY
Internal Thoracic/Mammary Artery : (perforating branches of internal mammary artery)
Lateral Thoracic Artery, Superior Thoracic Artery, Thoraco-acromial branch of AXILLARY artery
Lat branch of Post. Intercostal Arteries
VENOUS DRAINAGE
Superficial veins – drains into internal thoracic vein
Deep veins – Internal thoracic , Axillary & post intercostal veins
NERVE SUPPLY
Anterior and Lateral cutaneous br. of 4th to 6th intercostal nerve
- Sensory fibres to skin
- Autonomic fibres to smooth muscles
LYMPHATIC DRAINAGE
Lymph nodes draining the breast :
1) The axillary L.N.s
– Anterior
- Posterior
- Lateral
- Central
- Apical
2)Internal Mammary nodes ( Parasternal)
- lie along internal thoracic vessels
3) Supraclavicular nodes , Cephalic ( Deltopectoral nodes )
& the Post. Intercostal nodes
Lymphatic Vessels
A) Superficial Lymphatics : drains the skin over breast except for nipple &
areola
: into surrounding LN ( Axillary , internal mammary,
supraclavicular & cephalic )
B) Deep Lymphatics : drains breast
parenchyma
: Also nipple & areola
REGIONAL LYMPH NODES
Axillary (ipsilateral): interpectoral nodes and lymph nodes along the axillary vein and it’s tributaries which made be divided into the following levels
Level I- lymph nodes lateral to the lateral border of the pectoralis minor muscle
Level II - lymph nodes between the medial and lateral borders the pectoralis minor muscle
Level III- lymph nodes medial to the medial margin of the pectoralis minor muscle
Internal mammary (ipsilateral) : LNs in the intercostal spaces along the edge of sternum
Supraclavicular LNs : in SCF
Communication of superficial lymphatics crosses midline . Therefore Ca may spread from one breast to another.
Communication of lymph vessels with those of abdomen – secondaries in liver
Veins also spread Ca
- veins draining breast communicate with Vertebral
venous plexus of veins
- Spreads to Vertebra & Brain
SENTINAL LYMPHNODE
Is the first lymph node draining tumor bearing area of the breast
Sentinel lymph node biopsy :
Currently under evaluation
May become standard of care in future in management of axilla in pts. With clinically node negative disease
Lymphazurin (Blue dye)/ radioisotope lebelled albumin inj.
Detected visually or with hand held gamma camera
If only single sentinel LN is identified, False negative rate = 15 %
If 2 or more sentinel LNs identified, False negative rate reduced to < 5 %
Skip lesions < 3%
Anatomy resources
External link collections
Link collection 1
Link collection 2
CLASSIFICATION (WHO)
Epithelial Tumors
A.Benign
1.Papilloma
2.Pappilomatosis
3.Adenoma
B.Malignant
1Non Invasive
a Intraductal
b Intralobular
2Invasive
a Invasive Ductal Ca
b Paget Ds
c Predominant Intraductal Component
d Invasive Lobular Carcinoma
e Medullary Ca
f Mucinous Ca
g Invasive Papillary Ca
h Tubular Ca
i Adenoid Cystic Ca
j Secretory (Juvenile) Ca
k Apocrine Ca
l Ca with metaplasia
m Inflamatory Ca
MIXED CT AND EPITHELIAL TUMORS
a.Fibroadenoma
b.Benign Cystosarcoma Phylloides
c.Malignant Cystosarcoma Phylloides
Misc. Tumors
a.Haemangioma
b.Granular Cell Tumor
c.Angiosarcoma
d.Mammary Dysplasia / Fibrocystic Change
e.Ductal / Lobular Hyperplasia
f.Sclerosing Adenosis / Cysts
Tumor like lesions
Duct Ectasia, Inflammatory Pseudo tumors, Hamartoma, Gynecomastia
Classification of X tumors
The Abracadabra Classification
Individual diseases
Tumors of the Y region
ABCD tumor
EFGH tumor
Tumors of the Z region
IJK cancer
LMN tumor
Current issues
Is XYZ classification a complete disaster?
Is drug D going to improve outcomes over the EFG regimen?
List of pages dealing with breast cancer on Isocentre
Hagensen's Grave Signs
Haagensen's Grave signs are a group of signs that when present in patients of carcinoma breast indicate inoperability. These signs were identified by Haagensen and Stout in a review of the clinical...
Welcome to the Breast Sitegroup
This is the homepage for the Breast sitegroup. Below is a template for how the homepage could look. This page should list and link to content created within the sitegroup in an organized manner....