Podcast
Questions and Answers
Which of the following accurately describes the lymphatic drainage pathway of the lateral part of the breast?
Which of the following accurately describes the lymphatic drainage pathway of the lateral part of the breast?
- Drains into the pectoral lymph nodes. (correct)
- Drains directly into the apical lymph nodes.
- Drains into the sub-mammary plexus, then to the parasternal lymph nodes.
- Drains into the subscapular lymph nodes.
A patient is diagnosed with a tumor in the upper medial quadrant of the breast. Based on lymphatic drainage patterns, which lymph nodes are most likely to be involved first?
A patient is diagnosed with a tumor in the upper medial quadrant of the breast. Based on lymphatic drainage patterns, which lymph nodes are most likely to be involved first?
- Pectoral (anterior) lymph nodes
- Apical lymph nodes
- Parasternal lymph nodes (correct)
- Subscapular (posterior) lymph nodes
During a clinical examination, a physician palpates enlarged lymph nodes along the medial side of the axillary vein. Which group of axillary lymph nodes is most likely affected?
During a clinical examination, a physician palpates enlarged lymph nodes along the medial side of the axillary vein. Which group of axillary lymph nodes is most likely affected?
- Humeral (lateral) group (correct)
- Apical group
- Pectoral (anterior) group
- Central group
Which of the following structures contributes to the formation of the breast bed?
Which of the following structures contributes to the formation of the breast bed?
A surgeon is performing a mastectomy and needs to identify the main arterial supply to the medial aspect of the breast. Which artery should the surgeon locate?
A surgeon is performing a mastectomy and needs to identify the main arterial supply to the medial aspect of the breast. Which artery should the surgeon locate?
Which part of the axillary lymph nodes receives afferent lymphatic vessels directly from the upper limb (excluding those that drain along the cephalic vein)?
Which part of the axillary lymph nodes receives afferent lymphatic vessels directly from the upper limb (excluding those that drain along the cephalic vein)?
What is the origin of the sympathetic nerve supply to the nipple?
What is the origin of the sympathetic nerve supply to the nipple?
In which intercostal space is the nipple typically located?
In which intercostal space is the nipple typically located?
A patient presents with peau d'orange (skin dimpling) on the breast. Invasion of which structure is most likely causing this clinical sign?
A patient presents with peau d'orange (skin dimpling) on the breast. Invasion of which structure is most likely causing this clinical sign?
During embryonic development, at which week do the ectodermal 'milk lines' first appear?
During embryonic development, at which week do the ectodermal 'milk lines' first appear?
Following surgical removal of the pectoralis minor muscle due to extensive tumor involvement, what lymphatic drainage pathway would be MOST affected?
Following surgical removal of the pectoralis minor muscle due to extensive tumor involvement, what lymphatic drainage pathway would be MOST affected?
A patient presents with a lesion close to the subscapular artery. Which lymphatic drainage pathway is MOST likely to be the primary route of metastasis from this region?
A patient presents with a lesion close to the subscapular artery. Which lymphatic drainage pathway is MOST likely to be the primary route of metastasis from this region?
If a surgeon injures the lateral thoracic artery during a procedure, which group of axillary lymph nodes would MOST directly have its afferent lymphatic supply disrupted?
If a surgeon injures the lateral thoracic artery during a procedure, which group of axillary lymph nodes would MOST directly have its afferent lymphatic supply disrupted?
A 45-year-old woman is diagnosed with breast cancer that has spread to the central group of axillary lymph nodes. Which of the following represents the MOST likely subsequent lymphatic drainage pathway from these affected nodes?
A 45-year-old woman is diagnosed with breast cancer that has spread to the central group of axillary lymph nodes. Which of the following represents the MOST likely subsequent lymphatic drainage pathway from these affected nodes?
Which of the following BEST describes the significance of the suspensory ligaments of Cooper in the context of breast cancer progression?
Which of the following BEST describes the significance of the suspensory ligaments of Cooper in the context of breast cancer progression?
A surgeon is planning a procedure involving the breast and needs to consider the location of the nipple relative to the intercostal spaces. In the context of anatomical variations, which of the following is the MOST accurate statement?
A surgeon is planning a procedure involving the breast and needs to consider the location of the nipple relative to the intercostal spaces. In the context of anatomical variations, which of the following is the MOST accurate statement?
A 25-year-old female patient presents with an accessory nipple (polythelia) located along the milk line. Which of the following BEST explains the embryological basis for this anomaly?
A 25-year-old female patient presents with an accessory nipple (polythelia) located along the milk line. Which of the following BEST explains the embryological basis for this anomaly?
A pathologist is examining a breast tissue sample and notes extensive carcinoma invasion into the retro-mammary space. Which clinical sign is MOST likely to be observed in the patient due to this pathological finding?
A pathologist is examining a breast tissue sample and notes extensive carcinoma invasion into the retro-mammary space. Which clinical sign is MOST likely to be observed in the patient due to this pathological finding?
A clinician is assessing the sensory nerve supply of the breast after a trauma. Which statement BEST describes the regional distribution of sensory innervation to the breast?
A clinician is assessing the sensory nerve supply of the breast after a trauma. Which statement BEST describes the regional distribution of sensory innervation to the breast?
During a breast examination, a physician notes a palpable mass in the upper lateral quadrant. Given the lymphatic drainage patterns of the breast, which initial lymph node group is MOST likely to be involved in case of metastasis?
During a breast examination, a physician notes a palpable mass in the upper lateral quadrant. Given the lymphatic drainage patterns of the breast, which initial lymph node group is MOST likely to be involved in case of metastasis?
Flashcards
Anterior axillary lymph nodes
Anterior axillary lymph nodes
Along lateral thoracic artery, at lower border of pectoralis minor. Drains front of trunk and lateral/central breast.
Posterior axillary lymph nodes
Posterior axillary lymph nodes
Along subscapular artery, anterior to subscapularis. Drains back of trunk and tail of breast.
Lateral axillary lymph nodes
Lateral axillary lymph nodes
Along medial side of axillary vein. Drains upper limb (except cephalic vein area).
Central axillary lymph nodes
Central axillary lymph nodes
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Apical axillary lymph nodes
Apical axillary lymph nodes
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Polythelia
Polythelia
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Nipple
Nipple
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Areola
Areola
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Breast Extension
Breast Extension
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Medial arterial supply (breast)
Medial arterial supply (breast)
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Polymastia
Polymastia
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Mammary gland
Mammary gland
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Breast bed
Breast bed
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Intercostal veins
Intercostal veins
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Internal thoracic vein
Internal thoracic vein
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Inferior arterial supply (breast)
Inferior arterial supply (breast)
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Lateral arterial supply (breast)
Lateral arterial supply (breast)
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Superior arterial supply (breast)
Superior arterial supply (breast)
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Sensory nerve supply (breast)
Sensory nerve supply (breast)
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Lymphatic drainage of Nipple & areola
Lymphatic drainage of Nipple & areola
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Study Notes
Axillary Lymph Nodes
- Lymph nodes are divided into Anterior, Posterior, Lateral, Central, and Apical groups
Anterior Group (Pectoral)
- Site: Along the lateral thoracic artery, at the lower border of pectoralis minor
- Afferent: Front of trunk down to the umbilicus, lateral and central part of breast
- Efferent: Central and apical group
Posterior Group (Sub-scapular)
- Site: Along the subscapular artery, anterior to subscapularis
- Afferent: Back of trunk until the iliac crest and the tail of the breast
- Efferent: Central and apical group
Lateral Group (Humeral/ Brachial)
- Site: Along the medial side of the axillary vein
- Afferent: Upper limb, except along the cephalic vein
- Efferent: Central & apical group
Central Group
- Site: Base of the axilla
- Afferent: Anterior, Posterior, Lateral groups
- Efferent: Apical group
Apical Group
- Site: Apex of axilla
- Afferent: All axillary lymph nodes, the upper part of the breast and part of the upper limb along the cephalic vein
- Efferent: Subclavian trunk
- Note: the right subclavian trunk ends in the right lymphatic duct, while on the left side, it ends in the thoracic duct
Breast Development
- Two ectodermal "milk lines" appear at the 7th week of development
- Only the upper part of these lines remain, the rest disappear
Anomalies
- Polythelia: Accessory nipple along the remnant of the milk line
- Polymastia: Remnant of milk line develops as complete
Breast - Parts
- Nipple: Projection opposite the 4th intercostal space
- Areola: Pigmented area around the nipple
- Mammary gland
Breast - Extension
- From the 2nd rib (superiorly) to the 6th rib (inferiorly)
- From the sternal margin (medially) to the mid-axillary line (laterally)
Breast - Structure
- No fibrous capsule
- Divided by septa into 15-20 lobes
- Suspensory ligaments of Cooper suspend the breast to the pectoral fascia
Breast Bed - Formation
- Formed of the pectoralis major
- Serratus anterior
- External oblique
Clinical Notes
- Carcinoma invasion of suspensory ligaments causes skin dimpling
- Carcinoma invasion of the retro-mammary space causes fixation of the breast
Arterial Supply
- Medial part: perforating branch of the internal thoracic artery
- Lateral part: lateral thoracic of the 2nd part of the axillary artery
- Superior part: Acromio-thoracic of the 2nd part of the axillary artery
- Inferior part: Mammary branch of the 2,3,4 posterior intercostal arteries (ICA)
Venous Drainage
- Intercostal veins
- Internal thoracic vein
- Axillary vein
Nerve Supply
- Sensory:
- Upper part: supraclavicular nerve from cervical plexus
- Cutaneous branches of the 2-6 intercostal nerves
- Nipple: supplied by T4
- Sympathetic: From the thoracic sympathetic chain
Lymph Drainage
- Nipple and areola: Drain into the sub-areolar plexus
- Mammary gland: Drains into the sub-mammary plexus, which drains into regional lymph nodes
- Regional Lymph Nodes: Draining pattern according to the site on the breast
- The medial part of the breast drains into the para-sternal lymph nodes bilaterally
- The lateral and central part of the breast drains into the pectoral group
- The tail of the breast drains into the subscapular group
- The upper part of the breast drains into the apical group
- The lower part of the breast drains into the sub-diaphragmatic, rectus lymph nodes
- Commonest site for breast cancer is the upper lateral part of the breast
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