Lymphatic System and Venous Drainage

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Questions and Answers

What is the clinical importance of intercostal veins?

They drain into the vertebral venous plexus (correct)

They communicate with the axillary lymph nodes

They are involved in the development of breast tissue

They contribute to the lactation process

What is the function of the axillary lymph node groups?

To drain lymph from the breast tissue (correct)

To regulate hormonal stimuli in breast development

To control the flow of blood to the breast

To facilitate lactation in the breast

What is the significance of the pectoralis minor muscle in lymph node classification?

It divides the axillary lymph nodes into three levels (correct)

It is the primary site of lymph node metastasis

It controls the flow of lymph into the axillary nodes

It separates the axillary region from the breast tissue

What is the primary hormonal stimulus for breast development and function?

Estrogen and progesterone Signup and view all the answers

During which stage of life do physiological changes occur in the breast?

During puberty and menstrual cycles Signup and view all the answers

What is the purpose of dividing the axillary lymph nodes into levels?

To determine the prognosis after breast cancer treatment Signup and view all the answers

What is a condition characterized by the presence of extra breasts or nipples?

Polymastia Signup and view all the answers

What is a condition in which the nipple is directed inward?

Inverted nipple Signup and view all the answers

What is a type of breast disease that occurs in males?

Gynecomastia Signup and view all the answers

What is a chronic inflammatory condition of the breast?

Mammary duct ectasia Signup and view all the answers

What is a condition characterized by the presence of multiple small breast tumors?

ANDI syndrome Signup and view all the answers

What is a type of breast disease that occurs during lactation?

Acute lactational mastitis Signup and view all the answers

What is a condition characterized by the absence of breasts?

Amastia Signup and view all the answers

What is a type of breast disease characterized by the formation of cysts?

Cyst formation Signup and view all the answers

What is the term for a milk cyst in the breast?

Galactocele Signup and view all the answers

What is the primary purpose of performing duct galactography?

To identify a filling defect or obstruction in the duct Signup and view all the answers

What is the appropriate treatment for a single duct bloody discharge?

Microdochectomy Signup and view all the answers

What is the term for a discharge from multiple ducts with no palpable or mammographic mass?

Multiple duct discharge Signup and view all the answers

What is the purpose of estimating serum prolactin levels?

To diagnose galactorrhoea Signup and view all the answers

What is the likely cause of nipple discharge in a woman taking contraceptive pills?

Hyperprolactinaemia Signup and view all the answers

What is the term for a cyst that occurs due to the retention of acinar secretions?

Retention cyst Signup and view all the answers

What is the first step in the investigation of nipple discharge?

Test for occult blood in the discharge Signup and view all the answers

What is the surgical treatment for persistent and troublesome discharge?

Excision of the major ducts Signup and view all the answers

What is the name of the tumour that arises from the ductal epithelium?

Infiltrating ductal carcinoma Signup and view all the answers

What is the name of the disease that begins in the epithelium of the nipple?

Paget's disease of the nipple Signup and view all the answers

What is the term for the occurrence of a second breast cancer outside the breast quadrant of the primary cancer?

Multicentricity Signup and view all the answers

What is the percentage of cases where the lesion is bilateral in lobular carcinoma?

25% Signup and view all the answers

What is the term for the occurrence of a second cancer within the same breast quadrant as the primary cancer?

Multifocality Signup and view all the answers

What is the most common histological type of breast cancer?

Infiltrating ductal carcinoma Signup and view all the answers

What is the risk factor for breast cancer that is mentioned in the text?

All of the above Signup and view all the answers

What percentage of breast cancers are Adenocarcinoma with productive fibrosis?

80% Signup and view all the answers

Which type of breast cancer accounts for 4% of all cases?

Medullary carcinoma Signup and view all the answers

What is the main route of lymphatic spread in breast cancer?

By embolism and permeation Signup and view all the answers

What is the name of the condition characterized by nipple changes and eczematous-like changes?

Paget's disease of the nipple Signup and view all the answers

What is the term for the characteristic mammographic appearance of early breast cancer?

Clustered microcalcification Signup and view all the answers

What is the term for the orange peel appearance of the breast skin?

Peau d'orange Signup and view all the answers

What is the percentage of breast cancers that are Invasive lobular carcinoma?

10% Signup and view all the answers

What is the name of the staging system used for breast cancer?

Manchester staging Signup and view all the answers

Study Notes

Intercostal Veins

Drain into the azygos system and communicate with the valveless vertebral venous plexus (Batson's)
This communication could explain the tendency of breast cancer deposits to affect the axial skeleton and central nervous system

Lymphatic Drainage

Lymph vessels follow the course of blood vessels
Six axillary lymph node groups:
- Axillary nodes (lateral)
- Anteromedial (pectoral; external mammary)
- Posterior (subscapular) group
- Central group
- Apical group (subclavicular)
- Interpectoral (Rotter)

Axillary Lymph Nodes

Divided into three levels by the pectoralis minor muscle for prognosis after radical or modified radical mastectomy
- Level I nodes: located low in the axilla, lateral or below the lower border of the pectoralis muscle
- Level II nodes: located superficial or deep to the pectoralis minor muscle
- Level III nodes: located medial or above the muscle in the apex of the axilla

Physiology of the Breast

Hormonal control: breast development and function are initiated by estrogen, progesterone, and prolactin
Physiological changes occur at puberty, during menstruation, pregnancy, lactation, and after menopause

Congenital Anomalies

Anomalies of the nipple
Anomalies of the breast
Accessory breasts (polymastia)
Accessory nipples (polythelia)
Inverted nipple
Enlarged breasts
Amastia
Accessory axillary breast

Diseases of the Male Breast

Gynecomastia
Male breast cancer

Infectious and Inflammatory Disorders of the Breast

Acute lactational mastitis and breast abscess
Non-lactational mastitis
Chronic inflammatory conditions of the breast
Mammary duct ectasia (plasma cell mastitis)
Chronic pyogenic breast abscess
Hidradenitis suppurativa
Tuberculosis of the breast
Mondor's disease

ANDI Syndrome

Fibrocystic disease of the breast, a spectrum of breast conditions that ranges from normal to disorder to disease
Aberrations of Normal Development and Involution (ANDI)
Three stages: early reproductive years (15-25 years), later reproductive years (25-40 years), and involution (35-55 years)
Pathological types: adenosis, epitheliosis, fibrosis, cyst formation

Cysts of the Breast

Acinar cysts
Retention cysts
Galactocele (milk cyst)
Intra-cystic papilliferous carcinoma
Interacinar cysts

Nipple Discharge

Causes: duct ectasia, fibrocystic disease, duct papilloma, duct carcinoma, contraceptive pills, hyperprolactinaemia

Diagnosis

History and examination should provide information on:
- Nature of discharge
- Association with a mass
- Unilateral or bilateral
- Single duct or multiple duct discharge
- Use of contraceptive pills
Investigations:
- Test for occult blood in the discharge
- Cytology of the discharge for exfoliated cancer cells
- Soft tissue mammography
- Duct galactography
- Serum prolactin estimation in suspected cases of galactorrhoea

Treatment

A palpable mass should be excised for histology and treated accordingly
A single duct bloody discharge calls for excision of this duct by microdochectomy
Discharge from multiple ducts with no palpable or mammographic mass is initially treated conservatively by observation
Rarely, the discharge is persistent and troublesome, where it is surgically treated by excision of the major ducts

Breast Neoplasms

Classification and benign tumours:
- Duct papilloma
- Fibroadenoma
- Cystosarcoma phylloides

Carcinoma of the Breast

Aetiology:
- Risk factors
- Genetic factors (BRAC1 & BRACA2)
- Endocrinal factors (hormonal)
- Precancerous lesions
- Obesity
- Previous affection with breast cancer
Epidemiology:
- Natural history
Histopathology:
- Carcinoma may arise from the lobules, ducts, or nipple
- Types:
  - Carcinoma of the ducts
  - Carcinoma of the lobules
  - Paget's disease of the nipple
  - Multicentricity and multifocality
Classification of invasive carcinoma:
- Paget's disease of the nipple
- Invasive ductal carcinoma
- Adenocarcinoma with productive fibrosis (scirrhous, simplex, no special type; NST)
- Medullary carcinoma
- Mucinous (colloid) carcinoma
- Papillary carcinoma
- Tubular carcinoma
- Invasive lobular carcinoma
- Rare cancers (adenoid cystic, squamous cell, apocrine)

Spread

Local spread
Lymphatic spread (by embolism and permeation)
Blood stream spread

Hormone Receptors

Oestrogen
Progesterone

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Description

This quiz covers the lymphatic system, including the course of lymph vessels and axillary lymph node groups, as well as the importance of intercostal veins in draining into the azygos system and communicating with the vertebral venous plexus.