anatomy review

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visited=12%2F10%2F2009; visited=12%2F10%2F2009; visited=12%2F10%2F2009; visited=12%2F10%2F2009; visited=12%2F10%2F2009><table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=100 BGCOLOR="#CCCCFF" TEXT="#080000" bgproperties="fixed" background="04300640egdysm.jpg"> <div> <FONT SIZE="5" COLOR="#000066" FACE="Arial" ><B>breast pathology</B></FONT><FONT SIZE="5" COLOR="#000099" FACE="Arial" ><B> </B></FONT><B>    |     </B><A HREF="default.htm" TARGET="_top" TITLE="breast pathology"><U><B>home</B></U></A></div> <div> <B>anatomy review</B>   |   <A HREF="id17.htm" TARGET="_top" TITLE="histology review"><U>histology review</U></A>   |   <A HREF="id18.htm" TARGET="_top" TITLE="physiology review"><U>physiology review</U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="breast pathology"><U>breast pathology</U></A>   |   <A HREF="id26.htm" TARGET="_top" TITLE="to resume chart"><U>to resume chart</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="pictures"><U>pictures</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="breast exploration"><U>breast exploration</U></A>   |   <A HREF="id22.htm" TARGET="_top" TITLE="breast treatment and pronostic"><U>breast treatment and pronostic</U></A>   |   <A HREF="id29.htm" TARGET="_top" TITLE="breast cancer screening"><U>breast cancer screening</U></A>   |   <A HREF="id23.htm" TARGET="_top" TITLE="Contact Me"><U>Contact Me</U></A>   |   <A HREF="id28.htm" TARGET="_top" TITLE="for more reading"><U>for more reading</U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE="Related Links"><U>Related Links</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=200 BGCOLOR="#0000BF" TEXT="#F7F7FF"> <bR> <div> <B>anatomy review</B></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="histology review"><U><B>histology review</B></U></A></div> <div> <A HREF="id18.htm" TARGET="_top" TITLE="physiology review"><U><B>physiology review</B></U></A></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="breast pathology"><U><B>breast pathology</B></U></A></div> <div> <A HREF="id26.htm" TARGET="_top" TITLE="to resume chart"><U><B>to resume chart</B></U></A></div> <div> <A HREF="id20.htm" TARGET="_top" TITLE="pictures"><U><B>pictures</B></U></A></div> <div> <A HREF="id21.htm" TARGET="_top" TITLE="breast exploration"><U><B>breast exploration</B></U></A></div> <div> <A HREF="id22.htm" TARGET="_top" TITLE="breast treatment and pronostic"><U><B>breast treatment and pronostic</B></U></A></div> <div> <A HREF="id29.htm" TARGET="_top" TITLE="breast cancer screening"><U><B>breast cancer screening</B></U></A></div> <div> <A HREF="id23.htm" TARGET="_top" TITLE="Contact Me"><U><B>Contact Me</B></U></A></div> <div> <A HREF="id28.htm" TARGET="_top" TITLE="for more reading"><U><B>for more reading</B></U></A></div> <div> <A HREF="id24.htm" TARGET="_top" TITLE="Related Links"><U><B>Related Links</B></U></A></div> <bR> <bR> <div> <B><IMG SRC="10ec2d20.gif" border=0 width="194" height="210" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="10ffa120.gif" border=0 width="250" height="274" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> </td> <td valign="top" height=380 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>anatomy review</I></div> <div> <B> <A NAME="macroscopic_structures"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Macroscopic Structures <IMG SRC="13279770.gif" border=0 width="377" height="375" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B><B><IMG SRC="19482180.gif" border=0 width="386" height="280" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The normal, mature female breast varies from approximately 50 to 500 grams, and is largely influenced by the body habitus of the individual, with a large variation in the fat content of the breast. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">There is extension of the breast tissue into the axilla to a variable degree as well. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The normal breast is composed of roughly 15 to 25 lobes,</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> each of which has its own major duct opening into the lactiferous sinus, just below the nipple</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">. Each lobe is encapsulated by the connective tissue ligaments of Cooper, and each is further subdivided into multiple lobules, also referred to as the terminal ductal lobular unit (TDLU). </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Lobules are composed of multiple glandular units enveloped by a loose stroma and are demarcated by a basement membrane.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Adipose tissue is distributed within and around the lobes of breast parenchymal tissue. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The overlying nipple is composed of dense connective tissue with the confluence of each of the major ducts from the breast lobes, which coalesce </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">into the lactiferous sinus and lactiferous ducts. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The skin of the nipple contains multiple sebaceous glands and is variably pigmented, as is the surrounding areola, which contains bundles of smooth muscle cells and small milk ducts.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> The breast tissue lies superficial to the muscle of the chest, and is drained by lymph nodes to multiple sites, including the skin around the breast, the chest wall, and the axilla. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The axilla constitutes a large majority of the lymphatic drainage from the breast. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Thus, the tissue of axillary lymph node involvement by breast cancer is important in assessing the status of metastatic spread of the disease, and for appropriate surgical, medical, and radiation therapy.</div> <div> <B><IMG SRC="0f6cb2a0.gif" border=0 width="203" height="298" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0f813240.gif" border=0 width="275" height="292" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B><IMG SRC="0f9e0680.jpg" border=0 width="480" height="360" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0fab0460.jpg" border=0 width="432" height="326" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <bR> <div> <B>Parts of the </B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B>breast</B></FONT> </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT> is comprised of different structures, each with its own specific function. One-third of the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT> is comprised of fatty tissue. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The other two-thirds is made up of structural components called <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B>ducts</B></FONT> and <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B>lobules</B></FONT>. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Milk is produced in the lobules and funneled through the ducts to the nipple. </div> <bR> <div> <B>The ducts and the lobules are the sites where most </B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B>breast</B></FONT><B> abnormalities arise, both benign and malignant.</B> </div> <div> <B>Changes in the </B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B>breast</B></FONT><B>s</B></div> <bR> <bR> <div> <B>Menstruation </B></div> <div> The <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT> undergo many changes during a woman's lifetime. They don't start to mature until puberty when the ovaries start producing the hormone estrogen The <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT>s are very sensitive to hormonal changes and during the first two weeks of the menstrual cycle, estrogen stimulation causes growth of the ductal elements. During the later two weeks, progesterone, another hormone, causes the lobules to grow. This can cause painful swelling in the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT>s just before menstruation. </div> <bR> <bR> <div> <B>Pregnancy / Menopause </B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">If pregnancy occurs, other hormonal changes prepare the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT> for milk production. With menopause, estrogen levels diminish and the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT> tissue shrinks. Much of the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT> is then replaced with fatty tissue</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The normal female adult <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> is composed of two separate functional parts. The first of these is concerned with milk production, and is known as the epithelial component.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The second part consists of all the other tissues that make up and support the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT>. These include <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> fat, fascia (connective tissue), and muscles.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In order to understand the internal structure of the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT>, it is worth starting at the nipple and moving inwards.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Opening on to the surface of the nipple are 20 or so mammary ducts. Each of these ducts drains milk from different segment of the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT>. i.e. there are about 20 segments or lobes as they are known. An understanding of this arrangement is important when trying to understand <FONT SIZE="3" COLOR="#800000" FACE="Verdana" ><U>cancer</U></FONT> development. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">At the end of each mammary duct are a number of lobules that consist of multiple acini (singular = acinus). These are the milk-producing glands. Terminal ducts connect the acini to the mammary ducts.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The diagram below shows these anatomical features.</div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> gets its blood supply from two main sources. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The first is the internal mammary artery, which runs down on either side behind the sternum (<FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> bone), giving off perforating branches to the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> that enter its under surface between the ribs.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> The second is the lateral thoracic artery which is a branch of the axillary artery.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">This artery reaches the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> from under the arm up in the armpit. Further blood gets to the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> from the acromiothoracic artery and the intercostal arteries.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The blood supply of the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> is critically important when trying to understand <FONT SIZE="3" COLOR="#800000" FACE="Verdana" ><U>breast</U></FONT><U> </U><FONT SIZE="3" COLOR="#800000" FACE="Verdana" ><U>cancer</U></FONT> and how it spreads. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">As a general rule anywhere in the body, <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >cancer</FONT> may spread by one of three means. These are:</div> <div> <B><IMG BORDER="0" SRC="Symb075c00b70140ff000000.gif" HEIGHT="21" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">By blood vessels (haematogenous route)</B><FONT SIZE="4" COLOR="#000000" FACE="Arial" ><B> </B></FONT></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b70140ff000000.gif" HEIGHT="21" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">By lymph vessels (lymphatic route)</B><FONT SIZE="4" COLOR="#000000" FACE="Arial" ><B> </B></FONT></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b70140ff000000.gif" HEIGHT="21" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">By direct invasion of surrounding tissues</B><FONT SIZE="4" COLOR="#000000" FACE="Arial" ><B> </B></FONT></div> <bR> <bR> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In the case of the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT>, the most common method of <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >cancer</FONT> spread is via the lymphatics and by direct invasion, but haematogenous spread also occurs.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Another general rule in the body is that lymph vessels draining an organ, run alongside the arteries that supply blood to that organ. For this reason, in the case of the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT>, the lymph drainage (and hence spread of <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >cancer</FONT>) will be along the lymph vessels running with the internal mammary and lateral thoracic arteries.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">These lymph vessels drain into lymph nodes in the axilla (under the armpit) and in the internal mammary chain (behind the sternum). These are therefore the most common sites for lymph node metastases in <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >cancer</FONT> and are important when the <FONT SIZE="3" COLOR="#0000FF" FACE="Verdana" ><U>stage</U></FONT> and <FONT SIZE="3" COLOR="#0000FF" FACE="Verdana" ><U>prognosis</U></FONT> of the disease are being determined.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Blood draining from the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> does so via the veins that run with the arteries mentioned above. This is particularly important in the case of the intercostal veins since these connect with the azygos veins deep within the chest, and so allow a means of spread to the spinal column - a site where <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >cancer</FONT> often spreads.</div> <bR> <bR> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f0ff000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">2.  <A NAME="development_and_function"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Development and Function</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> develops rapidly at puberty in response to circulating hormones produced in the ovary - especially oestrogen. Throughout a woman's life the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> is in a constant state of flux under the influence of hormonal stimulation, and it is not until after the menopause that the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> finally enters a "resting" state. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The monthly menstrual cycle causes the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> glandularity to increase. The <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> also undergoes considerable change during pregnancy and <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> feeding (lactation).</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In summary, the <FONT SIZE="3" COLOR="#800000" FACE="Verdana" >breast</FONT> is a complex anatomical and functional organ. It can be affected by a number of both <FONT SIZE="3" COLOR="#0000FF" FACE="Verdana" ><U>benign</U></FONT> and <FONT SIZE="3" COLOR="#800000" FACE="Verdana" ><U>cancer</U></FONT><U>ous</U> conditions.</div> <bR> </td> </tr></table></body>