Lymphatic drainage of the breast

◼️About 85% drains into the axillary lymph nodes which are arranged as
1- Lateral group along the axillary vein.
2- Posterior group along the subscapular vessels.
3- Central group embedded in that fat at the centre of axilla.
4- interpectoral group, which lies between pectoralis major and minor muscles.
5- Apical group which are in continuity with the lateral group and receive efferents from all other groups, the apical group is also continuous with supraclavicular lymph nodes which drain into the subclavian lymph trunk or jugular lymph trunk or thoracic duct (on the left) which directly drain into the venous system. (see next image)

◼️ The remaining drainage goes to the internal mammary nodes which are deep to the thoracic cage and along the internal thoracic artery, some lymph drainage goes to the inframammary nodes and the upper abdomen.

#Breast

Note

The sentinel lymph node is the first lymph node which drains the tumor bearing area in the breast.

#Breast

Ligaments of cooper

◼️They are hollow strands of fibrous tissue filled with breast tissue.

◼️They firmly adhere to the superficial fascia and thereby to the skin (see figure).

◼️What is the clinical importance of cooper's ligaments?

#Breast

Extensions of the breast

◼️It is generally considered that the protruding part of the breast extend from the 2nd rib to the 6th rib, and from the lateral border of the sternum to the anterior axillary line.

◼️Infact, there is a thin layer of mammary tissue which extends considerably furthur, from the clavicle above to the 7th or even 8th rib below, and from the midline to the Latissimus Dorsi posteriorly, this fact is important surgically during mastectomy, the aim of which is remove the whole breast.

◼️The axillary tail of the breast is of surgical importance, sometimes it can be normally palpable, and may be seen premenstrually or during lactation, a well developed axillary tail may be mistaken for enlarged lymph nodes or lipoma.

#Breast

Plummer vinson syndrome

◼️ Also called Brown kelly paterson syndrome or simply sidropenic dysphagia.
◼️This condition is described in women who have iron defeciency anemia and a dysphagia referred high in the neck.
◼️Certainly there is a fibrotic thin web in the upper esophagus, which attributes to dysphagia.
◼️The pathophysiology of this condition is uncertain, some patients had developed postcricoid carcinoma, ulceration and strictures, some patients shows heterotropic gastric mucosa, which may explain for those patients who developed adenocarcinoma in the upper esophagus.
◼️These webs can be easily dilated.

Note

Crohn's disease of the esophagus responds poorly to medical treatment, and resection may be required, remember that the esophagus is an unusual site for Crohn's disease, but surprisingly in some patients the esophagus is the only site for Crohn's disease in which a diagnostic challenge arise.

Crush syndrome

-Crush syndrome also called bywater or traumatic rhabdomyolysis caused by reperfusion injury and it occur in crushing injuries of skeletal muscles , which become ischaemic, and upon removal of crushing pressure myoglobin enters bloodstream from lysed muscles causing acute renal tubular necrosis and renal failure , thats why in catastrophes , field amputation of limbs is required even when the limbs can be removed from underneath the crushing pressure

#Renal
#Vascular

25 cm structures:

■ Esophagus
■ Duodenum
■ Descending colon
■ Sigmoid colon
■ Ureter

#Anatomy
#Surgery

Most common:

-First Cause of death related to malingnancy in women is lung cancer .

-Most common malignancy in women is breast cancer .

-Most commom lung cancer in female is adenocarcinoma .

#Surgery

The most common (lung cancer)

-MCC of bronchial cancer is cigarette smoking.
-Most common type of lung cancer is adenocarcinoma.
-Least common type of lung cancer is large cell carcinoma.
-Worst type of lung cancer is mainly mesothelioma (2-3 months survival rate) and small cell carcinoma (1-2 years survival rate).
-Most common early symptom is dry cough.
-Most common lung cancer causing superior vena cava syndrome is small cell lung carcinoma (SCLC).
-Most common lung cancer causing pancoast tumor is squamous cell carcinoma.
-Most common lung cancer causing SIADH is small cell carcinoma (due to secretion of ADH).
-Most common lung cancer causing hypercalcemia is squamous cell carcinoma (due to secretion of PTH_like protein).
-Most common lung cancer causing cushing's syndrome is small cell carcinoma (due to secretion of ectopic ACTH).
-Lung cancer causing eaton_lambert syndrome is small cell carcinoma.
-Most common lung cancer causing hypertrophic osteoarthropathy is adenocarcinoma.
-Lung cancer causing gynecomastia and galactorrhoea in males and false positive pregnancy test in females is large cell carcinoma (due to secretion of beta_HCG).
-Most definitive diagnosis is biopsy
-Most useful initial test is CXR.
-Most common type of lung cancer in non-smoker is adenocarcinoma.
-Most common cavitating lung cancer is squamous cell carcinoma.
-Most sensitive lung cancer to radiotherapy and chemotherapy is small cell lung carcinoma.
-Least sensitive lung cancer to radiotherapy and chemotherapy is large cell carcinoma.
-The best prognostic tumor among lung cancers is squamous cell carcinoma.

#Respiratory

Urinary casts.

#Renal

-The majority of tumors in people with MEN I are benign . However, approximately 1 out of 3 pancreatic neuroendocrine tumors and mediastinal neuroendocrine tumors are cancerous .

#Endocrine

-Most common presentation of Hirschprung's disease is Abdominal distension .

#GIT

-Most common complication of measles is Otitis media .

#Infections

-Tests done, in suspecting DVT cases:

•MOSE'S sign/ Bancroft's sign - Calf tenderness on direct pressure on calf

•Pratt's sign - Calf tenderness on squeezing from side to side.

•HOMAN'S sign - By forcible dorsiflexion with extended knee / without folding the knee, tenderness felt over calf

•NEUHOF'S sign - Thickening and deep tenderness while palpating deep in calf muscle

•LINTON'S sign - After applying tourniquet at SFJ patient made to walk +/- removal of tourniquet -> prominent superficial veins observed.

#Vascular

Causes of localised Edema :

ALIVE


A. Allergic (angio-oedema)

L. Lymphatic (elephantiasis)

I. Inflammatory (infection, injury)

VE. VEnous (DVT, chronic venous insufficiency).

#Vascular

-The most common anterior mediastinal mass is Thymoma .

#Surgery

-Most common primary tumour leading to secondaries in pancreas is kidney.

#Surgery