Elastosis and other stromal reactions in benign and malignant breast tissue: an ultrastructural study

Perieccrine Coil Elastosis: An Unusual and Previously Unrecognized Aging-Related Phenomenon

ABSTRACT

Elastic fibers are present as a thin line around the normal secretory coil of eccrine and apocrine glands, although they are virtually imperceptible with hematoxylin-eosin staining. Skin aging is a consequence of intrinsic and extrinsic factors, and glycation and ultraviolet irradiation are involved in this process favoring elastosis. We report an unusual and prominent perieccrine elastosis on the left temple in the vicinity of a basal cell carcinoma in a 78-year old man with type 2 diabetes, dyslipidemia, and hypertension. Very thick multilamellar and tortuous elastic fibers surrounded the eccrine coils. This increased amount of elastic fibers was confirmed by orcein staining as well as amyloid-P and lysozyme immunostaining. Perieccrine coil elastosis is a very unusual phenomenon that to the best of our knowledge has not been reported. Similar to dermal actinic elastosis, the presence of perieccrine coil elastosis in a skin cancer microenvironment might hypothetically promote tumor growth because of the release of elastin-derived peptides.

Biochemical "decoding" of breast ultrasound images with optoacoustic tomography fusion: First-in-human display of lipid and collagen signals on breast ultrasound

To date, studies which utilized ultrasound (US) and optoacoustic tomography (OT) fusion (US-OT) in biochemical differentiation of malignant and benign breast conditions have relied on limited biochemical data such as oxyhaemoglobin (OH) and deoxyhaemoglobin (DH) only. There has been no data of the largest biochemical components of breast fibroglandular tissue: lipid and collagen. Here, the authors believe the ability to image collagen and lipids within the breast tissue could serve as an important milestone in breast US-OT imaging with many potential downstream clinical applications. Hence, we would like to present the first-in-human US-OT demonstration of lipid and collagen differentiation in an excised breast tissue from a 38-year-old female.

Elastosis in ERα-positive male breast cancer

In female breast cancer (BC), elastosis is strongly related to estrogen receptor alpha (ERα) expression. Male breast cancers almost invariably express ERα; so, the aim of this study was to investigate elastosis frequency in invasive male BC as well as clinicopathological correlations, in comparison with females. A total of 177 male BC cases and 135 female BC cases were included, all ERα-positive and invasive carcinoma of no special type. Elastosis on H&E-stained slides was scored in a four-tiered system as elastosis grade (EG) 0 (no elastosis) to EG3 (high amount of elastosis). EG scores in male BC were correlated to histopathological characteristics and overall surviva and compared with female BC EG scores. Male BC showed some degree of elastosis in 26/117 cases (22.2%) with none showing EG3, while female BC cases showed elastosis in 89/135 cases (65.9%) with 21.5% showing EG3 (p < 0.001). This difference retained its significance in multivariate logistic regression. In male BC cases, no significant correlations were found between the amount of elastosis and age, grade, mitotic activity index, and PgR. In addition, no significant prognostic value of elastosis was seen. In conclusion, despite high ERα expression, male BC showed significantly less elastosis than female BC. Elastosis did not show clinicopathological correlations or prognostic value. Therefore, elastosis seems to be a less useful ERα tissue biomarker with less clinical significance in male BC compared with females, pointing towards important BC sex differences.

Elastin in the Tumor Microenvironment

Elastic fibers are found in the extracellular matrix (ECM) of tissues requiring resilience and depend on elasticity. Elastin and its degradation products have multiple roles in the oncologic process. In many malignancies, the remodeled ECM expresses high levels of the elastin protein which may have either positive or negative effects on tumor growth. Elastin cross-linking with other ECM components and the enzymes governing this process all have effects on tumorigenesis. Elastases, and specifically neutrophil elastase, are key drivers of invasion and metastasis and therefore are important targets for inhibition. Elastin degradation leads to the generation of bioactive fragments and elastin-derived peptides that further modulate tumor growth and spread. Interestingly, elastin-like peptides (ELP) and elastin-derived peptides (EDP) may also be utilized as nano-carriers to combat tumor growth. EDPs drive tumor development in a variety of ways, and specifically targeting EDPs and their binding proteins are major objectives for ongoing and future anti-cancer therapies. Research on both the direct anti-cancer activity and the drug delivery capabilities of ELPs is another area likely to result in novel therapeutic agents in the near future.

Elastofibroma. Case Report

A case of subscapular elastofibroma in a 61-year-old male was studied by light and electron microscopy. Sixty-two cases of this lesion have been to date reported. At light microscopy, the mass was unencapsulated and consisted of dense collagen bundles with many thick elastinophilic fibers and globules. The ultrastructural examination showed the fibers contained a clear core of mature elastic tissue surrounded by a more electron-dense fibrillar material, which was attributed to newly formed elastin. After elastase digestion, the fibers failed to stain with orcein. The cells were very scanty and identified as fibroblasts. The hypothesis formulated by various authors about the nature of elastinophilic fibers and about the pathogenesis of elastofibroma are reviewed. Our findings seems to support those of most authors, who consider the lesion an abnormally increased reactive production of elastic tissue by fibroblasts in response to a mechanical stimulus.

Elastic fibers in myocardial scars in rats: development teraction with other components

This work was designed to determine the course of development of elastic fibers in myocardial scars in rats and their relationship to other components of such structures. Light and electron microscopic observations were made on tissues from 24 rats, killed at sequent stages from 4 to 24 days postinjury. By both techniques, elastic fibers, shown to be forming by 4 days, had increased in size and number with maturation of the scar. At later stages they became interdigitated with the stumps of viable myocytes. We also saw that these fibers often had formed close contacts with the cell surfaces of myofibroblasts and nonvascular smooth muscle cells; a process found in some other situations but not previously in myocardial scars. This information is relevant, in particular, to the dynamics of myocardial scars and thus to the maintenance of function in the injured heart, but also to elastic fiber behavior in general. The integral role of elastic fibers in cell-matrix interactions as well as their biomechanical function is emphasized.

Myofibroblast and concurrent ED-B fibronectin phenotype in human stromal cells cultured from non-malignant and malignant breast tissue

Primary cultures of stromal cells from non-malignant and malignant breast tissues contained myofibroblasts based on immunoreactivity to alpha-smooth muscle (alpha-sm) actin. The proportions of these cells were variable among cultures from non-malignant origin while consistently high in cultures from carcinomas. High expression of ED-B fibronectin and of type V collagen was observed in myofibroblast-containing cultures. While cells from non-malignant tissues grew relatively steadily, the proliferation of carcinoma-derived cells declined during serial subculturing. In both types of cultures, alpha-sm actin and ED-B fibronectin expression decreased with increasing passage numbers. Epidermal growth factor (EGF), fibroblast growth factor b (FGFb), transforming growth factor alpha (TGF alpha) and platelet-derived growth factor (PDGF) showed consistent mitogenic effects. Addition of FGFb prolonged culture growth and allowed alpha-sm actin and ED-B fibronectin expression to persist. These results demonstrate similar phenotypic modulations in stromal cells from non-malignant and malignant breast tissues that may reflect a common stromal response to various tissue injuries, including neoplasia.

Collagen induced MMP-2 activation in human breast cancer

Matrix metalloproteinase-2 (MMP-2), a zymogen requiring proteolytic activation for catalytic activity, has been implicated broadly in the invasion and metastasis of many cancer model systems, including human breast cancer (HBC). MMP-2 has been immunolocalized to carcinomatous human breast, where the degree of activation of MMP-2 correlates well with tumor grade and patient prognosis. Using Matrigel assays, we have stratified HBC cell lines for invasiveness in vitro, and compared this to their potential for metastatic spread in nude mice. HBC cell lines expressing the mesenchymal marker protein vimentin were found to be highly invasive in vitro, and tended to form metastases in nude mice. We have further discovered that culture on collagen-I gels (Vitrogen; Vg) induces MMP-2-activator in highly invasive but not poorly invasive HBC cell lines. As seen for other MMP-2-activator inducing regimens, this induction requires protein synthesis and an intact MMP-2 hemopexin-like domain, appears to be mediated by a cell surface activity, and can be inhibited by metalloproteinase inhibitors. The induction is highly specific to collagen I, and is not seen with thin coatings of collagen I, collagen IV, laminin, or fibronectin, or with 3-dimensional gels of laminin, Matrigel, or gelatin. This review focuses on collagen I and MMP-2, their localization and source in HBC, and their relationship(s) to MMP-2 activation and HBC metastasis. The relevance of collagen I in activation of MMP-2 in vivo is discussed in terms of stromal cell: tumor cell interaction for collagen I deposition, MMP-2 production, and MMP-2-activation. Such cooperativity may exist in vivo for MMP-2 participation in HBC dissemination. A more complete understanding of the regulation of MMP-2-activator by type I collagen may provide new avenues for improved diagnosis and prognosis of human breast cancer.

A unique case of apocrine carcinoma on the male pubic skin: histopathologic and ultrastructural observations

We report a case of cutaneous adenocarcinoma on the pubic region of a 56-year-old male. The exophytic tumor showed solid, ductal, and glandular patterns with decapitation secretion and mucinous carcinoma-like nests. Despite the exophytic nature of the lesion, an invasive growth pattern into the deep dermis and subcutaneous fat was seen. An additional characteristic of this tumor was the presence of Paget's phenomenon. From these findings, we conclude that this tumor is an apocrine adenocarcinoma having an unusual clinical appearance and unique histopathological features which have some similarities to apocrine carcinoma of the breast and some to syringocystadenoma papilliferum and nipple adenomatosis.

Relation of elastosis to biochemical and immunohistochemical steroid receptor findings, Ki-67 and epidermal growth factor receptor (EGFR) immunostaining in invasive ductal breast cancer

We studied 1073 cases of invasive ductal breast cancer, NOS for their elastic content (DEL, ductal+periductal elastosis; TEL, tumour elastosis) and compared the findings with the results of biochemical and immunohistochemical steroid hormone receptor examination. Tumours of patients up to 50 years of age and older were examined separately. In a number of tumours elastosis was also examined in relation to Ki-67 and epidermal growth factor receptor (EGFR) immunostaining. Sensitivity and specificity of DEL and TEL for predicting the receptor, Ki-67 and EGFR findings were estimated. Sensitivity of DEL and TEL for oestrogen and progesterone receptors is dependent on the degree of tumour differentiation and the degree of elastosis, increasing from DEL 1 degree and TEL 1 degree to DEL 3 degrees and TEL 3 degrees. It was more evident in grade 1 (G1) and G2 than in G3 carcinomas. Elastosis is a useful predictor of positive receptor findings particularly in G1 and G2 tumours with moderate and high-grade elastosis. It is a similarly useful predictor of negative receptor values in G3 carcinomas. The predictive value of DEL and TEL for the results of Ki-67 and EGFR immunostaining gradually decreases with increasing elastosis, consistent with the assumption that Ki-67 and EGFR identify the degree of tumour proliferation and invasion, while elastosis correlates with the degree of differentiation of breast cancer. Elastosis is a poor predictor of Ki-67 and EGFR findings in any individual breast cancer. Moderate and high-grade elastosis points to positive steroid hormone receptor assays in G1 and G2 carcinomas. In contrast, the lack of elastosis in G3 carcinomas may indicate a negative receptor assay. Both findings have a high degree of reliability.

Ultrastructural demonstration of type IV collagen deposits in periductal elastosis in breast cancer

In a previous study we demonstrated at light microscopical level the presence of variable amounts of type IV collagen in the areas of periductal and interstitial elastosis in breast cancer. The present work was directed towards a further study by immunoelectron microscopy of the distribution of type IV collagen in the areas of periductal elastosis. The semithin sections showed a distinct immunoreactivity of all basement membranes for type IV collagen but no staining of the interstitial stroma. Corresponding ultrathin sections demonstrated a broad basement membrane with immunoreactivity for type IV collagen at its outer side. Many punctiform deposits of type IV collagen were observed in the areas of periductal elastosis but not around normal ducts or vessels. Recently the role of type IV collagen as a structural component on anchoring plaques between the basement membrane and the underlying stroma in the dermis has been emphasized. The results of this study demonstrate the presence of type IV collagen deposits below a thickened basement membrane in breast cancer.

Modulation of collagen and fibronectin synthesis in fibroblasts by normal and malignant cells

The influence of various normal and malignant human cells on the level of collagen synthesis by human fibroblasts was tested in coculture. As revealed by immunoperoxidase staining, in cocultures with breast adenocarcinoma cells (MCF7, SA52, T47D) fibroblasts synthesized collagen while tumor cells did not. Fibroblasts displayed increased collagen production without change in the overall protein synthesis. Several other types of cells derived from normal human tissues (keratinocytes, normal mammary cells) or from fibrosarcoma, melanoma, cervical carcinoma, choriocarcinoma, or other breast adenocarcinoma (SW613, MDA, BT20) did not affect collagen synthesis of fibroblasts. Although to a lesser extent, this stimulating effect was reproduced by using the conditioned medium (CM) of the active cells but not with CM of the other cell types. A slight stimulation was also obtained when tumoral MCF7 cells and fibroblasts shared the same medium but were physically separated, suggesting that close contact was required for optimal stimulation of collagen synthesis. The collagen synthesis stimulating activity was not related to a modification of fibroblast proliferation rate. The production of collagen types I, III, and VI and fibronectin were increased in cocultures of fibroblasts with MCF7 cells. The increased synthesis of collagen types I and III and fibronectin was paralleled by similar changes in the steady-state level of their mRNAs. On the contrary, the increased production of collagen type VI appeared regulated at a post-transcriptional level.

Immunologic aspects of fibrosis in mouse mammary carcinomas

The nature of the fibrosis associated with mammary carcinomas MC2 and MC3 was investigated in syngeneic C3H mice. Accelerated and enhanced peri-tumor cellular and fibrotic responses and retarded tumor growth were observed in actively immunized and in adoptively immunized mice, and in mice treated with IL-2. T lymphocytes and, particularly, macrophages were closely associated with collagen deposition at the tumors. The collagen deposition frequently resulted in the encapsulation and regression of the less invasive tumor MC2. A cellular fibrous response was not observed at tumors implanted into athymic C3Hnu/nu mice. The results suggest that tumor fibrosis may in some circumstances be promoted by an immune response.

Tropoelastin heterogeneity: implications for protein function and disease

The organization of the tropoelastin gene is similar to that of other genes coding for matrix proteins in that the exons code for distinct domains of the protein. An unusual feature of tropoelastin expression is that the primary transcript of the gene coding for tropoelastin undergoes extensive, developmentally regulated alternative splicing, resulting in numerous protein isoforms. Although the significance of this heterogeneity is unknown, the multiple sequence variations may affect the function of tropoelastin. Without an understanding of the importance of the domains of tropoelastin and the process of fibrillogenesis, characterization of defects resulting in aberrant elastin production will be hindered. In this update, we review recent findings on tropoelastin and speculate as to the structural and regulatory role of various regions of this matrix protein.

Abnormal elastic fibers in elastosis of breast carcinoma. Ultrastructural and immunohistochemical studies

Elastosis in benign and malignant breast lesions was studied by light microscopic immunohistochemistry for elastin and by electron microscopy. Upon immunohistochemical examination for elastin, elastosis, particularly in scirrhous-type ductal carcinoma, showed two characteristic staining patterns: fibrously and intensely stained elastic fibers and evenly stained elastic masses. Elastic fibers showing increased fibrous staining occurred mainly in the stromal areas, and were considered to be newly formed because they consisted of tannic acid-positive amorphous components and abundant microfibrils. Evenly stained elastic masses were observed mainly in the periductal areas and showed less intense stainability. These masses consisted of numerous fine amorphous components with plentiful microfibrils. In some regions within these masses, there were condensed accumulations of irregularly arranged small amorphous components associated with only a few microfibrils. These amorphous components had an ill-defined outline and were occasionally associated with spiralling collagen fibrils and cell debris. On the basis of these findings, the periductal evenly stained elastic masses were thought to be formed by excessive production of elastic fibers and degradation of pre-existing and newly formed elastic fibers.

Elastosis in meningioma. A case report and electron microscopic study

A 55-year-old man underwent left frontoparietal craniotomy for total removal of a parasagittal meningioma. The tumor showed a predominant pattern of meningotheliomatous meningioma and a partial pattern of angiomatous, transitional and fibrous meningioma. A striking feature was the appearance of unusually numerous elastinophilic material in the intercellular stroma. We observed a process in which the progress of elastosis changed the appearance of meningotheliomatous meningioma to a hypocellular, and subsequently acellular fibroelastotic node. Three years after the first craniotomy, meningioma recurred at the same site. The recurrent tumor also showed the histological pattern of meningotheliomatous meningioma with stromal elastosis, as previously observed. This is the first report of a case of meningioma with stromal elastosis. The present case represents the first unequivocal demonstration of elastogenesis in meningioma.

Elastosis in breast carcinoma: II. Association of protease inhibitors with immature elastic fibres

The elastosis of 11 invasive ductal and infiltrative lobular carcinomas of the breast was specifically immunostained for the plasma protease inhibitors alpha-1 antitrypsin, alpha-1 antichymotrypsin, alpha-2 macroglobulin, inter alpha trypsin inhibitor and C1 esterase inhibitor. None of these components was detected in the elastic fibres of normal ducts or blood vessels in the breast. The elastosis in breast carcinomas was also stained by Concanavalin A and Triticum vulgaris lectins. Such lectin staining probably represents binding to the microfibrillar component of elastic fibres, which is increased in immature elastic fibres, thus suggesting that the elastotic fibres of breast carcinoma are recently synthesised. It is suggested that the presence of protease inhibitors may influence the metabolism of elastic fibres, facilitating elastic fibre proliferation by the inhibition of elastinolytic enzymes.

Stromal changes in invasive breast carcinoma: an ultrastructural study

The stroma in infiltrating breast carcinomas, with particular reference to stromal spindle cells, has been studied by electron microscopy. A mixture of cells including resting fibroblasts, active fibroblasts, early myofibroblasts, and mature myofibroblasts has been identified. In loose stroma, myofibroblasts possessed prominent organelles and showed secretory products along the cell surface, whereas in dense stroma, there was relative prominence of cytoplasmic filaments as well as other features consistent with a contractile state of myofibroblasts. The degree of myofibroblastic proliferation was related to the growth pattern of the tumour. It is suggested that the infiltrating process of cancer cells is analogous to wound production and healing with continuous granulation tissue and scar formation resulting in the characteristic desmoplastic reaction seen in certain breast carcinomas.

Clinicopathological significance of intratumoural variations in elastosis grades and the oestrogen receptor status of human breast carcinomas

Cryostat sections from seventy-eight female breast carcinomas were assayed for oestrogen receptors by isoelectric focusing. Adjacent cryostat sections stained by Miller's elastic/van Gieson's method were graded for elastosis. Elastosis was similarly graded on near-equatorial paraffin sections from the same tumours. A positive correlation was obtained between elastosis in the near equatorial sections and oestrogen receptor positivity (p less than 0.0005), menstrual status (p less than 0.05) and parity (p less than 0.01) but no correlation was found between these factors and elastosis graded on cryostat sections from the more peripheral areas which had been selected for oestrogen receptor assay. These observations suggest that the central region of breast carcinomas, where connective tissue responses are fully developed, exhibits grades of elastosis with greater clinical significance. This may explain the conflicting published observations on the correlations between elastosis and oestrogen receptor status, which we believe are due to the lack of uniformity in tissue sampling. The possible implications of the absence of significant correlation between elastosis grades and tumour size, nodal status and disease-free interval are discussed.

Elastosis in breast carcinoma: I. Immunohistochemical characterization of elastic fibres

Elastosis associated with invasive ductal and lobular carcinomas of the breast was examined by tinctorial and immunohistochemical staining methods, enzyme digestion, and electron microscopy. The elastotic material exhibited the tinctorial staining properties of elastic fibres, and the ultrastructural appearances were those of elastic fibres although there was a higher proportion of microfibrils than in normal mature elastic fibres. The elastosis was immunostained by antisera to human fetal elastin, lysozyme and amyloid P component, as in other sites where elastic fibres are found. These findings indicate that immunohistochemically intact elastic fibres are present in the elastosis of breast cancer. They also demonstrate that lysozyme and amyloid P component are co-distributed with elastic fibres in elastosis of breast carcinoma, as distinct components with different susceptibilities to enzyme digestion. The cellular origin of elastosis in breast carcinoma remains uncertain.

Myofibroblast activity of radial scars

Radial scars from 38 cases, comprising 12 associated with cancer and 26 with benign lesions, have been examined by electron microscopy. One-third of the lesions, regarded as being at an early stage of development, showed abundant spindle cells, which displayed the ultrastructural characteristics of myofibroblasts. These included many profiles of endoplasmic reticulum, prominent myofilaments and a close association with collagen and elastic fibres. The remaining 'mature' radial scars showed relatively few myofibroblasts, sparsely distributed in the stroma. The stromal cells associated with the 'early' lesions were seen in close proximity to degenerating parenchymal structures, which frequently showed loss of basal lamina. Obliteration of the central parenchymal component appeared to be a prominent feature of radial scar formation. The ultrastructural appearances are consistent with a progressive development of the lesion, associated with sporadic myofibroblast activity.

Elastosis in benign and malignant breast disease

Elastosis, the presence of clumps of elastic fibers, is known to occur frequently in association with breast carcinoma. To test the hypothesis that the degree of elastosis increases progressively in fibrocystic disease with the severity of epitheliosis (epithelial hyperplasia, papillomatosis; widely believed to be the only premalignant component of fibrocystic disease) and increases further with intraductal and infiltrating duct carcinoma, breast tissue stained for elastic fibers from 84 women in the fifth decade of life was studied. Fourteen cases were evaluated in each of six disease categories: fibrocystic disease without epitheliosis; fibrocystic disease with epitheliosis, graded subjectively as mild, moderate, or severe (based on the degree of epithelial hyperplasia); intraductal carcinoma; and infiltrating duct carcinoma of the breast. Periductal elastosis and stromal elastosis were graded on a scale of 0 to 4 (absent to massive). The grades of both periductal elastosis and stromal elastosis were compared with those for the six disease categories ranked by increasingly advanced disease. The results indicate that the grades of periductal elastosis (Spearman rank correlation coefficient [R] = 0.54; P less than 0.001) and stromal elastosis (R = 0.75; P less than 0.001) increase progressively with the severity of breast disease.

An autopsy study of radial scar in the female breast

In a study of breasts from 83 consecutive, unselected female autopsies, 23 women (28%) were found to have radial scars. The lesion was multicentric in 67% and bilateral in 43%. The frequency of radial scar was significantly increased among women with fibrocystic disease (43%) compared to women without this lesion (17%). No difference in the frequency of radial scar was registered between women with primary breast malignancy and women with either normal breasts or benign breast abnormalities. No radial scar demonstrated transition to invasive or in situ carcinoma. No evidence was found of any association between radial scar and breast carcinoma.

Ultrastructural cytochemical demonstration of elastin in the matrix of salivary gland tumors

Following light microscopic survey of the incidence of elastic tissue in 80 salivary gland tumors, tissue samples from 14 pleomorphic adenomas, three myoepitheliomas, and eight adenoid cystic carcinomas were processed for cytochemical demonstration of elastin with the tannic acid stain for ultra-thin sections. For comparative study, some other tumor types devoid of elastic tissue at the light microscopic level and non-neoplastic submandibular glands were also investigated. Elastic deposits of varying amounts were clearly revealed on the basal-lamina-like material and/or masses of microfibrils in the matrix close to the neoplastic myoepithelium and, to a lesser degree, immediately beneath the non-neoplastic myoepithelium. None of the other tumor types without myoepithelial differentiation contained elastic deposits closely associated with the neoplastic cells. Intimate topographical relationship of such as immature elastic fiber or developing elastic tissue to the neoplastic myoepithelial cells strongly indicated the primary origin of elastic components from these cells. It is postulated that the potential of salivary tumor cells to produce elastin is regarded as an indicator of their myoepithelial nature or differentiation.

An ultrastructural study on periductal elastosis in human breast tumors

An ultrastructural study on elastosis of human breast tumors was made with special attention to the periductal elastosis and the cell responsible for elastic fiber formation. The elastosis was found prominently in scirrhous type of duct carcinoma. In the area of mild periductal elastosis, the elastic fibers with many microfibrils and a tiny central elastin were seen around the periductal fibroblasts which were characterized by attenuated cytoplasms with aggregates of microfilaments and slightly developed rough endoplasmic reticulum. With the thickening of the periductal wall, such an area was replaced by abundant mature elastic fibers with peripheral microfibrils and a few intervening ordinary fibroblasts. Therefore, it was suggested that the periductal fibroblasts which transformed into ordinary fibroblasts during the development of elastosis were primarily concerned with the elastic fiber formation. In the interlobular tissue in which both fibroblasts and myofibroblasts were present, the elastic fibers were larger than those of the periductal area and had less microfibrils in their periphery. The relationship between microfibrils and elastin during the early elastosis, maturation process of the elastic fibers, and cell modulation of the fibroblasts in the breast elastosis were discussed.

Multicentric breast carcinomas: clinical-radiographic-pathologic whole organ studies and 10-year survival

Selection of breast cancer patients with microscopically limited disease but with excess mortality or women with regional disease and lessened mortality has remained an unsolved and critical challenge. The many usual histologic features such as tumor size, stage of disease or tumor differentiations were found reduced to lessened significant prognostic factors by the presence of multicentricity of tumors and multiplicity of histologic types of carcinoma. This observation was noted upon review of 161 clinical, radiographic and histopathologic whole breast studies on 156 patients with follow-up from 11-15 years. Epidemiologic, clinical, and radiographic data had been compiled prospectively prior to diagnosis. Women with single site and single type of carcinoma had a better prognosis (2.5% mortality per year) than those with multiple sites and multipe types (15% mortality per year) even though the stage of the disease may be similar. When the latter groups contained a scirrhous type duct carcinoma, the annual mortality rate approached 25%.

Histological differentiation in human breast cancer is related to steroid receptors and stromal elastosis

In 503 cases of human breast cancer, the stroma reaction of elastosis was investigated with respect to histological differentiation, pathological and biochemical prognostic factors, and steroid receptor (SR) content. Unlike perivascular elastosis, gland-related (ductal + interstitial) elastosis was not related to age, menopausal status, and number of pregnancies of each patient, and could thus be considered a histological feature characteristic of mammary cells. Elastosis was encountered most frequently in histologically differentiated lesions and in lesions of histoprognostic grades I and II (low degree of malignancy). Elastosis-positive lesions thus seem to constitute a good prognosis. Elastosis was related to the presence of estrogen and progestin receptors (ER and PR), and in menopausal patients it was observed mostly when both ER and PR were present concurrently, i.e., under conditions reflecting the hormone-dependence of neoplastic cells better than the presence of ER alone. Taken together, these results suggest that the presence of hormone-dependent cells in breast carcinomas can be demonstrated by both biochemical and morphological features. Since each of these factors has its own prognostic value, prognosis could probably be by the assessed more accurately if all these parameters were examined at the same time.

Newly synthesized elastin is associated with neoplastic epithelial cells in human mammary carcinoma

Indirect immunofluorescence with a purified antiserum to human foetal elastin has identified newly synthesized elastin on the membranes of neoplastic epithelial cells in human mammary carcinoma.

The influence of pathologic factors on breast cancer management

The pathologist routinely provides to the therapist data which are used in the management of breast cancer patients. Clinical as well as gross and microscopic examination provides information used for staging and treatment selection. Biologic neoplasia precedes the usual morphologic and cytologic changes that characterize precancer and in situ carcinoma to the pathologist. Minimal breast cancer, including in situ carcinoma and small (0.5 cm) infiltrating cancers, is now a recognized entity separable from clinical cancer, although therapy is not yet uniform. The pathologist can routinely report the gross size and contour of the cancer; microscopic evaluation of the primary cancer adds information on the histologic type, differentiation (histologic or cytologic grade), and such other data as blood vessel invasion and cellular infiltration. One of the most useful bits of information is the status of axillary lymph nodes: whether or not there are metastases, the number of nodes with metastases, and whether they are micrometastases or macrometastases that extend through the capsule and involve pericapsular vessels. All of these data can be recorded routinely and are useful in developing management criteria. The pathologist, as any other consultant, reports to the attending physician who then uses these data with all other pertinent facts to formulate an individualized therapeutic program.

Ultrastructural analysis of apocrine carcinoma of the human breast

A case report with ultrastructural analysis of an apocrine carcinoma of the breast is presented. The key finding with electron microscopy is numerous large mitochondria with abundant incomplete cristae. The ultrastructure of this tumor is compared to the ultrastructure of apocrine cells in the skin, oncocytes, and apocrine metaplastic cells of the breast. The apocrine carcinoma cells have some of the features of typical metaplastic breast epithelium and some features of oncocytes. Their exact origin remains open to speculation.

Stromal reaction to neoplasia: colonic carcinomas

The stroma and stromal reaction in the normal colon and in 14 different colonic tumors were studied by electron microscopy. Elastosis is a significant part of the stromal reaction to colonic adenocarcinomas and rectal squamous cell carcinomas. Two carcinoid tumors elicited no significant elastosis. In some of the adenocarcinomas, small muscular arteries close to neoplastic tissue developed massive elastosis of the media. This may indicate that the elastosis is due to stimulation of nonneoplastic stromal cells by some unknown neoplastic factor or factors.

Elastosis in benign and malignant salivary gland tumors. A histochemical and ultrastructural study

One hundred sixteen cases of various types of salivary gland tumors were examined for the presence of elastic tissue. Almost all the pleomorphic adenomas (97%) and all the malignant pleomorphic adenomas contained elastic tissue in varying amounts. A high percentage (82%) of adenoid cystic carcinomas also contained elastic tissue but the overall quantity was significantly less than in pleomorphic adenomas. All other salivary gland tumors studied, i.e. adenolymphomas, oxyphilic adenomas, mucoepidermoid tumor, and various variants of monomorphic adenomas, were devoid of significant elastic tissue. At the ultrastructural level, the elastic fibers were mainly seen close to neoplastic myoepithelial-like cells, and all stages of elastogenesis were present, ranging from young elastic fibers with a high microfibrilelastin ratio, usually associated with basal-membrane-like material, to mature fibers consisting mainly of an amorphous electron lucent central elastin component. It is postulated that elastic tissue in the salivary gland tumors is produced by the myoepithelial-like tumor cells rather than by tumor stromal induction as has been described in some types of breast carcinomas.