Total Lactate Dehydrogenase and Tumor Necrosis Factor Alpha Levels in Cyst Fluid of Women with Gross Cystic Breast Disease

Human gross cyst breast disease and cystic fluid: bio-molecular, morphological, and clinical studies

For more than one and a half century the cystic disease of the breast has been recognized as the most frequent female benign breast lesion. Although some conundrums and controversies exist about the relation between gross cysts and breast cancer, recent evidence suggests that the multidisciplinary study of gross cystic breast disease (GCBD) may be a powerful tool for predicting the natural history of the multifaceted gross cyst pathology. A lot of papers have been published on breast cyst fluids (BCF) concerning biochemical, hormonal and morphological aspects, demonstrating that the intracystic fluid contains a wide variety of components (such as ions, lipids, proteins, enzymes, growth factors and antigens) and suggesting that their profile provides additional knowledge on both physiopathology and etiologic pathways of human gross cystic breast disease. The aim of this overview is the critical evaluation of all data accumulated in the last thirty years, in order to highlight the utility of biochemical and epidemiological studies to identify gross cysts, if any, at higher breast cancer risk.

[Electrophoretic patterns of lactate dehydrogenase isoenzymes in fluid from 261 benign breast cysts]

BACKGROUND

Some groups have described the presence of lactate dehydrogenase (LDH) and certain isoenzymes in breast cyst fluids, but their clinical usefulness is unknown. We have studied the behavior of LDH isoenzymes in benign breast cysts fluids with the aim of understand their clinical meaning.

SUBJECTS AND METHOD

The study group included 261 benign breast cyst fluids classified, according to the Na+ / K+ ratio, as follows: type I (Na+ / K+ >/= 3): 188, and type II (Na+ / K+ > 3):73. The electrophoretic LDG isoenzymes analysis was carried out with the PARAGON system and the Appaise Junior densitometer from Beckman Instruments (U.S.A.).

RESULTS

The results were as follows: a) type II was more frequently associated with the presence of LDH than type I breast cyst fluids (41/73 vs 9/188; p < 0.0001) and b) the LDH5 isoenzyme positivity was higher in type II than in type I breast cysts fluids (29/41 vs 4/188; p < 0.001) also and it correlated with higher pH, C1, carcinoembryonic antigen and Na+ / K+ ratio values.

CONCLUSIONS

Our results led us to consider that LDH and LDH5 isoenzyme positivity is associated with type II breast cyst fluids, suggesting that it does not reflect a higher transformation risk, but rather that is a consequence of cyst evolution and of its lining wall.