α1-Antitrypsin, Transferrin, Alkaline Phosphatase, Phosphohexoseisomerase and γ-Glutamyltransferase in Breast Cyst Fluid

Levels of Human Chorionic Gonadotropin in Breast Cyst Fluid

The results of dosage of human chorionic gonadotropin (HCG) in 75 breast cyst fluids taken from 61 patients suffering from breast gross cystic disease (BGCD), 13 of which had multiple mono and / or bilateral cysts are discussed. The corresponding sera were also examined. Assays were carried out using the ELISA method. For comparison, HCG levels were also determined in 21 breast cyst fluids using RIA method. In 66.7% of the breast cyst fluids examined the hormone levels were higher than normal serum values. Corresponding sera showed HCG to be within the range of normal levels. In 5 patients the multiple and / or bilateral cysts showed widely differing hormone levels. The importance of these observations is discussed.

Circulating Immune Complexes in Human Breast Cyst Fluids: Relationship with Intracystic Immunoglobulin and Electrolyte Levels

Circulating immune complexes, the major classes of immunoglobulins and electrolyte concentrations were measured in sixty-two breast cyst fluids aspirated in women affected by gross cystic breast disease. Two main classes of cysts were defined according to the Na/K ratio. Appreciable levels of immunoglobulins were found in almost all samples examined; 66% of breast cyst fluids showed increased levels of immune complexes. A highly significant linear correlation between increased values of immune complexes and immunoglobulin M (p < 0.001) was found in apocrine cysts, characterized by Na/K ratio <3. However, a significant inverse linear correlation was found between positive values of immune complexes and lowered levels of immunoglobulins A (p < 0.001) and G (p < 0.001) in epithelial cysts with Na/K ratio > 3. These data suggest and confirm that the menstrual cycle can also influence or modulate the metabolic activity of human breast cells as a part of the secretory immune system. The relationship between immune complexes and immunoglobulins and electrolyte profiles may provide further knowledge about the immunological features of breast cyst fluid and suggest the possible alteration of immune-response in cystic breast lesions associated with increased cancer risk

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.

Ultrastructural characterization and biochemical profile of human gross cystic breast disease

Human gross cystic breast disease is a benign condition affecting about 7-10% of adult women occurring with the highest incidence in the premenopausal decade. Although breast cysts do not represent a preneoplastic condition per se, several studies indicate an increased breast cancer risk in women affected by this pathology. In this report we study 115 breast cystic fluid samples obtained by needle-aspiration from women with gross cystic breast disease. The samples were analysed biochemically and the cells contained therein were observed at the electron microscope. According to their biochemical profiles, the cysts were subdivided into three types: Type I, showing a Na/K ratio < 0.5 and a typical protein content; Type II, showing a Na/K ratio >10 and a protein content quite similar to plasma; Type III, showing a Na/K ratio between 1 and 7 and an intermediate protein content. The electron microscopic examination demonstrated that Type I cystic fluid cells exhibit morphological features typical of actively synthesising and secreting cells, while the characteristics of Type II cells indicate a low metabolic activity. Type III cells have characteristics typical of both Type I and Type II cells, thereby confirming the intermediate nature of this cyst type. We hypothesise that these cyst types could represent different developmental stages of a structural evolution pathway, during which the biosynthetically active 'apocrine stage' would be the key step to cell neoplastic transformation.

Lipid-associated sialic acid levels in human breast cyst fluids

Benign mammary gross cystic disease is the most common breast lesion. Women with apocrine changes of epithelium lining the cysts are at higher risk for developing breast cancer than the normal female population. Sialic acid has drawn considerable interest because of carbohydrate aberrations in malignant cells. The current investigation determined the concentrations of lipid-associated sialic acid (LASA) in 62 breast cyst fluids and sera. Data analyses show a significant increase in the mean values of LASA in metabolically active apocrine cysts when compared to the cysts with Na+/K+ > 3 (flattened cysts) (p < 0.001). The greater LASA levels in cyst fluids with lower intracystic Na+/K+ ratios could represent an altered expression of biosynthetic activity of the surrounding apocrine cell surface sialoglycolipid metabolism, providing a possible explanation of why women with apocrine cysts may be at greater cancer risk and being useful in further studies on functional stage changes in the cysts and their relationship to breast cancer.

Mutagens in human breast cyst fluid

Cyst fluids aspirated from patients presenting with palpable cysts of the breast were analysed for mutagenic activity, as determined by the Ames test. Of the 439 women studied, 9.6% had mutagen-positive fluids. There was no obvious relationship between the presence of mutagen-positive fluids and clinical or epidemiological details of the women from which they were obtained. Preliminary characterisation of the mutagenic activity suggested that the responsible agents have diverse chemical properties.

Ferritin and transferrin levels in human breast cyst fluids: relationship with intracystic electrolyte concentrations

The concentrations of sodium and potassium and the content of ferritin and transferrin, proteins considered as potential markers for identifying cells undergoing divisional activity, were measured in fluid from 30 human breast cysts. On the basis of the relative electrolyte concentrations, two main classes of cysts were defined. When the cyst fluids were subdivided according to their Na+/K+ ratio, a significant difference was found between menstruating vs. menopausal patients. The relationship between the two major iron-binding proteins and the Na+/K+ ratio may indicate the expression of a local higher biosynthetic activity in apocrine cysts associated with higher cancer risk.

Urokinase and tissue-type plasminogen activators are present in breast cyst fluids

Breast cyst fluids obtained by needle aspiration from 20 patients were analysed for the presence of urokinase-like (u-PA) and tissue-type (t-PA) plasminogen activators. Plasminogen, the natural substrate for these PAs, was also measured. u-PA activity was detected in 18 samples (mean +/- S.D. = 1.11 +/- 1.08 IU ml-1) and t-PA activity in 16 samples (0.35 +/- 0.28 IU ml-1). Plasminogen was detected in 10 samples (mean = 37 micrograms ml-1), range 28-85 micrograms ml-1) and was below the assay detection limit in the other samples. While both u-PA and t-PA specific activities were greater in the 10 cyst fluids categorized as Group A (Na+ to K+ concentration ratio less than 4) than in the 10 samples categorized in Group B (Na+ to K+ concentration ratio greater than 4), the differences were not statistically significant. Nevertheless, this is the first evidence that u-PA and t-PA are present in active forms in breast cyst fluids. The significance of such activities must be hypothetical, but it is possible that a study of factors influencing the levels of u-PA and t-PA within the breast may yield information about pathophysiology of cystic and other diseases of the breast.

Lactate dehydrogenase, isoenzyme patterns and cation levels in human breast gross cyst fluid

In order to investigate the diagnostic and/or prognostic value of total activity and isoenzymatic patterns of lactate dehydrogenase, 24 human breast gross cystic fluids were studied. A comparison of total lactate dehydrogenase activity to the serum level revealed an increased activity in about 63% of the cases examined; moreover, a significant increase in the slow-moving lactate dehydrogenase 4 and 5 isoenzymes was observed in some cyst fluids. The levels of Na+ and K+ concentrations were also analyzed and two classes of cysts were identified: one presenting Na+ and K+ levels similar to those found in extracellular compartment; the other with high K+ and low Na+ levels, characteristic of an intracellular fluid. This latter pattern could indicate an active metabolism of the epithelial cells lining the cysts. This breast cyst fluid also showed increased levels of lactate dehydrogenase 4 and 5 isoenzymes. The correlation between an increased activity of lactate dehydrogenase 4 and 5 isoenzymes and high K+ and low Na+ levels could be the expression of a high biosynthetic activity and of an anaerobic metabolism in some cysts, suggesting the evolution of the breast gross cyst lesion to malignancy. The importance of these observations is discussed.