Precise diagnosis of breast phyllodes tumors using Raman spectroscopy: Biochemical fingerprint, tumor metabolism and possible mechanism

BACKGROUND

Breast fibroadenomas and phyllodes tumors are both fibroepithelial tumors with comparable histological characteristics. However, rapid and precise differential diagnosis is a tough point in clinical pathology. Given the tendency of phyllodes tumors to recur, the difficulty in differential diagnosis with fibroadenomas leads to the difficulty in optimal management for these patients.

METHOD

In this study, we used Raman spectroscopy to differentiate phyllodes tumors from breast fibroadenomas based on the biochemical and metabolic composition and develop a classification model. The model was validated by 5-fold cross-validation in the training set and tested in an independent test set. The potential metabolic differences between the two types of tumors observed in Raman spectroscopy were confirmed by targeted metabolomic analysis using liquid chromatography-tandem mass spectrometry (LC-MS/MS).

RESULTS

A total of 204 patients with formalin-fixed paraffin-embedded (FFPE) tissue samples, including 100 fibroadenomas and 104 phyllodes tumors were recruited from April 2014 to August 2021. All patients were randomly divided into the training cohort (n = 153) and the test cohort (n = 51). The Raman classification model could differentiate phyllodes tumor versus fibroadenoma with cross-validation accuracy, sensitivity, precision, and area under curve (AUC) of 85.58 % ± 1.77 %, 83.82 % ± 1.01 %, 87.65 % ± 4.22 %, and 93.18 % ± 1.98 %, respectively. When tested in the independent test set, it performed well with the test accuracy, sensitivity, specificity, and AUC of 83.50 %, 86.54 %, 80.39 %, and 90.71 %. Furthermore, the AUC was significantly higher for the Raman model than that for ultrasound (P = 0.0017) and frozen section diagnosis (P < 0.0001). When it came to much more difficult diagnosis between fibroadenoma and benign or small-size phyllodes tumor for pathological examination, the Raman model was capable of differentiating with AUC up to 97.45 % and 95.61 %, respectively. On the other hand, targeted metabolomic analysis, based on fresh-frozen tissue samples, confirmed the differential metabolites (including thymine, dihydrothymine, trans-4-hydroxy-l-proline, etc.) identified from Raman spectra between phyllodes tumor and fibroadenoma.

SIGNIFICANCE AND NOVELTY

In this study, we obtained the molecular information map of breast phyllodes tumors provided by Raman spectroscopy for the first time. We identified a novel Raman fingerprint signature with the potential to precisely characterize and distinguish phyllodes tumors from fibroadenoma as a quick and accurate diagnostic tool. Raman spectroscopy is expected to further guide the precise diagnosis and optimal treatment of breast fibroepithelial tumors in the future.

Oestrogen And Progesterone Receptors' Expression Pattern In Fibro-Adenoma Of The Female Breast

BACKGROUND

Fibro-adenoma is the most common benign condition of the female breast comprising about 68% of all breast lumps. Fibroadenoma is an independent risk factor for the development of breast cancer. Complex fibroadenoma has a 2-3-fold increased risk ratio and simple fibroadenoma has 1.49 times increased risk ratio of developing cancer than the normal population over a period of 20 years. This study aimed to qualitatively check the frequency of oestrogen receptor-positive and progesterone receptor-positive cases of fibroadenoma in our region.

METHODS

This cross-sectional study was conducted in the pathology department of Ayub Medical College, Abbottabad from June 2020 to December 2021. Biopsy confirmed cases of fibroadenoma were examined using immune-histochemical stains to score qualitatively the expression pattern of ER and PR. Data was analyzed and assessed using SPSS version 25. A p-value of ≤0.05 was considered statistically significant.

RESULTS

The mean age of patients who presented with fibro-adenoma was 24.5±9.29 years with a median age of 21.5 years. In most cases, oestrogen receptor expression was mild 23 (54.76%) whereas progesterone receptor expression was severe 19 (45.23%). On chi-square test, the pattern of progesterone receptor expression for the category of hormone intake showed significant differences. Whereas, the pattern of oestrogen receptor expression for the categories of marital status, history of hormone intake, history of menstrual cycle and type of fibroadenoma showed no statistically significant difference.

CONCLUSIONS

Further study into the pathogenesis of fibroadenoma is required to understand the role of ER and PR and explore the therapeutic potential of such drugs that affects these receptors. Cabling.

Single cell profiling of female breast fibroadenoma reveals distinct epithelial cell compositions and therapeutic targets

Fibroadenomas (FAs) are the most common breast tumors in women. No pharmacological agents are currently approved for FA intervention owing to its unclear mechanisms and a shortage of reproducible human models. Here, using single-cell RNA sequencing of human FAs and normal breast tissues, we observe distinct cellular composition and epithelial structural changes in FAs. Interestingly, epithelial cells exhibit hormone-responsive functional signatures and synchronous activation of estrogen-sensitive and hormone-resistant mechanisms (ERBB2, BCL2 and CCND1 pathways). We develop a human expandable FA organoid system and observe that most organoids seem to be resistant to tamoxifen. Individualized combinations of tamoxifen with ERBB2, BCL2 or CCND1 inhibitors could significantly suppress the viability of tamoxifen-resistant organoids. Thus, our study presents an overview of human FA at single-cell resolution that outlines the structural and functional differences between FA and normal breast epithelium and, in particular, provides a potential therapeutic strategy for breast FAs.

Comparative Proteomic Profiling of Secreted Extracellular Vesicles from Breast Fibroadenoma and Malignant Lesions: A Pilot Study

Extracellular vesicles (EVs) shuttle proteins, RNA, DNA, and lipids crucial for cell-to-cell communication. Recent findings have highlighted that EVs, by virtue of their cargo, may also contribute to breast cancer (BC) growth and metastatic dissemination. Indeed, EVs are gaining great interest as non-invasive cancer biomarkers. However, little is known about the biological and physical properties of EVs from malignant BC lesions, and even less is understood about EVs from non-malignant lesions, such as breast fibroadenoma (FAD), which are clinically managed using conservative approaches. Thus, for this pilot study, we attempted to purify and explore the proteomic profiles of EVs from benign breast lesions, HER2+ BCs, triple–negative BCs (TNBCs), and continuous BC cell lines (i.e., BT-549, MCF–10A, and MDA-MB-231), combining experimental and semi-quantitative approaches. Of note, proteome-wide analyses showed 49 common proteins across EVs harvested from FAD, HER2+ BCs, TNBCs, and model BC lines. This is the first feasibility study evaluating the physicochemical composition and proteome of EVs from benign breast cells and primary and immortalized BC cells. Our preliminary results hold promise for possible implications in precision medicine for BC.

Patients With Invasive Ductal Carcinoma Have Reduced Levels of Decorin Expression in Their Breast Tissue Compared to Patients With Fibroadenoma While Plasma Decorin Remains Unchanged

BACKGROUND

Reduction in the level of tissue decorin is a hallmark of many types of cancer including breast carcinoma. However, reduced decorin expression has also been reported in several types of benign tumors to the extent that it has been proposed as a tissue marker to differentiate malignant from benign tumors. The aim of this study was to investigate the potential role of plasma decorin to distinguish breast cancer from fibroadenoma, the second most common type of benign tumor, after fibrocystic disease.

METHODS

From 35 patients recruited in this study, 24 were affected with invasive ductal carcinoma, either grade II (n = 14) or grade III (n = 10). The other 11 patients had fibroadenoma lesions in their breasts. Tissue decorin mRNA and protein levels were assessed with real-time qPCR and Immunohistochemical analysis. ELISA was employed to measure plasma levels of decorin.

RESULTS

The mean plasma decorin in cancer patients was measured to be 5.42 ± 1.83 ng/mL while fibroadenoma patients had an average of 4.22 ± 1.17 ng/mL decorin in their plasma. The difference was not significant. However, the mean expression level of decorin mRNA calculated by the 2-ΔΔCt method was 5.6-fold lower in the biopsied tissue specimens of IDC patients versus fibroadenoma, as expected. Consistent reduction in protein abundance was observed in the studied tissue sections.

CONCLUSION

We have shown that tissue decorin is a reliable marker, unaffected by patient disease stage, to differentiate IDC from fibroadenoma. However, plasma decorin does not seem to have diagnostic value in this regard.

Agnor Counts and their Combination with flow Cytometric Analyses and Clinical Parameters as a Prognostic Indicator in Breast Carcinoma

Silver binding nucleolar organizer regions (AgNORs) were counted in tissue sections and were shown to assist in the distinction between benign and malignant breast lesions. The mean AgNOR counts in fibroadenomas were 1.05 ± 0.85 (n=18), in lobular carcinoma 3.55 ± 0.56 (n=35), and in intraductal carcinoma 4.83 ± 1.20 (n=45). AgNOR counting may provide information on breast cancer prognosis supplementary to that obtained with other methods such as flow cytometric analysis. The AgNOR values in carcinomas were also compared with ploidy and S-phase fractions (S) by flow cytometry. More than 75% of the total cancers with counts above 3 dots per nuclear profile contained aneuploid cells, whereas 20% with counts below 3 contained diploid cells (P < 0.05). Similar trends were noticed with regard to S-phase fractions, which were 45% ± 12.5 and 14% ± 4.5, respectively, for the two groups (P < 0.05). AgNOR counting, flow cytometry and clinical parameters may provide complementary information on breast cancer prognosis.

C-Erbb-2 Protein Level in Tissue and Sera of Breast Cancer Patients: A Possibly Useful Clinical Correlation

Aims and background

The aims of this study were to assess the clinical utility of circulating preoperative HER-2 extracellular domain p105 detected by enzyme immunoassay (ELISA), to compare the tissue expression of HER-2/neu determined by immunohistochemistry (IHC), to correlate prognostic factors including tumor size, nodal involvement, and hormone receptor status, and to analyze the prognostic significance of the marker in relation to clinical outcome as measured by disease-free and overall survival.

Methods

In this study, we enrolled 108 consecutive patients with breast carcinoma, and obtained serum samples and frozen tumor tissues. We compared them with 57 women with fibroadenoma and 63 healthy women as controls.

Results

Univariate ANOVA analysis showed no relationship between HER-2/neu in tissue and serum. Preoperative serum levels of p105 were significantly higher in breast cancer patients than in women with benign disease or healthy women. Concerning the correlation between p105, HER-2/neu tissue expression, and the other prognostic factors, a statistically significant correlation between high serum p105 levels and ER-negative status in breast cancer patients was found. Kaplan-Meier analysis confirmed that patients with positive HER-2/neu tissue expression had a significantly shorter survival than those with negative expression. Analysis with the Cox model demonstrated that tumor size was the only significant independent prognostic factor.

Conclusions

This research failed to demonstrate a relationship between preoperative tissue overexpression and circulating HER-2/neu, suggesting that p105 does not represent a valid alternative to predict a worsened prognosis in breast cancer, but it could be a diagnostic marker to discriminate healthy subjects from breast cancer patients.

Fibroadenoma with "immature-like" type of usual ductal hyperplasia

We herein report a case of the breast fibroadenoma with foci of so-called immature variant of the conventional ductal hyperplasia. This type of usual ductal hyperplasia is histologically characterised by encircling intraductal proliferation of large cells with pale to amphophilic cytoplasm and large nuclei which vary in shape and in staining quality of the chromatin. We showed here, using the cytokeratin immunohistochemistry, that the proliferating cells were not of immature but rather mature immunohistochemical phenotype. Because of the presented discordance between immature histology and mature immunohistological profile we suggest that this rare type of usual ductal hyperplasia should be called "immature-like".

PLASMINOGEN AND ANGIOSTATIN LEVELS IN FEMALE BENIGN BREAST LESIONS

It is known that benign breast tissue exhibit relatively low angiogenic capacity. Activation of angiogenesis in mammary pre-malignant lesions could be associated with disease progression and high risk of transformation into the breast cancer. However, insight into the underlying molecular mechanisms involved in angiogenesis regulation in non-cancerous breast pathologies is still poorly defined. The purpose of the present study was to determine levels of plasminogen and its proteolytic fragments (angiostatins) in mammary dysplasia (mastopathy and breast cyst) and benign neoplasms (fibroadenomas). Plasminogen and angiostatins were analyzed using immunoblotting and quantified by densitometric scanning. The significant increase in plasminogen levels was found in fibrocystic, cysts, and non-proliferatious fibroadenoma masses (4.7-, 3.7-, and 3.5-fold, respectively) compared to healthy breast tissues (control). In the same benign lesions, 6.7-, 4-, and 3.7-fold increase in plasminogen 50 kDa fragment (angiostatin) levels as compared with control were also observed. Activation of matrix metalloproteinase-9, which was detected using gelatine zymography, could be responsible for plasminogen cleavage and abundance of angiostatin infibrocystic and cyst masses. In contrast, dramatic decrease of both plasminogen and angiostatin levels (3.8- and 5.3-folds, respectively) was shown in tissues of proliferatious form of fibroadenoma in comparison with that of the dormant type of this neoplasm. Based on the obtained results, we concluded that angiostatin, a potent vessel growth inhibitor and anti-inflammatory molecule, can play a crucial role in pathophysiology of non-cancerous breast diseases. Further studies are needed to evaluate potential diagnostic and clinical implications of these proteins for prediction and therapy of benign breast pathologies.

[Expression and clinical significance of MTDH and VEGF in triple-negative breast cancer]

OBJECTIVE

To study the expression and clinical significance of MTDH and VEGF in triple-negative breast cancer (TNBC).

METHODS

Tissue samples of 168 breast cancers (including 112 TNBC tissue and 56 non-TNBC tissue), 10 breast fibroadenomas and 15 normal breast tissues were collected. Postoperative specimens were examined by immunohistochemistry for MTDH and VEGF expression. The correlation between the expression of MTDH and VEGF and clinicopathological features was analyzed.

RESULTS

MTDH and VEGF were expressed in 57.1% and 49.4% of breast cancer patients, 64.3% and 56.3% in TNBC patients, respectively, significantly higher than that in the non-TNBC tissues, breast fibroadenomas and normal breast tissues (P<0.05 for all). Statistically significant correlation was found between the MTDH and VEGF expressions (r=0.356, P<0.001). Moreover, MTDH expression was correlated with tumor size, BMI index, lymph node metastasis, pathological stage, recurrence and metastasis, and the expression of p53 and Ki-67 proteins (P<0.05 for all). The VEGF protein expression was correlated with lymph node metastasis, pathological staging, recurrence and metastasis, and the expression of Ki-67 protein (P<0.05 for all). The patients with high expression of MTDH and VEGF showed a lower DFS and OS (P<0.05 for both).

CONCLUSIONS

MTDH and VEGF expression may be correlated with tumor angiogenesis and progression and has the potential to be valuable prognostic factors in patients with TNBC.

Armc8 expression was elevated during atypia-to-carcinoma progression and associated with cancer development of breast carcinoma

Armadillo repeat-containing protein 8 (Armc8) is a key factor to regulate cell membrane adhesion complex through promoting α-catenin degradation. However, its expression and function in human malignant tumors are largely unknown. Here, we present our study investigating Armc8 expression in tumor and non-tumor breast tissues including 45 normal epithelia, 53 lesions of hyperplasia with or without dysplasia, 22 benign tumors, and 92 carcinomas including 28 carcinomas in situ and 64 infiltrating carcinomas using immunohistochemistry (IHC) and Western blotting study. Armc8 expression was detected mainly in the cytoplasm with occasional membrane immunostaining. The positive rate of Armc8 expression in normal breast epithelia (8.9%, four out of 45) was very low. No significant difference was found between Armc8 expression in usual ductal hyperplasia (UDH) (11.1%, two out of 18), benign breast tumors including intraductal papilloma (10.0%, one out of 10) and fibroadenoma (8.3%, one out of 12), and normal breast epithelia (p>0.05). Elevated expression of Armc8 was found in breast epithelia with dysplasia (24.0%, six out of 25) compared to that in normal breast epithelia, UDH, and benign breast tumors (p<0.05). Armc8 expression in breast carcinoma including breast carcinoma in situ (10/28, 35.7%), infiltrating ductal carcinoma (60.7%, 34/56), and infiltrating lobular carcinoma (50.0%, 4/8) was higher than that in normal breast epithelia, UDH, benign breast tumors, and breast epithelia with dysplasia (p<0.05). The highest expression of Armc8 was found in infiltrating breast carcinoma (59.4%, 38/64) compared to all the other breast tissues. Higher Armc8 expression was found to be linked to lymph node metastasis and advanced tumor-node-metastasis (TNM) stages (III+IV) in infiltrating breast carcinoma (p<0.05). We further confirmed Armc8 expression in breast epithelial cell line MCF10A and breast carcinoma cell lines including MCF-7, MDA-MB-231, and ZR751 using Western blotting and immunofluorescent study. These results indicate that the elevated expression of Armc8 may be involved in carcinogenesis including atypia-to-carcinoma progression and cancer development of breast carcinoma.

[Methylation of Runx3 promoter in different breast lesions]

OBJECTIVE

To investigate the methylation status of Runx3 promoter and Runx3 expression in breast lesion tissues.

METHODS

One hundred and fourteen breast lesions, including 35 cases of fibroadenoma, 39 cases of intraductal carcinoma, 40 cases of invasive ductal carcinoma, and 33 cases of normal breast tissue from Fabruary 2010 to August 2012 were included in this study. Runx3 protein expression was assessed by immunohistochemical SP method; whereas methylation of Runx3 promoter was assessed by high resolution melting (HRM) analysis.

RESULTS

Runx3 protein was mainly expressed in the cytoplasm of ductal epithelial cells. The expression rates of Runx3 in normal breast tissue, fibroadenoma, ductal carcinoma in situ, invasive ductal carcinoma were 87.9% (29/33), 85.7% (30/35), 53.8% (21/39), and 40.0% (16/40) respectively. The methylation rates of Runx3 promoter were 12.1% (4/33), 20.0% (7/35), 46.2% (18/39), and 57.5% (23/40), respectively. Correlation analysis between promoter methylation and protein expression of Runx3 in different breast tissue showed the r value in normal breast tissue, fibroadenoma, ductal carcinoma in situ and invasive ductal carcinoma was -0.431 (P = 0.012), -0.408 (P = 0.015), -0.589 (P = 0.000) and -0.743 (P = 0.000) respectively.

CONCLUSIONS

Runx3 protein expression shows a downward trend in ductal carcinoma in situ and invasive ductal carcinoma, meanwhile its promoter methylation increases significantly. The methylation of Runx3 promoter may be one of the important factors in the occurrence and development of breast cancer.

[Expression of neuronal marker protein gene product 9.5 and its clinicopathologic significance in breast cancer]

OBJECTIVE

To detect the expression of pan-neuronal marker protein gene product (PGP)9.5 and its clinicopathologic significance in breast cancer.

METHODS

The expression of PGP9.5 was examined by immunohistochemistry EnVision method in 196 cases during 2007 to 2011, including 20 normal tissues, 14 cases of fibroadenoma, 18 cases of ductal carcinoma in situ (DCIS) and 144 cases of invasive ductal carcinoma (IDC) of the breast. The relationship between PGP9.5 expression and clinicopathologic characteristics of IDC was assessed.

RESULTS

PGP9.5 expression was localized in the stroma of all normal breast tissues, but there was no expression observed in all fibroadenomas and DCIS. Overall, the expression rate of PGP9.5 in IDC was 61.8% (89/144). PGP9.5 expression increased from grade 1 tumors (29.4%, 10/34) to grade 2-3 tumors (71.8%, 79/110; P = 0.000). In addition, patients with less than 3 years disease-free survival tended to show higher PGP9.5 expression (64.8%, 35/54), compared to patients with equal to and/or more than 3 years disease-free survival (46.7%, 42/90; P = 0.035). However, there was no correlation between PGP9.5 expression and tumor size, tumor stage, lymph metastasis, hormone receptor expression.

CONCLUSION

PGP9.5 expression is correlated with tumor grade and prognosis in IDC of the breast.

Nuclear survivin expression in stromal cells of phyllodes tumors and fibroadenomas of the breast

BACKGROUND/AIM

Survivin is expressed in the nucleus and/or cytoplasm of various types of malignant tumor cells. Nuclear survivin is indispensable for complete mitosis, while cytoplasmic survivin functions as an apoptosis inhibitor. We examined the difference in the survivin expression among stromal cells of fibroadenoma, and benign and malignant phyllodes tumors.

MATERIALS AND METHODS

Tumor sections were immunohistochemically stained with an anti-human survivin antibody and the labeling index of survivin was calculated.

RESULTS

In stromal cells of all tumors, survivin was expressed in the nuclei but not in the cytoplasm. The labeling indices of the stromal cells in five malignant phyllodes tumors (20.5±3.0) were significantly greater than those observed in eight fibroadenomas (1.9±0.6) or nine benign phyllodes tumors (3.0±0.9).

CONCLUSION

In the present study it was shown that stromal cells in malignant phyllodes tumors express nuclear survivin more extensively than stromal cells in benign phyllodes tumors or fibroadenomas.

Increased oxidative damage to membrane lipids following surgery for breast cancer

OBJECTIVES

To evaluate the level of oxidative damage to membrane lipids due to the breast cancer surgery in the early postoperative period.

PATIENTS AND METHODS

Blood samples were collected on the preoperative day and 24 hours postoperatively in 71 women operated for breast cancer, and preoperatively in 38 female patients with benign breast tumour. Lipid peroxidation (LPO) in the blood samples was estimated by measuring the concentrations of malondialdehyde+4-hydroxyalkenals (MDA+4-HDA) with spectrophotometry.

CLINICAL DATA INCLUDED

tumour site, tumour histological findings, cancer stage, grade, tumour volume, state of lymph nodes, type of surgery for breast, type of surgery for axilla.

RESULTS

Blood LPO level was similar in breast cancer patients and benign tumour patients (2.01±0.46 nmol/ml vs. 1.92±0.39 nmol/ml, respectively; p>0.05). In cancer patients, MDA+4-HDA increased on the first postoperative day, i.e. from 2.01±0.46 nmol/ml to 2.58±0.98 nmol/ml (p=0.0001). In women with benign breast tumour, LPO did not relate to the histological finding (p=0.8915). In the breast cancer group, preoperative LPO did not correlate with age, tumour volume and number of metastatic lymph nodes. Level of MDA+4-HDA was similar in stages I/II (2.03±0.46 nmol/ml) compared to stages III/IV (1.69±0.26 nmol/ml, p=0.1521). Consequently, levels of MDA+4-HDA did not relate to disease stage (p=0.1364).

CONCLUSIONS

Surgery for breast cancer causes peripheral increase in oxidative damage to macromolecules in the early postoperative period. Therefore, perioperative antioxidant supplementation should be considered.

[Expression of vascular endothelial growth factor receptor 3 in human breast cancer and its significance]

OBJECTIVE

To investigate the expression and prognostic value of vascular endothelial growth factor receptor 3 (VEGFR-3) in human breast cancer.

METHODS

A tissue microarray containing cores was constructed from 173 female patients with primary breast cancers (experimental group) and 19 female patients with benign breast lesions (control group) between March 2004 and June 2007. HE staining was performed to determine the quality of tissue microarray and immunohistochemistry staining was used to detect VEGFR-3 expression in the tissue microarray. Statistical analysis was performed to show the association between VEGFR-3 expression and clinicopathologic parameters.

RESULTS

Histological examination showed that the tissue microarray had good quality, which could represent the histological characteristics of breast cancer and benign breast lesions. VEGFR-3 was expressed in 55.5% (96/173) breast cancer patients of experimental group, while the expression was negative in lesions of control group. VEGFR-3 expression rate had no significant relation with age, estrogen receptor, and progesterone receptor (P > 0.05). VEGFR-3 expression rate correlated positively with tumor size and pathological staging compared to VEGFR-3 negative tumors (P < 0.05). The positive expression rate of VEGFR-3 in breast cancer with lymph node metastasis was significantly higher than that without lymph node metastasis (P < 0.05). Furthermore, VEGFR-3 positive staining correlated with human EGF receptor 2 expression (P < 0.05).

CONCLUSION

The expressions of VEGFR-3 in human breast cancer have close relations with lymph node metastasis. Thus, VEGFR-3 may be a potential prognostic indicator and a new anti-cancer target for breast cancer.

Selenium levels in neoplastic breast lesions

AIMS AND OBJECTIVES

The aim of this prospective case controlled study was to evaluate the tissue levels of selenium in patients with cases of fibroadenoma, cancer of the breast and in the controls in order to relate them to the occurrence of breast diseases.

SUBJECTS AND METHODS

Consecutive consenting patients who had histologically confirmed breast cancer and fibroadenoma attending the General surgical outpatients departments of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, were recruited for the study. One gram of core disease breast tissues was taken for Selenium level estimation.

RESULTS

There were 127 female subjects;. 95 (74.8%) cases of fibroadenoma and 32 (25.2%) of breast cancer. While breast cancer was common on the left, fibroadenoma was more common on the right breast (? = 8.994; p=0.011). The median tissue level of selenium in patients with fibroadenoma was 0.0272 mg/g with a range of 0.0124 to 0.0576 mg/g and that of the cancer patients was 0.0178 mg/g with a range 0.0072 to 0.0436 mg/g. These were statistically significantly different ( p=0.001). Factors affecting tissue selenium level include age (p<0.001), overall stage of breast cancer (p<0.001), maximum length of breast mass (p=0.023), previous delivery (p=0.004), age at last confinement (p=0.007), parity (p<0.001), oestrogen receptor (ER) status (p<0.001) and progesterone receptor (PR) status (p=0.021).

CONCLUSION

Tissue selenium was lower in breast cancer than in fibroadenoma; Tissue selenium inhibits carcinogenesis; low tissue level of selenium therefore may be a factor in the development of breast cancer.

Adipose tissue fatty acid composition in Greek patients with breast cancer versus those with benign breast tumors

BACKGROUND

Fatty acid composition of adipose tissue is a most reliable biomarker of long-term dietary fatty acid intake. Few studies have implemented biomarkers of fatty acid intake in relation to breast cancer. In this study the relation between adipose tissue composition and breast cancer was investigated.

PATIENTS AND METHODS

Fatty acid composition in breast and buttock adipose tissue from 94 Greek women with breast cancer and 57 with benign breast tumors was determined. Multivariate analysis was performed to determine the association between fatty acid groups and breast cancer risk.

RESULTS

In pre-menopausal women, elevated total polyunsaturated fatty acids (PUFA) in breast adipose tissue and N-3 PUFA in buttock adipose tissue were associated with reduced odds of breast cancer (odds ratio, OR=0.19; 95% confidence interval, CI=0.05-0.76, p<0.02 and OR=0.02; 95% CI=0.0009-0.36, p<0.009).

CONCLUSION

Adipose total PUFA and N-3 PUFA were inversely-related to breast cancer risk in Greek pre-menopausal women. These results may have specific impact on habitual fat intake recommendations.

Expression of JMJD2A in infiltrating duct carcinoma was markedly higher than fibroadenoma, and associated with expression of ARHI, p53 and ER in infiltrating duct carcinoma

Jumonji Domain Containing 2A (JMJD2A) may be a cancer-associated gene involved in human breast cancer. With a view to investigating expression of JMJD2A in human breast cancer and benign lesion tissues as well as relationship between JMJD2A and tumor related proteins, histological and immunohistochemical analysis, Western blot and quantitative real-time PCR in infiltrating duct carcinoma and fibroadenoma for JMJD2A and immunohistochemical analysis and quantitative real-time PCR in infiltrating duct carcinoma for tumor related proteins (ARHI, p53, ER, PR and CerbB-2) were performed. Histological examination validated the clinical diagnosis. The JMJD2A positive rate of infiltrating duct carcinoma was significantly higher than fibroadenoma by immunohistochemical analysis. The mean optical density of JMJD2A in infiltrating duct carcinoma was higher than fibroadenoma by western blot. JMJD2A mRNA level in infiltrating duct carcinoma was higher than fibroadenoma by quantitative real-time PCR. Spearman correlation analysis revealed that the expression of JMJD2A was associated with ARHI, p53 and ER from immunohistochemical results respectively. Pearson correlation analysis revealed that the expression of JMJD2A was associated with ARHI, p53 and ER from quantitative real-time PCR results respectively. Expression of JMJD2A in infiltrating duct carcinoma was higher, and associated with ARHI, p53 and ER. The results may take JMJD2A as a potential diagnostic and therapeutic target in human breast cancer.

Immunohistochemical profile of the estrogen and progesterone receptors in mammary benign lesions

The immunohistochemical diagnosis for estrogen and progesterone receptors must be carried out in the tracking of every primary tumor, benign or malign, especially in the case of in situ carcinoma.

MATERIAL AND METHOD

We have studied the expression of estrogen and progesterone receptors in benign lesions, identifying phenotypes depending on the presence of estrogen and progesterone receptors.

RESULTS

The result "positive" or "negative" in the report sent to the doctor is not sufficient, the inclusion of the total score in the case of a positive result, the clone used, the usage / non-usage of antigenic exposure and also the quality control being necessary. The benign mammary lesions occur in the context of a hormonal imbalance, which, in the long run runs the risk of developing a mammary carcinoma.

CONCLUSION

The further study of the hormonal spectrum of those lesions, considered as pre-malignant, may lead to the identification of some groups of hyperplastic lesions, presenting a high risk for developing a mammary cancer.

Changes in glycosaminoglycans and proteoglycans of normal breast and fibroadenoma during the menstrual cycle

BACKGROUND

Fibroadenoma is the most common breast tumor in young women, and its growth and metabolism may be under hormonal control. In the present paper we described the proteoglycan (PG) composition and synthesis rate of normal breast and fibroadenoma during the menstrual cycle.

METHODS

Samples of fibroadenoma and adjacent normal breast tissue were obtained at surgery. PGs were characterized by agarose gel electrophoresis and enzymatic degradation with glycosaminoglycan (GAG) lyases, and immunolocalized by confocal microscopy. To assess the synthesis rate, PGs were metabolic labeled by 35S-sulfate.

RESULTS

The concentration of PGs in normal breast was higher during the secretory phase. Fibroadenoma contained and synthesized more PGs than their paired controls, but the PG concentrations varied less with the menstrual cycle and, in contrast to normal tissue, peaked in the proliferative phase. The main mammary GAGs are heparan sulfate (HS, 71%-74%) and dermatan sulfate (DS, 26%-29%). The concentrations of both increased in fibroadenoma, but DS increased more, becoming 35%-37% of total. The DS chains contained more β-d-glucuronic acid (IdoUA/GlcUA ratios were >10 in normal breast and 2-7 in fibroadenoma). The 35S-sulfate incorporation rate revealed that the in vitro synthesis rate of DS was higher than HS. Decorin was present in both tissues, while versican was found only in fibroadenoma.

CONCLUSIONS

In normal breast, the PG concentration varied with the menstrual cycle. It was increased in fibroadenoma, especially DS.

GENERAL SIGNIFICANCE

PGs are increased in fibroadenoma, but their concentrations may be less sensitive to hormonal control.

Phyllodes tumors and fibroadenoma common beginning and different ending

Phyllodes tumors and fibroadenomas are the most common benign breast tumors. They arise from intralobular fibrous tissue as a unique lesion and after a period of time they differentiate in two direction: to fibroadenoma and to phyllodes tumors. Fibroadenomas grow up to 2-3 cm and then stop growing but phyllodes tumors grow continually and sometimes are to 40 cm big. Both these lesions have two components, epithelial and stromal. Clinically fibroadenomas are well circumscibed, hard, oval, movable lesions. They can be solitary, multiple, unilateral and bilateral. They are hormone dependent changes, because they change their own consistency during menstrual cycle and gravidity. The most commonly used histological classification is in two types: pericanalicular and intracanalicular type. Phyllodes tumors make about 1% of all breast tumors. This tumor has many synonyms. It starts as fibroadenoma in intralobular stromal component. It has continuous growth and biologically it can be benign, borderline and malignant. The first description is from Miller (1838). The main goal is to find the divergence point when the developing is direct to fibroadenoma or phyllodes tumor. The second goal is to investigate the fate of epithelial and stromal component in these two lesions. Retrospective analysis is made of all fibroadenomas and phyllodes tumors in Pathology Department of Medical Center "Bezanijska kosa" in the period from 1998 to 2006. In this period, 2919 women were operated for breast changes. 343 fibroadenoma (24, 4%), were diagnosed, benign phyllodes tumor in 95 women (6.7%) and malignant phyllodes in 4 cases or 0.2%. All slides from these patients were analysed for many different histological parameters and immunohistological investigation for steroid receptors was also used, c-erbB2 (Her2/Neu), PCNA (proliferative cellular nuclear antigen) and Ki-67, androgen receptor and p53. All data were statistically investigated (Odds ratio, confidence interval, Fisher exact test, Wilcoxon sum test and Kendall test). It was concluded that fibroadenomas and phyllodes tumors arise from intralobular fibrous tissue, both changes have very close histology in the beginning and divergent growth starts later. Differences are present in stromal component. Phyllodes tumor has two component stroma. Stromal cells in phyllodes tumors are more PCNA positive than in fibroadenomas, also Ki-67 and androgen receptors are more positive in phyllodes tumors. Histologically phyllodes tumors have perforated capsule with finger like projections. These data determine surgical procedure, wide excision in phyllodes and simple excision in fibroadenomas.

Evaluation of E6 and E7 mRNA expression in HPV DNA positive breast cancer

Several studies have suggested a possible role for HPV in the pathogenesis of the breast cancer. We investigated the presence of the HPV DNA in breast cancers and non malignant disease breast tissues by the use of a standard HPV detection method (INNO-Lipa HPV), in order to detect HPV DNA in metastatic nodes, to investigate a possible cervical HPV co-infection, and to evaluate the E6/E7 mRNA expression in HPV DNA positive breast cancer tissues. The rate of HPV infection was significantly higher in the cancer group than in controls (9/31 vs. 0/12, p = 0.04). One out of eight metastatic axillary nodes was positive for HPV infection; 2/3 of the positive HPV breast cancer patients were co-infected at the cervical site. The role of the virus in breast oncogenesis is still unclear, since our analysis failed in demonstrating the expression of viral E6 and E7 in positive HPV positive breast tumor tissues.

Combined development of thyroid gland and reproductive system benign diseases

The aim of the study is to establish the role of endocrine disturbances in development of malignant tumors in patients with thyroid gland and reproductive system pathology. We studied 207 patients with synchronic and metachronic development of thyroid gland and reproductive system benign tumors. The patients' average age was 35-58 years. According to study the following aspects were determined: clinical and hormonal aspect of thyroid gland and reproductive system benign tumor disease coincidence, analyses of thyroid gland and reproductive system pre-cancer disease pathogenesis, neuroendocrine relations-like increased thyrotrophic hormone secretion causes strengthening of prolactin secretion, which depresses luteinizing hormone release and increases production of follicular stimulating hormone. It has been proved that fibromyomas absolute hyperestrogenemia which develops during hypersecretion of follicular stimulating hormone (FSH) plays a role in etiology of uterine Gonadoliberin hypersecretion, especially follicular stimulating hormone FSH and corpus luteum deficiency is very important in development of ovarian pre-cancer and cancer diseases.

[Robo1 expression in breast cancer and its relationship to brain metastasis]

OBJECTIVE

To detect the expression of Robo1 in different breast tumors and its association with the breast cancer brain metastasis.

METHODS

Labelled streptavidin-biotin (LSAB) staining was used to examine the Robo1 expression in specimens from 24 cases of invasive ductal carcinoma (IDC) with brain metastasis, 71 cases of IDC without brain metastasis, 22 cases of ductal carcinoma in situ (DCIS) and 23 cases of fibroadenoma.

RESULTS

The expression pattern of Robo1 in DCIS (59.1%) and IDC (45.3%) was significantly lower than that in adenofibroma (87.0%, P < 0.05). The expression of Robo1 in IDC with brain metastasis (12.5%) was significantly lower than that in IDC without brain metastasis (56.3%, P < 0.05). The expression of Robo1 was much higher in more than 50 year-old-group (57.8%) than that in less than 50 year-old-group (34.0%) of IDC patients. The overall survival time in patients with the Robo1 negative expression was significantly shorter than those with positive expression (P < 0.05). No correlation was found between the Robo1 expression and the tumor size, lymph node metastasis, pathologic stage, histological grade and clinical stage (P > 0.05).

CONCLUSIONS

The Robo1 expression correlates negatively with IDC brain metastasis, and correlates positively with the age and prognosis of IDC patients. Robo1 may be applied as a marker in evaluation of the IDC prognosis and brain metastasis.

[Abnormal expression of RSK-4 and its clinical significance in breast cancer]

OBJECTIVE

To study the expression and clinical significance of ribosomal S6 kinase-4 (RSK-4) in breast cancer and explore the role of RSK-4 in the genesis and development of breast cancer.

METHOD

The expression levels of RSK-4 mRNA and protein were detected in 56 cases of breast cancer and the normal breast tissues, as well as in 20 cases of breast benign lesions, by reverse transcriptase polymerase chain reaction (RT-PCR) and immunohistochemistry.

RESULTS

The expression rates of RSK-4 mRNA in breast cancer, the normal breast tissues and breast benign lesions were 48.2%, 76.8% and 75.0%, respectively. The expression level of RSK-4 mRNA in breast cancer was significantly lower than those in normal breast tissues and breast benign lesions tissues (P < 0.05). The expression level of RSK-4 significantly correlated with tumor size and clinical stage (P < 0.05).The expression rate of RSK-4 protein was 39.3% in breast cancer tissues, which was significantly lower than that of normal breast tissues (71.4%) and breast benign lesions (75.0%, P < 0.01). The expression level of RSK-4 protein was lower in breast cancer with large tumor, high clinical stage and lymph node metastasis. In 56 cases of breast cancer samples, the consistency rate of RSK-4 mRNA and protein was 73.2%. A significant correlation was found between RSK-4 mRNA and protein (χ² = 10.254, P < 0.05).

CONCLUSION

The down-regulation of RSK-4 expression in breast caner suggests that it is a breast cancer suppressor gene, and the lack or down-regulation of RSK-4 expression is involved in the genesis and progression of breast cancer.

4-Vinylcyclohexene diepoxide (VCD) inhibits mammary epithelial differentiation and induces fibroadenoma formation in female Sprague Dawley rats

4-Vinylcyclohexene diepoxide (VCD), an occupational chemical that targets ovarian follicles and accelerates ovarian failure in rodents, was used to test the effect of early-onset reproductive senescence on mammary fibroadenoma formation. One-month female Sprague Dawley rats were dosed with VCD (80 mg/kg or 160 mg/kg) and monitored for 22 months for persistent estrus and tumor development. Only high-dose VCD treatment accelerated the onset of persistent estrus relative to controls. However, both doses of VCD accelerated mammary tumor onset by 5 months, increasing incidence to 84% (vs. 38% in controls). Tumor development was independent of time in persistent estrus, 17 β-estradiol, androstenedione and prolactin. Delay in VCD administration until after completion of mammary epithelial differentiation (3 months) did not alter tumor formation despite acceleration of ovarian senescence. VCD administration to 1-month rats acutely decreased mammary alveolar bud number and expression of β-casein, suggesting that VCD's tumorigenic effect requires exposure during mammary epithelial differentiation.

Human sodium iodide symporter (hNIS) in fibroadenoma breast--a immunohistochemical study

Human sodium iodide symporter (hNIS), responsible for the active transport of iodine is an integral plasma membrane glycoprotein present in the thyroid cells and extrathyroid tissues like breast and salivary glands. If its functional form is unequivocally shown in benign or malignant breast tissues, then it may serve as a basis for diagnosis and treatment using radioactive iodine. With an aim to analyze the hNIS expression in a distinct benign breast condition of fibroadenoma, biopsy proven fibroadenoma tissues, normal non-lactating breast tissue and biopsy proven infiltrating duct carcinoma tissues were examined for hNIS expression using immunohistochemistry. Out of 20 biopsy proven fibroadenoma tissues, 19 (95%) showed positivity for hNIS protein and only one was negative. Of these 10% were mildly positive, 50% cases were moderately positive and 35% showed intense positivity. None of the control tissue obtained from reduction mammoplasty specimens or normal breast tissues samples (5 cms away from the tumor) were positive, hNIS was also intensely positive in 9 out of 10 (90%) infiltrating duct carcinoma tissues and moderately positive in one case. These preliminary results show that hNIS was present in high frequency as demonstrated by immunohistochemistry in fibroadenoma breast.

[Significance of chemokine receptor CXCR3 expression in breast cancer]

OBJECTIVE

To investigate the expression of CXCR3 and its association with clinicopathologic features in breast carcinoma.

METHODS

The expression level of CXCR3 in 18 samples of breast cancer and corresponding normal tissues was investigated using reverse transcriptase-polymerase chain reaction (RT-PCR) and real-time RT-PCR analysis. Immunohistochemistry was carried out to examine the expression of CXCR3 in 80 breast cancers, 20 fibroadenomas and 15 normal breast tissues.

RESULTS

(1) RT-PCR and real-time RT-PCR analysis showed a higher level of CXCR3 in breast cancer tissues than that in the corresponding normal breast tissues (P < 0.05). (2) Immunohistochemistry analysis showed that the positive rate of CXCR3 in breast cancer tissues was significantly higher than that in fibroadenomas and the normal breast tissues (P < 0.05). The expression level of CXCR3 in the lymph node-positive group was higher than that in the lymph node-negative group (P < 0.05). The expression of CXCR3 was positively correlated with the number of lymph nodes involved by metastasis, tumor size and pTNM tumor stage (P < 0.05).

CONCLUSIONS

Chemokine receptor CXCR3 was up-regulated in breast cancer, and was associated with the progression of breast cancer. CXCR3 might be a novel molecular marker to predict lymph node metastasis and prognosis of breast cancer.

Up-regulation of human arrest-defective 1 protein is correlated with metastatic phenotype and poor prognosis in breast cancer

BACKGROUND

Human arrest defective 1 protein (ARD1), as a N-terminal acetyltransferase, has been reported to play a crucial role in tumorigenesis, but the results are somewhat controversial. To explore the clinical and pathological significance of ARD1 in breast tumorigenesis, we analyzed ARD1 status in multiple types of breast disease.

METHODS

The expression of ARD1 protein was assessed by immunohistochemistry in 356 cases including 82 invasive ductal carcinomas (IDC), 159 fibroadenomas, 66 hyperplasia of mammary glands, 19 inflammatory breast disease, 30 breast cysts, and in 29 postoperative treatment patients. We assessed the relationship of ARD1 protein with clinical and pathological characteristics using χ2 test.

RESULTS

ARD1 protein was observed at 61.0% (50/82), 54.7% (87/159), 37.9% (25/66), 36.8% (7/19) in IDC, fibroadenoma, hyperplasia, and inflammation, respectively, and less than 30.0% for breast cyst. Thus, high ARD1 expression correlated with breast cancer (relative risk = 1.32, P < 0.005). Moreover, the level of ARD1 protein in carcinoma patients was distinctly related to lymph node metastasis and ER status, with 94.0% (47/50) as copmpared to 6.0% (3/50) in metastatic and non-metastatic (P < 0.001), and 84.0% (42/50) and 16.0% (8/50) for ER + and ER - (P < 0.01), respectively. In addition, the level of ARD1 appeared to have potential for evaluation of prognosis in breast cancer patients after postoperative therapy.

CONCLUSIONS

These results suggest that ARD1 expression may be as a potential target for exploring the mechanism of breast cancer metastasic to lymph nodes and hormone-responsive regulation.

Role of exogenous and endogenous sources of estrogen on the incidence of breast fibroadenoma: case-control study in Iran

Breast fibroadenoma (FAD) is the most common benign mammary condition among women but the environmental risk factors have not identified yet. As the role of long term estrogen exposure in the incidence of FAD has been remained controversial; we have decided to investigate the possible role of endogenous and exogenous sources of estrogens in present study. Women less than 45 years old who underwent surgery from June 2009 to June 2010 were matched with controls by age and hospital. From reproductive factors, lack of breast feeding (p< 0.001, 8.76 CI95% 3.79-20.24), Nulliparity (p=0.001, OR=8.09, CI95% 3.505-18.67), Lack of parity (p=0.001, OR=6.64, CI 95% 2.56-16.31) and Hormonal dysfunction (p=0.016, OR=4.66, CI 95% 1.26- 17.28) were considered as the most important ones. Adiposity and abnormal weight gain after 18 years were considered as major background factor which induce FAD and may be contributed to the level of endogenous estrogen. Out of evaluated exogenous sources of estrogen, lower age at first OCP consumption (20.76_+3.87 vs. 22.85_+3.88, p=0.046) and living near Polycyclic aromatic hydrocarbons (PAHs) producing factories (p< 0.001, OR=3.7, CI95%1.61-7.94), were considered as the main sources of exposure to xenestrogens in FAD patients but FAD showed inverse association with cigarette smoking because of antiestrogenic activities of cigarette smoking . This study concludes that the incidence and development of FAD could be associated with the reproductive history of women, activity of ovarian hormones as well as environmental factors.

Association between glycodelin and aryl hydrocarbon receptor in Iranian breast cancer patients: impact of environmental endocrine disrupting chemicals

Breast cancer affects Iranian women one decade younger than their counterparts in other countries and the underlying risk factors have remained controversial. The aryl hydrocarbon receptor (AhR) mediates the effects of many environmental endocrine disruptors and contributes to the many other genes and Gd is an endocrine-regulated glycoprotein which may induce by AhR ligands in endometrium. This study has aimed to compare the interactions between Gd and AhR and other fundamental genes (p53, K-Ras, ER, PgR, AR) between pre and post menopausal Iranian breast cancer patients. To conduct immunohistochemical studies with appropriate monoclonal antibodies, 25 premenopausal invasive ductal carcinomas and 29 postmenopausal invasive ductal carcinomas were selected retrospectively in 2008-2010 from the pathology department of Imam Khomeini hospital complex of Tehran. Higher levels of AhR in epithelial cells of premenopausal patients and breast fibroadenoma emphasized the susceptibility of these cells to environmental induced tumors. Current study demonstrated a significant association between tumoral levels of Gd and AhR (p=0.002) in breast cancers which confirms the preliminary hypothesis about the role of TCDD exposure on Gd biosynthesis and secretion in TCDD-treated endometrial epithelial cells. In summary this study showed the dual prognostic role of Gd especially in premenopausal breast cancer which could be induced by AhR overexpression. Further studies are necessary to find the direct role of breast carcinogens as well as endocrine disrupting chemicals on the differential levels of Gd in breast tumors.

Expression of c-kit in common benign and malignant breast lesions

AIMS AND BACKGROUND

c-kit (CD117) is a transmembrane tyrosine kinase that acts as a type III receptor for mast cell growth factor. In recent years, the role of c-kit in the development of preinvasive and invasive breast carcinomas has been investigated. The aim of our study was to detect c-kit expression in the entire spectrum of common benign and malignant breast lesions in correlation with a well-studied myoepithelial or stem-cell like marker (p63).

METHODS AND STUDY DESIGN

We evaluated 270 cases of benign and malignant breast lesions including fibrocystic disease, fibroadenoma, sclerosing adenosis, atypical ductal hyperplasia, ductal/lobular carcinoma in situ, and ductal/lobular/mixed type carcinoma. C-kit staining was evaluated in the cytoplasm/cell membrane in epithelial and myoepithelial cells and p63 in the nuclei of myoepithelial cells.

RESULTS

c-kit was highly expressed (85.3%) in benign lesions (fibrocystic disease, sclerosing adenosis, fibroadenoma), and p63 expression was 95.5% in the aforementioned lesions. c-kit distribution in preinvasive and invasive lesions was as follows: ductal/lobular carcinoma in-situ, 43%/35%; ductal/lobular carcinoma, 36%/39%; and mixed type carcinoma, 20%. c-kit was highly expressed in myofibroblast/fibroblast cells only in grade III ductal/lobular carcinomas. c-kit was totally absent in stromal cells in benign lesions and in situ carcinomas whereas expression was weak in grade I and II carcinomas.

CONCLUSIONS

Combined overexpression of c-kit and p63 is indicative of benign breast lesions. In contrast, there is reduced expression of c-kit in in situ and invasive breast carcinomas, with simultaneous overexpression in the stromal cells. This suggests that c-kit may play a role in breast cancer progression.

[Expression of BCSG1-siRNA in tumor transplants of human breast cancer cell line in nude mice]

OBJECTIVE

To investigate the inhibitory effects of siRNA targeting BCSG1 gene expression in tumor transplants of human breast cancer cell line in nude mice.

METHODS

Four-pairs of small interfering RNA sequences of BCSG1 were chemically synthesized and inserted into the plasmid expression vectors, and were then transfected into human breast carcinoma cell line MCF7 by liposome method. Plasmid vector with unrelated sequence was used as the vector control. Cells transfected with 4 siRNA sequences, control vector and naive FCF7 cells were transplanted into the nude mice. The tumor inhibition was analysised. Immunohistochemical SP method and semi-quantitative RT-PCR were adopted to detect the BCSG1 mRNA and protein expression, respectively. Breast tissue samples of human infiltrating ductal carcinoma, ductal hyperplasia and fibroadenoma were also used as the controls.

RESULTS

The inhibition rates of tumor growth in four BCSG1-siRNA transfected groups were remarkably higher than those of the vector control group and naive MCF7 cells (P<0.01). Compared with that of the vector control and naïve MCF7 cell group, there was a significant decrease of BCSG-1 protein expression in the four experimental groups by immuno-histochemistry staining (P<0.01). In addition, BCSG1 mRNA expression in the four groups transfected with BCSG1-siRNA were significantly less than that of the control vector group, naive MCF7 cell control group and human breast IDC (P<0.01).

CONCLUSION

BCSG1-siRNA down-regulates the expression of BCSG1 and inhibits effectively growth of the transplaned human breast cancer cell line in nude mice.

[Application of serum proteomic mass spectrum analysis in breast cancer]

OBJECTIVE

To analyze the characteristics of serum proteins mass spectra in healthy controls, benign breast tumors, and CA15-3 negative or CA15-3 positive breast cancer patients by surface enhanced laser desorption ionization time of flight mass spectrometry (SELDI-TOF-MS).

METHODS

Tissue samples of 113 cases of breast cancer (93 case of CA15-3 negative, 20 case of CA15-3 positive), 103 cases of benign breast tumor and 92 cases of healthy controls were examined and analyzed by SELDI and protein chip (CM10) techniques. Biomarker Pattern Software (BPS) was used to detect the protein peaks significantly different between them and establish a diagnostic pattern which was further evaluated by a blind test.

RESULTS

Twelve significantly different protein peaks were found in serum samples between breast cancer patients and healthy controls. Eleven significantly different peaks were found between benign breast tumor patients and healthy controls. By combined analysis of those three different protein mass spectra, the peak 15 952 was found to be significantly different between breast cancer group and healthy controls, and the peak 7985 was significantly different among breast cancer group, benign breast tumor group and health controls. The blind test with the differential proteins for the serum samples of 93 cases of CA15-3 negative breast cancer and 36 cases of benign breast tumors showed that the sensitivity was 80.6% and specificity was 91.7%. The blind test in 20 cases of CA15-3 positive breast cancer and 36 cases of benign breast tumors showed that the sensitivity was 75.0% and specificity was 91.7%. Four significantly different protein peaks were found between the benign breast tumor patients and CA15-3 negative breast cancer patients. No significantly different protein were found between CA15-3 negative and CA15-3 positive patients.

CONCLUSION

Significantly different protein peaks can be screened out in breast cancer, benign breast tumor patients and healthy controls by SELDI-TOF-MS analysis.

Role of hormonal and environmental factors on early incidence of breast cancer in Iran

Although the probability of having breast cancer increases with the age in general, this malignancy affects Iranian women at least one decade younger than their counterparts in other countries. However the underlying risk factors for the discrepancy have not been identified. The aryl hydrocarbon receptor (AhR) mediates the effects of many environmental endocrine disruptors and contributes to the loss of normal ovarian function in polluted environments. This study was aimed to compare the interactions between AhR and other fundamental genes (p53, K-Ras, ER, PgR) in a clinical setting. To conduct the immunohistochemical studies using appropriate monoclonal antibodies, 25 premenopausal invasive ductal carcinoma, 29 postmenopausal invasive ductal carcinoma and 30 breast fibroadenoma were selected retrospectively from 2004 to 2007 in the pathology department of Imam Khomeini hospital complex of Tehran University of Medical Sciences . Higher levels of AhR in epithelial cells of premenopausal patients and breast fibroadenoma emphasized the susceptibility of these cells to environmental-induced tumors. AhR overexpression contributed to ER-/PgR-immunophenotype in young/premenopausal patients but the same pattern was not observed in benign and postmenopausal malignant tumors. It seems that early incidence of breast cancer in Iran is the result of interactions between hormonal and environmental factors.

O-glycosylation expression in fibroadenoma

Fibroadenomas are human benign breast tumors characterized by proliferation of epithelial and stroma cells of the terminal ductal unit. Expression of O-glycans seems to contribute to the proliferation and transformation events. With this in mind, we evaluated the expression of glycans in fibroadenoma tissue through immunohistochemistry with antibodies against mucin epitopes (Anti CA15-3 and MUC1), as well as with lectins specific for glycans linked to proteins or lipids, and we compared findings with healthy breast specimens. Our results show positive expression of CA15-3 and MUC1 in fibroadenoma tissue, mainly in duct and stroma cells, whereas, in normal samples, staining was observed in duct cells. The lectin from Glycine max recognized equally well duct and stroma cells; this was the only lectin showing co-localization with anti-CA15-3 in healthy and tumor tissues. Dolichos biflorus, Artocarpus integrifolia, and Griffonia simplicifolia lectins recognized duct cells in control healthy tissues as well as in fibroadenoma tissue. The lectin from Amaranthus leucocarpus recognized only duct cells in control samples, whereas, in fibroadenoma tissue, it recognized duct and some stromal cells, suggesting that O-glycans-type mucin linked to proteins and mucin participate in the development of fibroadenomas.

Comparison of telomere length and telomerase activation between breast fibroadenoma and infiltrating ductal carcinoma in Malaysian women

A study was initiated to explore possible differences in handling telomere attrition in the most common lignant and benign tumours of the breast in Malaysian women. Infiltrating ductal carcinoma (IDC) and fibroadenoma (FA) represented the malignant and benign prototypes respectively. 29 IDC, 28 FA and 22 benign non-lesional control (BNL) breast tissue samples were analysed for telomerase activation using a Telomerase PCR ELISA kit (Boehringer Mannheim). In addition, 23 IDC, 12 FA and 14 BNL were subjected to telomere length determination with a TeloTAGGG Telomere Length Assay Kit (Roche Diagnostic GmbH, Germany), following digestion of genomic DNA by frequently cutting restriction enzymes RsaI and HinfI. Mean telomerase activity in IDC (A450nm=0.3338), but not FA (A450nm=0.0003) was significantly raised (p<0.05) compared with BNL (A450nm=0.0031). Similarly IDC (1.2 kb), but not FA (2.2 kb), showed significant telomere shortening (p<0.05) relative to BNL (2.9 kb). The findings imply that telomere attrition and telomerase activation differ between malignant and benign tumours of the breast and may be important for targeted therapy.

[Hemodynamic changes in benign and malignant breast tumors and the mechanism]

OBJECTIVE

To compare the histological morphology, hemodynamics and angiogenesis-related molecules between benign and malignant breast tumor and investigate their variation in different perfusion regions in the same type of tumors.

METHODS

Thirty patients with malignant breast carcinoma and 30 with breast fibroadenoma underwent contrast-enhanced ultrasound examination with time-intensity quantitative analysis. The perfusion indices including peak intensity (PI), area under the curve (AUC), time to peak (TTP) and wash-out time (WOT) were measured both inside and on the margin of the foci. The expressions of CD34, vascular endothelial growth factor (VEGF), and Flk-1/KDR in both groups were measured immuhistochemically.

RESULTS

The time-intensity curve (TIC) of malignant tumor group was characterized by rapid ascent and slow descent, while that of the benign group presented with slow ascent and rapid descent. The AUC and WOT of the malignant tumor group were significantly higher than those of the benign group, while the PI and TTP showed no significant difference. In malignant tumor group, PI, AUC and WOT on the margin of the foci were significantly higher those of the inside region, while TTP showed a reverse pattern. No significant differences were found in the perfusion parameters between the inside and outside of the foci in the benign group. The distribution of CD34 was heterogeneous in breast carcinoma, and the micro-vessels were densely distributed especially on the margin of the cancer nest. The microvessel density of the malignant group (34.48-/+8.34) was significantly higher than that of the benign group (18.65-/+4.69). Diffuse or focal high VEGF expression was found on the margin of the cancer nest and necrotic tissue, but hardly detected in the benign group. Flk-1/KDR expressed diffusely or focally in breast carcinoma with especial high expression on the margin of the cancer nest and necrotic tissue, but was virtually undetectable in the benign group.

CONCLUSION

The perfusion pattern, TIC, mean perfusion parameter and variation of the regional perfusion parameters provide valuable evidence for differential diagnoses between benign and malignant breast tumors. Molecular imaging targeting VEGF and Flk-1/KD shed light on new approaches to early diagnosis of breast carcinoma.

[Expression of CD147, matrix metalloproteinases and transforming growth factor beta1 in breast cancer]

OBJECTIVE

To investigate the expression of CD147, matrix metalloproteinase (MMP)-2, MMP-9, Transforming growth factor (TGFbeta1) and TGFbetaRI proteins and their relationships to breast cancer.

METHODS

The expression of CD147, MMP-2, MMP-9, TGFbeta1 and TGFbetaRI proteins was examined on tissue chips containing 160 cases of breast carcinomas by S-P immunohistochemical method.

RESULTS

The positive rates of CD147, MMP-2, MMP-9, TGFbeta1 and TGFbetaRI proteins were 87.5% (140/160), 96.9% (155/160), 95.0% (152/160), 73.7% (118/160) and 60.6% (97/160), respectively. The expression of CD147 was positively correlated with axillary lymph node metastasis, TNM staging and HER2 over expression (P < 0.01, P < 0.05 and P < 0.01, respectively), and inversely correlated with PR expression (P < 0.05). The patients' relapse-free survival was shorter in TGFbeta1-positive group than in TGFbeta1 negative group (P < 0.05). Both the expression of MMP-2 and MMP-9 were positively correlated with CD147 expression; and both the expression of TGFbeta1 and TGFbetaRI were positively correlated with CD147 expression (P < 0.01 and P < 0.05, respectively).

CONCLUSION

The expression of CD147 is considered closely correlated with tumor invasion, metastasis and prognosis in breast cancer, and has also a close correlation with MMP-2, MMP-9, TGFbeta1 and TGFbetaRI expression.

Progesterone receptors A and B and estrogen receptor alpha expression in normal breast tissue and fibroadenomas

Fibroadenomas are the most common benign breast tumors, occurring mainly in young women. Their responses to the hormonal environment are similar to those of normal breast tissue, which suggests that steroid receptors may play a role in tumor development. We evaluated the gene and protein expression of progesterone receptors A and B (PRA and PRB) and the protein expression of estrogen receptor alpha (ER-alpha) in fibroadenoma samples, comparing with adjacent normal breast tissue, from 11 premenopausal women. Progesterone and estradiol levels were determined. No alterations in the PRs gene and protein expression and the ER-alpha protein expression were observed between the follicular and luteal phases, in normal breast versus fibroadenomas. Protein levels of PRA and PRB were higher in fibroadenomas compared to normal breast tissue (P = 0.038 and P = 0.031), while the PRs mRNA levels were similar in both tissues (P = 0.721 and P = 0.139). There were no differences in ER-alpha protein expression between normal breast tissue and fibroadenomas (P = 0.508). The PRA:PRB ratio was similar in the tissues, and also showed a strong correlation in both (r = 0.964, P = 0.0001). Our data suggest a role of PRs in the growth and development of fibroadenomas, although without alterations of the PRA:PRB ratio in these tumors. The absence of alterations in ER-alpha protein levels could be a characteristic behavior of fibroadenomas, unlike breast cancer.

Analysis of human mammary fibroadenoma by Ki-67 index in the follicular and luteal phases of menstrual cycle

OBJECTIVES

Fibroadenoma is the most common benign mammary condition among women aged 35 or younger. Expression of Ki-67 antigen has been used to compare proliferative activity of mammary fibroadenoma epithelium in the follicular and luteal phases of the menstrual cycle.

MATERIALS AND METHODS

Ninety eumenorrheic women were selected for tumour excision; they were assigned to either of the two groups, according to their phase of menstrual cycle. At the end of the study, 75 patients with 87 masses were evaluated by epithelial cell Ki-67 expression, blind (no information given concerning group to which any lesion belonged).

RESULTS

Both groups were found to be homogeneous relative to age, menarche, body mass index, previous gestation, parity, breastfeeding, number of fibroadenomas, family history of breast cancer and tabagism. Median tumour size was 2.0 cm and no relationship between proliferative activity and nodule diameter was observed. No typical pattern was observed in the expression of Ki-67 in distinct nodules of the same patient. Average values for expression of Ki-67 (per 1000 epithelial cells) in follicular and luteal phases were 27.88 and 37.88, respectively (P = 0.116).

CONCLUSION

Our findings revealed that proliferative activities in the mammary fibroadenoma epithelium did not present a statistically significant difference in the follicular and luteal phases. The present study contributes to clarifying that fibroadenoma is a neoplasm and does not undergo any change in the proliferative activity during the menstrual cycle.

Gene and protein expression of p53 and p21 in fibroadenomas and adjacent normal mammary tissue

The aim of this study was to compare p53 and p21 mRNA, and proteins levels between fibroadenomas and adjacent normal mammary tissue of women in reproductive age. A transversal study was performed. Fourteen patients who attended the Breast Service of the Hospital de Clínicas de Porto Alegre were assessed and submitted to surgical resection of fibroadenomas. Fragments of the central area of the fibroadenoma and adjacent normal mammary tissue were obtained. mRNA expression for genes p53 and p21 was evaluated by RT-PCR, and protein expression by the western blot. Paired analyses showed higher gene expression of p53 (P = 0.017) and p21 (P = 0.003), and a higher protein expression of p53 (P = 0.001) in fibroadenomas as compared to normal breast tissue. p21 protein expression was not different (P = 0.97) between the fibroadenoma and the adjacent normal mammary tissue samples. These results suggest the participation of p53 in the formation of fibroadenomas. The role of p21 in fibroadenomas remains to be defined.

[Endocrine secretion in endometrial and breast malignant tumors in elderly women]

Hystochemical and immunohystochemical investigations revealed APUD tumor cells in malignant endometrial and breast tumors, which affect elderly women. Identification of the hormones produced by APUD-cells in carcinomas and neuroendocrine tumors could form the basis for selecting the optimal method of treatment, including selection of pills to correct the impaired patients' hormonal status.

STEAP1 is over-expressed in breast cancer and down-regulated by 17beta-estradiol in MCF-7 cells and in the rat mammary gland

Six transmembrane epithelial antigen of the prostate 1 (STEAP1) was identified as a prostate-specific cell-surface antigen over-expressed in prostate cancer, and in human cancer cell lines obtained from several other tissues. Its cell surface location in all tumor types analyzed so far, and its absence in most vital organs in humans, turned STEAP1 into a potential target for anti-tumor immunotherapy. This study provides experimental evidence that STEAP1 is also over-expressed in human breast cancer cases, and in normal breast tissue adjacent to breast tumors, where it is localized in the cell membrane of epithelial cells. It is also demonstrated that STEAP1 transcription correlates negatively with estrogen receptor (ER) immunoreactivity, and positively with tumor grading in breast cancer cases. As estrogens are involved in breast cancer onset and progression, the response of STEAP1 to 17beta-estradiol (E2) was investigated in the mammary gland of rats, and in the human breast cancer cell line, MCF-7. These experiments demonstrated that STEAP1 is down-regulated by E2 in both models. The mechanisms underlying the STEAP1 response to E2 in vitro were further investigated in MCF-7 cells, and the results obtained suggest an effect mediated by the membrane-bound ERalpha (mbERalpha).

[Relation of lymphatic microvessel density detected by monoclonal antibody D2-40 with VEGF-C expression in breast cancer]

OBJECTIVE

To investigate the relationship of lymphatic micovessel density (LMVD) detected by monoclonal antibody D2-40) with the VEGF-C expression in human breast cancer.

METHODS

Tissue samples of 102 breast cancers, 25 breast fibroadenomas and 10 normal breasts were collected. Immunohistochemical staining was used to detected the lymphatic micovessels with monoclonal antibody D2-40. The expression of VEGF-C was detect by SP immunohistochemistry, and VEGF-C mRNA by hybridization in situ.

RESULTS

In 102 breast cancers, the positive rate of D2-40 was 76.5% (78/102), higher than that in the breast fibroadenomas. LMVD in the periphery of breast cancer was 30.1 lymphatic microvessels per x 100 field of vision, which was significantly higher than that in the central area of the tumors (P = 0.000). The LMVD in the periphery of the breast cancers was correlated with the number of metastatic lymph nodes (r = 0.964, P < 0.01). The positive rates of VEGF-C protein and mRNA were 55.9% (57/102) and 59.8% (61/102), respectively, significantly higher than that in the breast fiberoadenomas and normal breast tissues (chi2 = 11.653, P = 0.003; chi2 = 10.345, P = 0.006), and were significantly correlated with the status of lymph node metastasis, clinical stage and the expressions of c-erbB-2 and p53 protein (P < 0.05). Both of VEGF-C protein and mRNA were significantly correlated with LMVD detected by D2-40 (P < 0.05), especially with the LMVD in the periphery of breast cancers (P < 0.05).

CONCLUSION

The monoclonal antibody D240 can be used to detect the lymphatic endothelium in human breast cancer. The lymphatic microvessel density in the periphery of breast cancer is correlated with the lymph node metastasis and expression of VEGF-C. Therefore, VEGF-C may play a significant role in the lymphangiogenesis leading to metastasis of breast cancer.

[Distribution of actin isoforms in normal, dysplastic, and tumorous human breast cells]

The distribution of beta- and gamma-cytoplasmic actins was compared in the normal cells and dysplastic malignant breast epithelial cells. In the normal luminal epithelium, beta- and gamma-cytoplasmic actins were located in different cell compartments: gamma-actin was more expressed in the apical parts of epithelial cells while beta-actin was in their basolateral domain. Polarized distribution of actinic isoforms was partially preserved in the papillomas and fibroadenomas; a more pronounced coexpression of isoforms was detected in the dysplastic proliferates. In ductal and lobular in situ carcinoma cells, gamma-actin filamentous structures were absent while the gamma-cytoplasmic actin network throughout the cytoplasm was increased. It is generally accepted that the enhanced motility of cancer cells as to the nonmalignant situation is crucial in the process of cancer invasion. The authors' findings suggest that specific monoclonal antibodies to beta- and gamma-cytoplasmic actins may be used as supplementary markers that can differentiate benign and malignant breast neoplasms.