Breast carcinoma with positive results for melanoma marker (HMB-45). HMB-45 immunoreactivity in normal and neoplastic breast

HMB-45 (melanocytic cell-specific monoclonal antibody) immunoreactivity has been detected by the immunoperoxidase technique in the cytoplasm of 2 of 100 breast carcinomas. In addition, normal breast lobules and ducts were occasionally found to have positive results in 6 of 100 cases. These findings indicate the need to exercise caution in the interpretation of HMB-45 immunoreactivity for immunohistochemical characterization of neoplasms.

Quantification of epidermal growth factor in human breast cyst fluids: correlation with dehydroepiandrosterone-sulphate and electrolyte concentrations

Epidermal growth factor (EGF), dehydroepiandrosterone (DHA)-sulphate and [Na+] and [K+] were assayed in 78 cyst fluids from patients with a palpable breast cyst. Epidermal growth factor was detected in all but 2 cysts, the mean value +/- SEM being 506.2 +/- 39.3 ng/ml, with a range of 0-1,599 ng/ml. When the cyst fluids were sub-divided according to their [Na+]:[K+] ratio, group A cyst fluids ( [Na+]:[K+] less than 3) had a significantly higher (p less than 0.001) level of EGF than group B cyst fluids ([Na+]:[K+] greater than 3). Furthermore, the relationship between EGF and [Na+] and [K+] and between EGF and DHA-sulphate seemed to differ between the 2 cyst types and each cyst type was therefore analyzed separately.

Dehydroepiandrosterone sulfate (DHEA-S) and DHEA-S-like compounds in fibrocystic disease of the breast

We assayed Type 1 (high K+) and Type 2 (high Na+) human breast cyst fluids for DHEA-S. When an antibody specific for the 3-sulfoconjugate end of DHEA-S was used, Type 1 cyst fluids (n = 18) showed a content of 114 +/- 68 micrograms/mL (mean +/- sigma) and Type 2 cyst fluids (n = 14) of 35 +/- 17 micrograms/mL (P less than 0.01). Using an antibody specific for the D-ring, the results were 151 +/- 91 micrograms/mL and 51 +/- 32 micrograms/mL, respectively (P less than 0.01). The apparent concentrations of DHEA-S were statistically different, even though both assays gave equal results in serum from normal adults. The presence of other compounds in individual cyst fluid samples was examined by extraction and chromatography. DHEA-S immunoreactivity was found in both early and late eluting fractions in Type 1 cyst fluids and in late eluting fractions from Type 2 cyst fluids. Only the late eluting fraction from Type 2 fluids had approximately equal immunoreactivity with both antibodies. In addition to authentic DHEA-S, breast cyst fluids contain other materials that react with DHEA-S antibodies. Radioimmunoassays for DHEA-S in cyst fluid must be specifically validated because of the presence of these compounds.

Breast cyst type does not predict the natural history of cyst disease or breast cancer risk

The sodium (Na) and potassium (K) concentrations were measured in the fluid of 169 breast cysts aspirated from 101 consecutive patients presenting to a single clinic. The Na/K ratio was used to define cysts as either apocrine (Na/K less than 3) or flattened (Na/K less than 3) in type. There was no consistency in the type of cyst for individual patients. Cyst type was not predictive of further cyst development, neither was a particular cyst type associated with the development of, or a history of, breast cancer.

Smooth-muscle differentiation in stromal cells of malignant and non-malignant breast tissues

A mouse monoclonal antibody (MAb) recognizing alpha-smooth-muscle actin has been used to study smooth-muscle differentiation features in the stromal cells of desmoplastic reactions accompanying mammary tumors. We have studied, by the same immunohistochemical technique, a series of malignant and non-malignant human breast tissues. Cells composing the desmoplastic reaction were found to express alpha-smooth-muscle actin in all the 11 breast carcinomas examined, whereas no immunostain was demonstrated in the stromal cells of 7 breast tissue samples histologically defined as normal. Three of 9 cases of fibrocystic disease showed a minority of positively stained stromal cells, generally in association with epithelial hyperplasia. All the 7 cases of sclerosing adenosis, 3 of 4 cases of diffuse papillomatosis and all 3 intraductal papillomas exhibited a majority of immunoreactive stromal cells. Numerous stromal cells in 3 of 11 circumscribed fibroadenomas analyzed expressed low amounts of alpha-smooth-muscle actin. The factor(s) responsible for smooth-muscle differentiation in stromal cells are presently unknown, but the detection of this previously unsuspected stromal cell phenotype in nonmalignant mammary tissues might help in characterizing the variant morphological aspects designated under the label "fibrocystic disease" and in understanding the biology of premalignant or early malignant lesions of the breast.

Absence of in vitro mutagenicity of the fluid from breast cysts of women with macrocystic disease

Cystic fluid from 30 Greek women suffering from macrocystic disease was tested for mutagenicity in the Salmonella typhimurium mutagenicity assay using three bacterial strains in the presence or absence of liver homogenate. None of the samples tested showed mutagenic potential in this test supporting the absence of potential carcinogens in the cyst fluids.

Fractionation of type V collagen from carcinomatous and dysplasic breast in the presence of alkaline potassium chloride

A simple, one-step fractionation technique suitable for the finest quantitation of type V collagen from acidic mixtures of interstitial collagens is reported. The technique is based on the higher solubility of this collagen type in alkaline KCl-phosphate solution, and the purity of the sample has been monitored by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and electron microscopic analyses. The latter reveal that the majority of the molecules are endowed with a thread portion and a terminal knob, and show a low tendency to originate ordered and reproducible polymers at low temperature.

Silicon in human breast tissue surrounding silicone gel prostheses. A scanning electron microscopy and energy dispersive X-ray investigation of normal, fibrocystic and peri-prosthetic breast tissue

Implanted silicone breast prostheses leak silicone gel through the intact membrane. In order to determine the exact location and to achieve a semiquantitative estimation of the amount of silicone in the surrounding tissue, a method involving scanning electron microscopy (SEM) and energy dispersive analysis of X-rays (EDAX) was used. By this method we were able to demonstrate the presence of the element silicon (Si) (main component of silicone, a polymer with a general formula e.g. (CH3[Si(CH3)2O]n Si(CH3)3 along the inner border of vacuoles corresponding to the light microscopic localization of droplets and in macrophages. The tissue adjacent to the prostheses had a higher silicon content than the control tissue.

A comparison of serum and breast duct fluid-immunoassayable prolactin and growth hormone with bioassayable lactogenic hormones in healthy women and patients with cystic breast disease

Serum and breast fluid obtained by nipple aspiration were collected from 46 healthy premenopausal women, and 36 patients with cystic breast disease and cyclical mastalgia of similar age. Serum prolactin and growth hormone levels determined by radioimmunoassay were similar in the two groups, but the patients showed a significant elevation in bioactive lactogenic hormones (prolactin plus growth hormone) as determined by the Nb2 rat lymphoma cell bioassay (P less than 0.001). The radioimmunoassayable prolactin levels in breast fluid were extremely variable; there was a trend towards higher concentrations in the cystic breast disease patients, but this just failed to achieve statistical significance (P = 0.06). Immunoreactive growth hormone was rarely detected in nipple aspirates obtained from either the patient or control groups. The mean breast fluid bioactive lactogenic hormone level was significantly higher in the cystic breast disease patients than in the normal controls (P less than 0.001); also ten of 46 (22%) controls, but only two of 36 (6%) patients had no detectable bioactivity. It is concluded that lactogenic hormone bioactivity, when assessed by the Nb2 cell assay, is indicative of an endocrine abnormality which is associated with benign breast disease, and is reflected in breast duct fluid, but is not identified by the conventional radioimmunoassays.

pH as a marker of breast cyst fluid biochemical type

A previous study reported pH levels in human breast cyst fluid ranging from 7.00 to 7.80 with the cut off between Type I (high K+, low Cl-) and Type II (high Na+, high Cl-) cysts at pH 7.40. Our data indicate a wider range of pH levels in human breast cyst fluids with Type I cysts consistently having acidic levels below pH 7.0 while Type II cysts had pH levels greater than 7.0. Type I acidic cysts characteristically also contain greater amounts of organic acids than Type II cysts. Thus, the pH of breast cyst fluid appears to be related to the electrolyte profile.

Cations and dehydroepiandrosterone-sulfate in cyst fluid of pre- and menopausal patients with gross cystic disease of the breast. Evidence for the existence of subpopulations of cysts

Cations (K+ and Na+) content was evaluated in 444 breast cyst fluid (BCF) specimens, aspirated from 391 patients with gross cystic disease of the breast (GCD), a benign form admittedly at major risk of cancer. In 306/444 BCF, dehydroepiandrosterone-sulfate (DHA-S) content was also evaluated. A positive correlation (P less than 0.001) was observed between log K+ vs. log DHA-S whereas a negative correlation was found between log Na+ and log DHA-S (P less than 0.001). Cysts were subdivided in three types according to their cationic concentration: most were of type I (K+/Na+ greater than 1.5) and type II (K+/Na+ less than 0.66) whereas only 10% was of the type III (intermediate). No statistical difference in subtype distribution was apparent when considering patients aspirated in the follicular vs. luteal phase of the menstrual cycle; on the contrary, a significant difference (P less than 0.001) was found between menstruating vs. menopausal patients (type I = 54.8% vs. 32.2%; type II = 34.5% vs. 58.1%, respectively). Ninety-four BCF samples were aspirated simultaneously in 41 patients bearing multiple cysts: the same cationic subtype was present in 29/41 patients. Our data confirm and extend previous observations, and provide conclusive evidence that breast macrocysts can be divided on the basis of their electrolyte composition into different types. Accordingly, the composition of BCF should always be assessed for prospective studies on GCD and breast cancer risk.

[Radioimmunoassay of 5-androstene-3 beta, 17 beta-diol in plasma and breast cyst fluid]

A simple and reliable radioimmunoassay for the determination of 5-androstene-3 beta,17 beta-diol (5-Adiol) in peripheral plasma and in breast cyst fluid, after chromatography on Celite microcolum has been described and evaluated. The antiserum used was raised in the rabbit injected with dehydroepiandrosterone-15 alpha-carboxymethyl-bovine serum albumin. In men below 40 years of age the levels ranged from 0.85 to 2.80 ng/ml (mean +/- SEM: 1.52 +/- 0.11; n = 24) and from 0.50 to 2.20 ng/ml (mean: 0.93 +/- 0.09; n = 20) in men aged between 41 and 62 years. The mean level was significantly different (p less than 0.001) between the two groups. A significant correlation (r = -0.56 p less than 0.01) was demonstrated between age and all male levels. In women the mean plasma level was in the follicular phase: 0.81 +/- 0.07 ng/ml (range: 0.40 - 1.50; n = 17; age: 19-41 years) and in the luteal phase: 0.83 +/- 0.05 ng/ml (range: 0.40 - 1.30; n = 29; age: 18-43 years). No cyclical change and no correlation with age could be evidenced. A significant difference (p less than 0.001) was shown between females and the young male group. In breast cyst fluid the levels of unconjugated 5-Adiol ranged from 0.05 to 13.70 ng/ml (mean: 2.21 +/- 0.73; n = 23) whereas the sulfate concentrations ranged from 75 to 7,500 ng/ml (mean: 1,973 +/- 543; n = 18), thus demonstrating very wide inter-individual variations.

Presence of alpha-lactalbumin, epidermal growth factor, epithelial membrane antigen, and gross cystic disease fluid protein (15,000 daltons) in breast cyst fluid

The frequency of gross cystic breast disease in premenopausal women and its possible association with increased breast cancer risk emphasize the importance of investigations relating to breast cyst fluid composition. In order to contribute to a better analysis of this medium, we have measured four proteins the presence of which in human milk was well documented. Breast cyst fluid specimens from 266 breast cyst disease patients were assayed and compared as to concentrations of alpha-lactalbumin, gross cystic disease fluid protein (GCDFP-15), epidermal growth factor (EGF), and epithelial membrane antigen (EMA). All the analyzed cyst fluids contained GCDFP-15, EMA, and EGF whereas alpha-lactalbumin was detected in only 14.2% of fluids assayed. Positive correlations were observed between GCDFP-15 and EMA concentrations (P less than 0.005), as well as GCDFP-15 and EGF concentrations (P less than 0.0005). The cyst fluid GCDFP-15 and EGF levels were higher when alpha-lactalbumin concentrations were below detection limits. This association was statistically significant for GCDFP-15 (P less than 0.03) and for EGF (P less than 0.001). These results suggest that GCDFP-15 and EMA could be the biochemical expression of apocrine metaplasia and epithelial hyperplasia, respectively, two histopathological features which characterize breast cystic disease. On the other hand, the occasional presence of alpha-lactalbumin in the cyst fluid would reflect the persistence of differentiated cells in the epithelium surrounding the cyst and would be inversely proportional to the degree of cellular proliferation. The omnipresence of EGF in the cyst fluid argues for the hypothesis of its production by the mammary gland. The highly significant relationship between GCDFP-15 and EGF levels in the medium remains to be elucidated but may be related to an androgen sensitivity in the breast epithelium surrounding the cyst.

Estrogen and progesterone receptors in benign breast tumors and lesions: relationship with histological and cytological features

The pattern of estrogen (ER) and progesterone receptors (PR) and their relationship to histo- and cyto-pathological parameters has been studied in 97 cases of benign breast disease and benign phyllode tumors (95 women, of whom 76 were premenopausal, and 2 men). Total (cytosolic + nuclear) ER and PR were assayed by a single-saturating dose method using a tris-KCl buffer. The cut-off between positive and negative ER and PR assay was 100 femtomoles/g tissue. All specimens were processed for histological examination: epithelial and fibroblastic proliferation, epithelial/stromal ratio and presence of focal or diffuse hyalinosis. In 33% of the 46 cases of fibrocystic disease one receptor at least was present (13% ER+, 31% PR+). All the 8 cases in which infiltrating epitheliosis was present were PR+ and 4 of them were also ER+. In 72% of the 31 fibroadenomas one receptor at least was present (19% ER+, 71% PR+). In all these cases levels of receptors were lower than in malignant tumors. An inverse correlation between PR + prevalence and fibrohyalinosis was observed; on the other hand a positive relationship between PR + and fibroblastic (p less than 0.001) or epithelial (p less than 0.01) proliferation was found. In all 5 benign phyllode tumors examined PR + were present at a very high level, almost as high as in malignant tumors. Of the 15 other benign breast lesions, all but one (1 hamartoma) were ER- and PR-.

Immunohistochemistry of a component protein of the breast cystic disease fluid with mol. wt 15,000

A specific protein from the liquid of a mammary cyst with a molecular weight of 15,000 (GCDFP 15) was studied in normal and pathological mammary tissue using an immunohistochemical method (peroxidase-anti-peroxidase complex). An immunoreactivity of the GCDFP type was found in normal idrosadenoid glands having an apocrine secretion. Histologically normal mammary tissue was not immunoreactive. In benign breast tissue the GCDFP was found particularly in epithelium undergoing apocrine metaplasia (55/55) and in atypical lobular epithelial hyperplasia (8/10). Of the adenocarcinomas of the breast 136/161 (84%) were immunoreactive, especially lobular carcinoma (13/13). The proportion of tumors with a high percentage of immunoreactive cells (76-100%) was greater for Bloom's grade I (1/29: 34%) than for grade III (10/66: 15%). A significant correlation was found between the percentage of immunoreactive cells and the cytosolic concentration of progesterone receptors. The morphological intracellular identification of GCDFP (due to its greater sensitivity) and its correlation with progesterone receptors allowed a more precise evaluation of the functional state and the hormonal dependency of the breast cells by underlining the heterogeneity of the tumoral cell population.

Natural history of cystic disease: the importance of cyst type

All breast cysts aspirated from a series of 100 patients followed for a minimum period of 2 years were classified on the basis of electrolyte composition as apocrine or flattened, this being the nature of the epithelium lining the two populations of breast cysts. Patients with a single cyst were more than 3 times as likely to have a flattened rather than an apocrine cyst. Multiple cysts, whether simultaneous or sequential in any individual patient, were usually all of the same type, and were more commonly apocrine than flattened. A comparison of the frequency of subsequent cysts in patients whose initial cysts were of either apocrine or flattened type showed further cysts were over 5 times more common in patients who presented with apocrine cysts. These observations suggest that the natural history of cystic disease is closely related to cyst type.

Presence and characterization of prolactin receptors in human benign breast tumours

Prolactin receptors have been determined in 64 benign breast tumours. A specific binding of 0.5% or more (with a range of 0.5-3.3%) was found in 34.4% of the cases and was considered prolactin-receptor-positive. The binding was found to be specific only for lactogenic hormones. By Scatchard analysis the dissociation constant was 2.55 X 10(-10) mol/l and the binding capacity was 4.6 fmol/mg protein.

Estriol in human breast cyst fluid

Although cystic lesions of the breast are not precancerous per se, statistical studies have indicated that this condition predisposes a 2- to 4-fold greater risk for breast cancer. Seeking a hormonal etiology to this correlation, investigators have analyzed breast cyst fluid ( BCF ) for steroids and have compared the levels to those in the blood. The 17-ketosteroids-androsterone, dehydroisoandrosterone and their sulfates are elevated in BCF . The same is true for estrone sulfate and estradiol-3-sulfate. We have found the most dramatic differences with estriol-3-sulfate (E3-3S), the concentration of which ranged from 187-6134 pg/ml in over 40 specimens analyzed, whereas in 12 serum specimens from normal women, E3-3S was barely detectable. The origin of E3-3S is not known. [3H]E3-3S is not concentrated in BCF following its injection into an arm vein. The blood half-life of [3H]E3-3S is much lower than that of estrone sulfate. Samples of breast nipple aspirates from normal women were also analyzed for E3-3S. None could be detected. The best explanation of the data accumulated thus far is that E3-3S is synthesized at the epithelial lining of the cyst and released into the BCF , from which its efflux is inefficient.

Feulgen DNA cytophotometry in histologic sections of mammary neoplasms

Because of a lack of suitable archival material, it is rarely possible to make retrospective studies of the correlation between the prognosis for a patient with mammary carcinoma and the distribution of nuclear DNA in the cells of the neoplasm. An investigation of the possibility of using sections cut from paraffin-embedded specimens showed that such sections are not suitable for use in retrospective studies of breast carcinoma. Because of such factors as the heterogeneity in size and shape of the nuclei from neoplastic cells and their tendency to mold around each other, determinations of DNA content of cells in sections were extremely difficult; in this particular carcinoma it was found that the distribution of nuclear DNA as obtained from a Feulgen-stained histologic section was not the same as that obtained from a Feulgen-stained imprint smear, and some polyploid tumors were erroneously classified as aneuploid.

Classification of human breast cysts according to electrolyte and androgen conjugate composition

One hundred human breast cyst fluids have been analysed for sodium (Na+), potassium (K+) and dehydroepiandrosterone (DHA) sulphate. Concentrations varied greatly between individual cyst fluids, Na+ from 20 to 185 mmol/l, K+ from 5 to 160 mmol/l and DHA-sulphate from 1.5 to 87 mumol/l. Analysis of the inter-relationships between Na+, K+ and DHA sulphate revealed two major sub-populations of cyst fluids--one group in which Na+ levels were markedly in excess of K+ and DHA sulphate concentrations were low and the other in which K+ was the predominant cation and DHA sulphate concentrations were high.

Cyclic adenosine 3':5'-monophosphate receptor proteins in dysplastic and neoplastic human breast tissue cytosol and their inverse relationship with estrogen receptors

The cyclic adenosine 3':5'-monophosphate (cAMP)-binding proteins of dysplastic (control) and neoplastic human breast tissue cytosols were investigated after photoaffinity labeling with 8-azido-cyclic adenosine 3':5'-[32P]monophosphate (8-N3-cAMP) by sodium dodecyl sulfate/polyacrylamide gel electrophoresis. Four main binding proteins, all specific for cAMP, were identified, with molecular weights of 52,000, 49,000, 39,000, and 37,000. According to their molecular weights, elution on diethylaminoethyl cellulose, and in vitro phosphorylation, the Mr 49,000 and 52,000 species correspond to the regulatory subunits (R-I, R-II) of cAMP-dependent protein kinases types I and II. The smaller cAMP receptors (Mr 39,000 and 37,000) are proteolytic fragments of the intact R-proteins. Dissociation constants (Kd) with 8-N3-cAMP of 0.8 nM for R-I, and 0.12 microM for R-II were obtained; the proteolytic fragments exhibited Kd's similar to that of R-I. No difference in the 8-N3-cAMP affinities and labeling efficiencies was found between control and neoplastic tissues. Although the average incorporation of 8-N3-cAMP was 0.29 +/- 0.02 (S.E.) pmol/mg protein for control and 0.45 +/- 0.06 pmol/mg protein for neoplastic breast tissue cytosol, this difference does not reflect different cellular concentrations of cAMP receptors since the content of blood protein components is lower in tumor tissue. However, tumor cytosols exhibited an increased content of proteolytic R-fragments, and the ratio of intact cAMP receptors versus proteolyzed R-proteins was significantly (p less than 0.01) higher in control (8.3 +/- 0.9) than in tumor (3.0 +/- 0.5) tissue. The average R-I/R-II ratio was greater than 1 in each case, but no significant difference was observed between control and neoplastic tissue. Inverse relationships were obtained, especially between proteolyzed R-fragments and estrogen receptors, when the contents and ratios of cAMP-binding proteins were correlated with the contents of estrogen and progesterone receptors in tumor tissue by a Spearman rank correlation coefficient r = -0.55 (significance of difference from zero being p less than 0.01).