Ultrastructure of the human mammary gland. I. Development of the fetal gland throughout gestation

A reinterpretation of human breast anatomy includes all the layers of the anterior body wall

Mammary glands define mammals as a group, yet a comprehensive anatomical description of the mammary gland does not exist for almost any mammalian species. In humans, the anatomical and surgical literature provide conflicting and incomplete descriptions of the gross anatomy of the breast. We dissected 9 male and 15 female human body donors to clarify this gross anatomy. We found that, like other epidermally derived glands of the body, the mammary glandular tissue is constrained to a membrane-bound, central structure referred to as the corpus mammae in the surgical literature, and not dispersed throughout the breast as typically described in the anatomical literature. The major fasciae of the human anterior body wall, including the superficial fatty Camper's fascia and the deeper membranous Scarpa's fascia, both contribute to the structure of the breast. This anatomical arrangement suggests that, as the mammary gland invaginates posteriorly from the integument during embryological development, the mammary fat pad most likely derives from Camper's fascia, and growth of Scarpa's fascia around this fat pad forms the anterior and posterior lamellae of the breast pocket. Anteriorly, Scarpa's fascia becomes a double layer that creates the surface structure of the breast. Posteriorly, Scarpa's fascia forms a circummammary ligament that (1) stabilizes the breast against the thoracic wall and (2) is continuous with Scarpa's fascia on the rest of the anterior body wall. The suspensory ligaments of the breast represent the typical retinaculae cuti found consistently throughout the human body wall, and do not directly attach to the skin. Instead, these retinaculae attach to the anterior or posterior lamella of Scarpa's fascia.

Development of the human breast

Mammalia are so named based on the presence of the mammary gland in the breast. The mammary gland is an epidermal appendage, derived from the apocrine glands. The human breast consists of the parenchyma and stroma, originating from ectodermal and mesodermal elements, respectively. Development of the human breast is distinctive for several reasons. The human breast houses the mammary gland that produces and delivers milk through development of an extensive tree-like network of branched ducts. It is also characterized by cellular plasticity, with extensive remodeling in adulthood, a factor that increases its susceptibility to carcinogenesis. Also, breast development occurs in distinct stages via complex epithelial-mesenchymal interactions, orchestrated by signaling pathways under the regulation of systemic hormones. Congenital and acquired disorders of the breast often have a basis in development, making its study essential to understanding breast pathology.

Anatomy of the human mammary gland: Current status of knowledge

Mammary glands are unique to mammals, with the specific function of synthesizing, secreting, and delivering milk to the newborn. Given this function, it is only during a pregnancy/lactation cycle that the gland reaches a mature developmental state via hormonal influences at the cellular level that effect drastic modifications in the micro- and macro-anatomy of the gland, resulting in remodeling of the gland into a milk-secretory organ. Pubertal and post-pubertal development of the breast in females aids in preparing it to assume a functional state during pregnancy and lactation. Remarkably, this organ has the capacity to regress to a resting state upon cessation of lactation, and then undergo the same cycle of expansion and regression again in subsequent pregnancies during reproductive life. This plasticity suggests tight hormonal regulation, which is paramount for the normal function of the gland. This review presents the current status of knowledge of the normal macro- and micro-anatomy of the human mammary gland and the distinct changes it undergoes during the key developmental stages that characterize it, from embryonic life through to post-menopausal age. In addition, it discusses recent advances in our understanding of the normal function of the breast during lactation, with special reference to breastmilk, its composition, and how it can be utilized as a tool to advance knowledge on normal and aberrant breast development and function. Finally, anatomical and molecular traits associated with aberrant expansion of the breast are discussed to set the basis for future comparisons that may illuminate the origin of breast cancer.

Human breast development

This review is intended to give an overview of current knowledge on human breast development. It focuses on the limitations of our understanding on the origins of human breast cancer in the context of this mainly morphological and static assessment of what is known about human breast development. The world literature is very limited and caution is needed in drawing analogies with the mouse. There is an increasing emphasis on research to understand normal stem cells in the breast on the assumption that these are the targets for the initiation of breast cancer. It is thus a priority to understand normal human breast development, but there are major obstacles to such studies mainly due to ethical considerations and to tissue acquisition.

Intrauterine breast development and the mammary myoepithelial lineage

As their name implies, the myoepithelial cells found at the epithelial-mesenchymal interface of the human mammary gland disclose features suggestive of a dual epithelial-like and muscle-like differentiation, i.e. they co-express various keratins and vimentin intermediate filaments, as well as smooth muscle-related antigens. This article provides an overview of the literature on intrauterine breast development with special emphasis on the myoepithelial component of the fetal human mammary gland epithelium. It discusses original and recently published immunohistochemical data on myoepithelial precursors and reasserts the relevance of developmental, morphological fetal tissue-based studies to the understanding and the clinical management of adult diseases.

Morphogenesis of mammary gland development

Development of the mammary gland in females is a dynamic, orchestrated process that occurs throughout postnatal development. Initiated during embryogenesis, epithelial cells advance into the underlying stromal matrix to form a primitive rudimentary structure. With the onset of puberty this anlage then responds to hormonal and local cues to rapidly establish a ductal network. Whereas in mice this network is relatively simple, in humans there is significantly more branching morphogenesis to develop terminal duct lobular unit structures. With the onset of pregnancy and associated changes in the hormonal and local environment, alveolar development progresses to establish a gland that is densely filled with alveolar structures by the end of pregnancy. Concomitantly, mammary epithelial cells within the gland begin to attain their unique ability to synthesize various milk constituents, such that by parturition, functional lactogenesis can be realized.

Basal cells of second trimester fetal breasts: immunohistochemical study of myoepithelial precursors

The molecular characterization of human mammary myoepithelial cells is incomplete, hindering our understanding of its importance in breast physiology and pathology. Because data on the precursors of this cell lineage remain scarce and often contradictory, basal epithelial cells of second trimester fetal breasts were studied by light microscopy (LM) and immunohistochemistry (IHC). Up to 20 wk of gestational age, the mammary rudiments only comprised roundish primary outgrowths, "primary buds," more likely to represent immature nipples than true mammary tissue. At 21 wk secondary outgrowths, "projections," extended from enlarged primary buds into well-vascularized layers of dense mesenchyme. Basal projection cells had a partial myoepithelial-like phenotype: they reacted with CD29, CD49f, CD104, keratin 14, vimentin, S100beta protein, and p63; furthermore, many became positive for keratin 17, alpha-smooth muscle actin, and CD10 (but not for keratin 19) between wk 21 and 25. The continuous basement membrane associated with the fetal mammary rudiments was strongly positive for collagens type IV and VII, and for laminin 5. Consistently strong and basally polarized staining for hemidesmosomal components suggested that although incompletely differentiated, most second trimester myoepithelial precursors might already mediate local epithelial-mesenchymal interactions, i.e., complex signaling pathways which are crucial for both orderly growth during development and maintenance of homeostasis during adult life. Because they are likely implicated in the phenomenon of menstrual cycle-related growth spurts in the adult resting breast, the strategically positioned cells of the myoepithelial lineage might constitute critical protagonists in defective epithelial-mesenchymal signaling associated with cancer progression.

Breast development gives insights into breast disease

AIMS

Studies of developing human breasts are essential for understanding the organogenesis as well as molecular pathogenesis of benign and malignant breast diseases. In this study we have examined the distribution of TGF-alpha, TGF-beta 1, tenascin-C and collagen type IV with the aim of starting to build a picture of the profile of molecules that may be involved in the development of the human breast.

METHODS AND RESULTS

Ten fetal breasts (16 to 23 weeks of gestation) and 45 infant breasts, ranging in age from newborn to 2 years, were used in this study. Paraffin sections from these samples were immunostained with antibodies for these proteins and for Ki67 to elucidate the level of proliferative activity in different stages of breast development. TGF-alpha immunoreactivity was observed both in the stromal and the epithelial cells within fetal and infant breasts up to 25 days. TGF-beta 1 immunoreactivity was localized in the extracellular matrix. Tenascin-C was found around the neck of the developing breast bud and in the extracellular matrix of the infant with peaks in the newborn at 6-12 weeks. The immunoreactivity for type IV collagen was more intense in the region of the breast bud neck in the fetal breasts and reduced around the tips of lobular and terminal-end buds within the infant breasts.

CONCLUSIONS

The distribution of the growth factors and extracellular matrix proteins within the developing human breast indicates that they play a significant role in different cellular compartments during morphogenesis and provides insights into breast disease.

The development of epithelial phenotypes in the human fetal and infant breast

In order to explain the molecular events that contribute to benign and malignant breast disease, it is essential to understand the cellular context in which these are occurring. This study describes a detailed analysis of the epithelial phenotypes in the human fetal and infant breast and provides a starting point for such consideration. Using methacarn-fixed, paraffin sections from ten fetal and 45 infant breast, immunostained with a panel of antibodies to cytoskeletal proteins and kappa-casein, it has been possible to define in detail the chronological evolution of the major cell types in the human breast from 16 weeks of intrauterine life to 2 years of age, in both sexes. Cells at the tips of the lobular buds and terminal end buds have a characteristic cytoskeletal protein profile, suggesting that they may have the capacity to generate both basal cells and luminal cells. Based on the expression of cytoskeletal proteins in the developing fetal and infant breast, a model system has been proposed for mammary epithelial differentiation.

Glycogen-rich clear cell carcinoma of the breast: report of a case with fine-needle aspiration cytology and immunocytochemical and ultrastructural studies

Fine-needle aspiration cytology, immunocytochemistry, and electron microscopic findings are described in a case of glycogen-rich clear cell carcinoma of the breast. The aspirate contained many small and large papillary cell groups and numerous single tall columnar cells with apical cytoplasmic projections and mild to moderate degree of nuclear pleomorphism. Cytochemical localisation of glycogen and immunostaining on air-dried smears with CEA and actin monoclonal antibodies permitted the correct identification and differential diagnosis of the tumor. Electron microscopic examination of the resected specimen confirmed the diagnosis of glycogen-rich clear cell carcinoma. The differential diagnosis and potential diagnostic pitfalls are discussed, and recommendation are offered to prevent misdiagnosis.

Immunolocalisation of cell surface peptidases in the developing human breast

The immunocytochemical distribution of three cell surface peptidases was investigated in samples of developing infant breast ranging in age from newborn to 9.5 months. We have previously demonstrated that in the adult breast these enzymes identify subpopulations of epithelial cells and fibroblasts. We therefore wished to address two questions: (a) At what stage in breast development can fibroblast subpopulations be identified, and (b) Is the distribution of these peptidases related to cellular differentiation and morphogenesis? At the histological level there was a cuff of stromal cells closely associated with the developing ductular and lobular structures. At all stages of ductular and lobular development the fibroblasts in this layer were consistently negative for dipeptidyl peptidase IV (DPP IV) and clearly distinguished from the fibroblasts in the surrounding matrix, some of which expressed DPP IV in an age-dependent manner. Within the infant breast aminopeptidase N (APN) was localised to luminal epithelial cells and all fibroblasts, whilst neutral endopeptidase (NEP) was specifically localised to myoepithelial cells. These results are considered in relation to the role of stromal-epithelial interactions during morphogenesis and the proposed function of these enzymes.

Growth and development of the human infant breast

Seventy-two samples of infant breasts, aged from newborn to 2 years, were collected at necropsy. Whole-mount preparations and histological sections were made. A system of classification was devised to study the extent of the structural development of the ductal system (morphological types I, II, and III) and the functional differentiation of the lining epithelium (functional stages I to V). There was no correlation between the age of the infant and the type of development of the ductal system. In contrast, the epithelial differentiation followed a chronological pattern, starting with secretory changes and apparently going through a period characterized by apocrine metaplasia before post-secretory involution. These epithelial changes were not associated with the morphological type of the ductal system. There were no distinguishing features between the breasts from the two sexes. Immunoperoxidase staining for actin and kappa-casein was carried out to study the myoepithelial cells and secretory cells, respectively. Myoepithelial cells were present at all stages and prominent staining for casein was observed up to 2 months of age. Embryonic-type adipose tissue was seen in 7 cases, in one of which it was associated closely with the developing ductal system. Extramedullary hematopoiesis was observed in the periductal connective tissue until 4 months of age. This paper describes the most extensive anatomical and histological study of the human infant breast to date and lays the foundation for a detailed study of the epithelial and stromal changes that take place during human breast development.

Organization and growth of mammary epithelia in the mammary gland fat pad

Mammary gland development consists of a series of very highly ordered events involving interactions among a number of distinct cell types. An important aspect of mammary gland development is that the mammary gland consists of a fat pad of mesodermal origin into which epithelial cells of ectodermal origin proliferate. This proliferation of epithelial cells into the mammary fat pad is the subject of this review. The nature of the stroma into which epithelial cells proliferate is of considerable importance in determining the structure of the resulting gland. In mice, white adipose tissue appears to be required for normal mammary development. Transplantation of mammary epithelia to other types of stroma does not support epithelial growth or result in abnormal growth. To date, a synthetic substratum capable of mimicking white adipose tissue has not been developed. Although collagen gel cultures are generally considered superior to glass or plastic substratum in supporting near normal epithelial growth, the technique has not advanced to the point that the in vivo growth pattern is duplicated. Recent research on the generation of chimeric mammary tissue (by transplanting mammary epithelia from rats, cows, and women to the mammary fat pads of athymic nude mice) suggests that there are important species differences in the stromal requirements for mammary gland development. In particular, extensive and expansive growth of rat mammary tissue is observed in mouse mammary fat pads. However, the mouse mammary fat pad appears incapable of supporting expansive growth of bovine or human mammary epithelia. The reason for this difference is not clear. However, human and bovine mammary epithelia may require the presence of more fibrous (collagenous) tissue than rodent mammary epithelia for normal proliferation.

Ultrastructure of human fetal mammary gland

Early cytodifferentiation of human fetal mammary gland was studied at the time of the beginning of the sexual differentiation during the sixth to eleventh developmental weeks. The gland appeared as a solid epithelial ingrowth into the underlying mesenchyme on both sides of the thoracic wall at the age of 5 weeks in both sexes. These ingrowths contained primitive glycogen-rich cells with large nuclei. The surrounding mesenchymal cells gathered around the basal lamina. These cells differentiated into fibroblasts, and collagen fibers were seen in the mesenchyme near the mammary buds. No lumina appeared within the buds during this study. Differences between the male and female mammary epithelium or mesenchyme were not observed, although androgen synthesis and secretion in the fetal testis had already begun. The close connections and concomitant differentiation of the mammary bud epithelium and mesenchyme during the early embryogenesis in this study suggest that epithelio-mesenchymal interaction plays an important role in the differentiation of human mammary gland.

Basal clear cells of the normal human breast

The ductal system of the human breast consists of two major cell types: epithelial and myoepithelial. In some reports a third cell type, given various names is mentioned. In this study it is called a basal clear cell. The role of this cell, unlike that of the epithelial and myoepithelial cells, remains unclear, although it has been suggested that it may have a stem cell function. We illustrate here that there is an ultrastructural transition between the basal clear and myoepithelial cell; suggesting that it acts as a precursor of the myoepithelial cell, and may not be a stem cell for both epithelial and myoepithelial cells.

Malignant mixed tumor of the skin: malignant chondroid syringoma

Malignant tumors of sweat gland origin are rare. Probably one of the rarest types, still poorly understood, is the so-called malignant chondroid syringoma or malignant mixed tumor of the skin. A case of malignant chondroid syringoma is presented. Ultrastructural study proves very useful for the differential diagnosis with other chondroid or chordoid tumors.

Familial intra-areolar polythelia with mammary hypoplasia

Dysplastic divided nipples (intra-areolar polythelia) have been found bilaterally in a mother, her two daughters and one son. Two of the patients had mammary hypoplasia, one had unilateral hypoplasia of the pectoral muscle and duplication of the renal pelvis and ureter. The mammary findings are consistent with autosomal dominant inheritance. Whether they represent a new mammo-renal syndrome is uncertain. Reconstructive surgery was performed on two patients. Due to the deformity the mother was unable to nurse her children; following reconstructive surgery the daughter was able to feed her baby normally.

Glycogen-rich clear cell carcinoma of the breast: a light and electron microscopic study

A glycogen-rich clear cell carcinoma arose in the breast of a 49-year-old woman. Light microscopic examination of the neoplasm revealed both intraductal papillary growth and stromal invasion. Electron microscopic examination demonstrated neoplastic cells that contained massive quantities of nonmembrane-bound particulate glycogen and that formed numerous acini. Apically, these cells formed microvilli; laterally they formed tight junctions and desmosomes. Morphologic features of this neoplasm are similar to those of the fetal breast and to some other clear cell carcinomas arising elsewhere in the body.

Breast development in the newborn

Breast size and milk secretion was studied in term and preterm infants. Breast nodules were palpable in most of the mature infants, both boys and girls. In 6 term infants without palpable breast tissue there was a high incidence of complications during late pregnancy or delivery. In light-for-gestational age infants the breast diameter was generally appropriate for gestation. None of the infants under 31 weeks' gestation had palpable breast tissue at birth, but some in the first weeks of life developed breast tissue and secreted milk. Milk had been secreted by most of the mature infants by age 7 days, and the onset was earlier in light-for-dates infants. The breast does not regress rapidly after birth. The nodules persist into the second half of the first year by which time sex differences have emerged. Clearly the growth and activity of the neonatal breast cannot be explained solely in terms of the influence of maternal hormones towards the end of gestation. Further studies on early breast tissue development may indicate the other endocrine factors concerned.

The fine structure of the normal, resting terminal ductal-lobular unit of the female breast

The fine structure of the terminal ductal-lobular unit (TDLU) of the normal, resting female breast is described. Tissue used conformed to strict criteria for normal. 4 distinct cell types, were observed, epithelium, myoepithelium, macrophages and lymphocytes. A gradation in structure, especially of myoepithelium, was found between the ductule tip and intralobular duct, apparently reflecting the age and function of each region. Cilia originating from the myoepithelial cells are possibly sensory in function. Epithelial vesicular inclusions may represent minimal secretory activity, transport of material across the cell, or be lysosomal in nature. The capillaries in close contact with the delimiting fibroblasts of the epithelial-stromal junction (ESJ) are described and the zone designated the capillary-fibroblast junction (CFJ). The CFJ is conceived as a regulatory unit similar to the ESJ, and may contribute to dysplasia due to biochemical or functional alterations, or to disruption of the microvascular geometry.