Background: The precise histopathologic diagnosis of a breast lesion is the first step towards the most appropriate inclusive patient’s management. The aim of this study was to evaluate the correlation between histochemical patterns of connective tissue fibers and NORs in breast lesions. Methodology: Patients with breast cancer (n = 25) were ascertained as the case group, and those with benign breast lesions were ascertained as a control group (n = 25). Histochemical evaluations of elastic fibers, reticular fibers and mean AgNORs count were performed for all study subjects. Results: Elastic fibers intensity was brought into being lessening in benign lesions and upturns in the direction of malignant lesions. The intensity of elastic fibers was found to intensify with rises of neoplastic changes in breast cancer and this was found to be statistically significant P < 0.001. Mean AgNORs counts displayed increased clusters among malignant cases equated to benign ones. Mean AgNORs count significantly increased with neoplastic proliferation P < 0.005. Conclusion: Demonstration of connective tissue fibers (particularly elastic fibers) can strength the diagnostic evidence for conventional histopathology diagnosis. Mean AgNORs count can merge as an important quantitative marker in breast cancer diagnosis.
References
[1]
Globocan (2018) Breast: Cancer Incidence and Mortality Statistics Worldwide and by Region, 2018.
http://gco.iarc.fr/today/data/factsheets/cancers/20-Breast-fact-sheet.pdf
[2]
Morrow, M., Schnitt, S.J. and Norton, L. (2015) Current Management of Lesions Associated with an Increased Risk of Breast Cancer. Nature Reviews Clinical Oncology, 12, 227-238. https://doi.org/10.1038/nrclinonc.2015.8
[3]
Asirvatham, J.R., Falcone, M.M. and Kleer, C.G. (2016) Atypical Apocrine Adenosis: Diagnostic Challenges and Pitfalls. Archives of Pathology & Laboratory Medicine, 140, 1045-1051. https://doi.org/10.5858/arpa.2016-0238-RA
[4]
Dion, L., Racin, A., Brousse, S., et al. (2016) Atypical Epithelial Hyperplasia of the Breast: State of the Art. Expert Review of Anticancer Therapy, 16, 943-953.
https://doi.org/10.1080/14737140.2016.1204916
[5]
Yeo, S.K. and Guan, J.L. (2017) Breast Cancer: Multiple Subtypes within a Tumor? Trends in Cancer, 3, 753-760. https://doi.org/10.1016/j.trecan.2017.09.001
[6]
Walaszek, K., Lower, E.E., Ziolkowski, P. and Weber, G.F. (2018) Breast Cancer Risk in Premalignant Lesions: Osteopontin Splice Variants Indicate Prognosis. British Journal of Cancer, 119, 1259-1266. https://doi.org/10.1038/s41416-018-0228-1
[7]
Agoumi, M., Giambattista, J. and Hayes, M.M. (2016) Practical Considerations in Breast Papillary Lesions: A Review of the Literature. Archives of Pathology & Laboratory Medicine, 140, 770-790. https://doi.org/10.5858/arpa.2015-0525-RA
[8]
Jorns, J.M. (2016) Papillary Lesions of the Breast: A Practical Approach to Diagnosis. Archives of Pathology & Laboratory Medicine, 140, 1052-1059.
https://doi.org/10.5858/arpa.2016-0219-RA
[9]
Montes, G.S. (1996) Structural Biology of the Fibers of the Collagenous and Elastic Systems. Cell Biology International, 20, 15-27.
https://doi.org/10.1006/cbir.1996.0004
[10]
Winzer, K.J., Bellach, J. and Hufnagl, P. (2013) Long-Term Analysis to Objectify the Tumor Grading by Means of Automated Microscopic Image Analysis of the Nucleolar Organizer Regions (AgNORs) in the Case of Breast Carcinoma. Diagnostic Pathology, 8, 56. https://doi.org/10.1186/1746-1596-8-56
[11]
Wei, S. (2016) Papillary Lesions of the Breast: An Update. Archives of Pathology & Laboratory Medicine, 140, 628-643.
[12]
Bancroft, J.D. and Gamble, M. (2011) Theory and Practice of Histological Techniques. 6th Edition, Churchill Livingstone/Elsevier, London, 121-135.
[13]
Ahmed, H.G. and Babiker, A.E. (2009) Assessment of Cytological Atypia, AgNOR and Nuclear Area in Epithelial Cells of Normal Oral Mucosa Exposed to Toombak and Smoking. Rare Tumors, 1, e18. https://doi.org/10.4081/rt.2009.e18
[14]
Ghosh, L., Ghosh, B.C. and Das Gupta, T.K. (1980) Ultrastructural Study of Stroma in Human Mammary Carcinoma. The American Journal of Surgery, 139, 229-232.
https://doi.org/10.1016/0002-9610(80)90260-3
[15]
Frantz, C., Stewart, K.M. and Weaver, V.M. (2010) The Extracellular Matrix at a Glance. Journal of Cell Science, 123, 4195-4200. https://doi.org/10.1242/jcs.023820
[16]
Nakanishi, I., Moriizumi, T., Ooi, A., Oda, Y. and Kajikawa, K. (1983) An Ultrastructural Study on Periductalelastosis in Human Breast Tumors. Acta Pathologica Japonica, 33, 761-772.
[17]
Fisher, E.R., Anderson, S., Redmond, C. and Fisher, B. (1993) Pathologic Findings from the National Surgical Adjuvant Breast Project Protocol B-06. 10-Year Pathologic and Clinical Prognostic Discriminants. Cancer, 71, 2507-2514.
https://doi.org/10.1002/1097-0142(19930415)71:8<2507::AID-CNCR2820710813>3.0.CO;2-0
[18]
Masters, J.R., Millis, R.R., King, R.J. and Rubens, R.D. (1979) Elastosis and Response to Endocrine Therapy in Human Breast Cancer. British Journal of Cancer, 39, 536-539. https://doi.org/10.1038/bjc.1979.98
[19]
Pai, M.R., Pai, K.N., Rao, R.V., Naik, R. and Shankarnarayana, B.P. (1999) Connective Tissue Stromal Changes in Tumors and Tumor-Like Lesions of the Breast. Indian Journal of Pathology and Microbiology, 42, 327-332.
[20]
Akhtar, G.N., Chaudhry, N.A., Tayyab, M. and Khan, S.A. (2004) AgNOR Staining in Malignant and Benign Effusions. Pakistan Journal of Medical Sciences, 20, 29-32.
[21]
Costa Ade, L., de Araújo, N.S., Pinto Ddos, S. and de Araújo, V.C. (1999) PCNA/AgNOR and Ki-67/AgNOR Double Staining in Oral Squamous Cell Carcinoma. Journal of Oral Pathology & Medicine, 28, 438-441.
https://doi.org/10.1111/j.1600-0714.1999.tb02103.x
[22]
Ahmed, H.G., Al-Adhraei, M.A. and Ashankyty, I.M. (2011) Association between AgNORs and Immunohistochemical Expression of ER, PR, HER2/neu, and p53 in Breast Carcinoma. Pathology Research International, 2011, Article ID: 237217.
https://doi.org/10.4061/2011/237217
[23]
Rzymowska, J. (1997) AgNOR Counts and Their Combination with Flow Cytometric Analyses and Clinical Parameters as a Prognostic Indicator in Breast Carcinoma. Tumori, 83, 938-942. https://doi.org/10.1177/030089169708300613
[24]
Maria Luiza, S.M., Benedicto, C., Russo, J., Planding, W. and Schenck, U. (2008) Image Analysis of the AgNOR Response in Ras-Transformed Human Breast Epithelial Cells. Acta Histochemica, 110, 210-216.
https://doi.org/10.1016/j.acthis.2007.10.016
[25]
Sivrides, E., Anastasiadis, P. and von Lüdinghausen, M. (1992) Argyrophilic Staining for Nucleolar Organizer Region (AgNOR). A Suitable Methodology for Differential Diagnosis of Breast Lesions? Zentralblatt fur Pathologie, 138, 103-107.
[26]
Ruschoff, J., Neumann, K., Contractor, H., Plate, K. and Thomas, C. (1990) Assessment of Nucleolar Organizer Regions by Automatic Image Analysis in Breast Cancer: Correlation with DNA Content, Proliferation Rate, Receptor Status, and Histopathological Grading. Journal of Cancer Research and Clinical Oncology, 116, 480-485.