RESUMO
OBJECTIVE: To assess the relationship between the presence of PVUII and XBAI polymorphisms in the estrogen receptor α gene and mammographic density in postmenopausal women. METHODS: For the present analysis, 189 postmenopausal women who had never used hormonal therapy and who did not have clinical or mammographic features were selected. Based on the ACR-BIRADS(®) 2003 classification, the mammographic density was determined by three independent readers (two subjective ratings and one computerized). Blood samples were available to extract DNA according to KIT GFX(®) protocol. PCR-RFLP was then used to identify the polymorphisms. RESULTS: There was a high degree of agreement among the three readers to determine the mammographic density (κ > 0.75). Sixty women (32%) had dense breasts and 129 (68%) had non-dense breasts. The PVUII polymorphism was found in 132 (69.8%) of 189 women, while the XBAI polymorphism was found in 135 (71.4%) women. Parity (p = 0.02) and body mass index (p < 0.0001) were associated with mammographic density. It was observed that, for the XBAI polymorphism, women with two mutated alleles were approximately 2.5 times more likely to be classified in the dense breasts group (p = 0.003) and the presence of both wild alleles was associated with fibroglandular tissue replacement by fat (p = 0.02). CONCLUSIONS: There was no significant association of the PVUII polymorphism in the estrogen receptor α gene with mammographic density (p = 0.34). However, the XBAI polymorphism was observed at a higher mutated homozygous frequency in women with dense breasts and there was an increased frequency of wild-type homozygous and heterozygous women with fat-replaced breasts (p = 0.01).
Assuntos
Neoplasias da Mama/genética , Receptor alfa de Estrogênio/genética , Glândulas Mamárias Humanas/anormalidades , Polimorfismo Genético/genética , Pós-Menopausa/genética , Adulto , Alelos , Índice de Massa Corporal , Densidade da Mama , Feminino , Genótipo , Haplótipos , Humanos , Pessoa de Meia-Idade , Paridade , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , GravidezRESUMO
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.
Assuntos
Neoplasias da Mama/patologia , Proliferação de Células , Fibroadenoma/patologia , Fase Folicular/metabolismo , Antígeno Ki-67/metabolismo , Fase Luteal/metabolismo , Adolescente , Adulto , Fatores Etários , Aleitamento Materno/estatística & dados numéricos , Neoplasias da Mama/complicações , Neoplasias da Mama/metabolismo , Feminino , Fibroadenoma/complicações , Fibroadenoma/metabolismo , Fase Folicular/sangue , Humanos , Fase Luteal/sangue , Obesidade/complicações , Progesterona/sangue , Tabagismo/complicações , Adulto JovemRESUMO
CONTEXT: The malignant variety of the phyllodes tumor is rare. The occurrence of invasive lobular carcinoma within fibroadenoma is rare as well. DESIGN: Case report. CASE REPORT: A 58-year-old black female patient was referred to the Mastology unit of the Department of Gynecology, Federal University of São Paulo / Escola Paulista de Medicina, in February 1990, presenting an ulcerated tumor in the right breast with fast growth over the preceding six months. She was a virgin, with meno-pause at the age of 45 years and had not undergone hormone replacement treatment. The physical examination showed, in her right breast, an ulcerated tumor of 20 x 30 cm which was not adher-ent to the muscle level, multilobular and with fibroelastic consistency. The axillary lymph nodes were not palpable. The left breast showed a 2 x 3 cm painless, movable nodule, with well-defined edges, and fibroelastic consistency. We performed left-breast mammography, which showed several nodules with well-defined edges, the largest being 2 x 3 cm and exhibiting rough calcification and grouped microcalcifications within it. The patient underwent a frozen biopsy that showed a malignant variant of the phyllodes tumor in the right breast and fibroadenoma in the left one. After that, we performed a total mastectomy in the right breast and an excision biopsy in the left one. Paraffin study confirmed the frozen biopsy result from the right breast, yet we observed that in the interior of the fibroadenoma that was removed on the left, there was a focal area of invasive lobular carcinoma measuring 0.4 cm. The patient then underwent a modi-fied radical mastectomy with total axillary lymphadenectomy. None of the 21 dissected lymph nodes showed evidence of metastasis. In the follow-up, the patient evolved asymptomatically and with normal physical and laboratory examination results up to July 1997.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Lobular/patologia , Fibroadenoma/patologia , Neoplasias Primárias Múltiplas/patologia , Tumor Filoide/patologia , Neoplasias da Mama/ultraestrutura , Carcinoma Lobular/ultraestrutura , Feminino , Fibroadenoma/ultraestrutura , Humanos , Mamografia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/ultraestruturaRESUMO
OBJECTIVE: To evaluate by hysteroscopy and histopathology the influence of tamoxifen in the endometrium of post-menopausal women with previous breast cancer. METHOD: Out of 46 patients studied, 20 of them had been using tamoxifen for an average length of 12 months, and are still being followed-up. Hysteroscopy with endometrial biopsy was performed before and after the use of the drug. RESULTS: The prevalence of endometrial activity before and after this hormoniotherapy was the same, i.e. 10.0%, showing a non-significant variation. CONCLUSION: The hormoniotherapy with tamoxifen has not increased the endometrial proliferactive activity of postmenopausal patients with breast cancer. The most common hysteroscopical finding was numerous vesicles disseminated throughout the uterine cavity probably due to atrophy of the endometrium.
Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Endométrio/patologia , Tamoxifeno/uso terapêutico , Biópsia , Neoplasias da Mama/patologia , Estudos de Casos e Controles , Endométrio/efeitos dos fármacos , Feminino , Humanos , Histeroscopia , Pessoa de Meia-Idade , Pós-Menopausa , Estudos ProspectivosRESUMO
OBJECTIVES: The effect of tamoxifen on cyclic mastalgia and on chemoprophylaxis against breast cancer is little known, mainly due to the difficulties in studying the normal human gland. We proposed to evaluate the mitotic index and the nuclear volume of the lobule of women medicated with tamoxifen only during the luteal phase of the menstrual cycle in order to observe the effect of tamoxifen on the normal human mammary gland. METHODS: Twenty-four premenopausal women with fibroadenoma diagnosed via biopsy were studied. The phase of the cycle was determined by the date of menstruation and serum progesterone level in the luteal phase (> or = 3 ng/ml). The patients admitted to the study and were given written informed consent to participate in the investigation, which was previously approved of by the hospital Ethics Committee. Patients were divided at random into two groups: Group I consisted of 12 untreated women (control) and Group II consisted of 12 patients treated with 20 mg/day tamoxifen for 10 consecutive days beginning on the 13th day of the menstrual cycle. In both groups, the patients were submitted to biopsies of the nodule and of a 1-cm3 fragment of adjacent mammary parenchyma between the 23rd and 26th day of the cycle. The mitotic index (number of mitoses/1000 nuclei counted) and mean nuclear volume (mean of 10 nuclear volumes for each case) were measured. RESULTS: No mitosis was observed in Group II. There was a reduction in the mean nuclear volume in Group II (Mann-Whitney test). CONCLUSIONS: Tamoxifen, when administered only during the luteal phase of the menstrual cycle, significantly reduces the nuclear volume and mitotic activity of the epithelium. This data demonstrates an antagonistic action of tamoxifen on estrogen even when administered for short periods of time.
Assuntos
Mama/efeitos dos fármacos , Antagonistas de Estrogênios/farmacologia , Fase Luteal , Índice Mitótico , Tamoxifeno/farmacologia , Adulto , Mama/citologia , Divisão Celular , Epitélio/efeitos dos fármacos , Feminino , Humanos , Menarca , Pessoa de Meia-IdadeRESUMO
We determined the nuclear volume of fibroblasts of the normal mammary lobular stroma during the follicular and luteal phases of the menstrual cycle. Twenty patients aged 15 to 35 years and eumenorrheic for at least 6 months were randomly assigned to 2 groups, i.e., 10 women in the follicular phase and 10 in the luteal phase. The nuclear volume was 34.4 micron 3 and 98.8 micron 3 for the follicular and luteal phases, respectively, with the difference being statistically significant (p < 0.05). These data suggest a higher metabolic activity in the mammary intralobular stroma during the luteal phase of the menstrual cycle, probably due to a synergistic action of estradiol and progesterone.
Assuntos
Mama/citologia , Fibroblastos/citologia , Fase Folicular , Fase Luteal , Adolescente , Adulto , Feminino , Humanos , Distribuição AleatóriaRESUMO
A rare case of leiomyoma of the breast is reported, with a discussion of the clinical aspects and of the differential diagnosis. Excluding tumors originating from the areolar-papillary complex and the skin, this neoplasm is extremely rare, with only 11 cases reported so far. The histogenesis of the lesion is still controversial.
Assuntos
Neoplasias da Mama/diagnóstico , Leiomioma/diagnóstico , Feminino , Humanos , Mamografia , Pessoa de Meia-IdadeRESUMO
We evaluated the mitotic index and nuclear volume of the epithelium of the human mammary lobule during the menstrual cycle. Thirty patients were selected and divided at random into two groups, i.e., 15 women in the proliferative phase and 15 in the secretory phase. Normal mammary tissue was obtained on the occasion of fibroadenoma enucleation. Mitotic indices (/1000) and nuclear volume (micron 3) were 0.0 and 53.8, respectively, during the proliferative phase, and 11.6 and 130.0, respectively, during the luteal phase, the difference being statistically significant (p < 0.05). These data indicate that the proliferative stimulus of the mammary lobule is more intense during the luteal phase of the normal cycle and may probably be due to a synergistic action between progesterone and estradiol.
Assuntos
Ciclo Menstrual/fisiologia , Índice Mitótico , Adulto , Divisão Celular/fisiologia , Núcleo Celular/ultraestrutura , Feminino , Humanos , Cinética , Estatística como AssuntoRESUMO
CA 15.3, a new tumor marker, is a glycoprotein antigen produced in greater amounts by breast tumor cells. It can be quantitatively detected, circulating in human serum or plasma, using an immunoradiometric assay with monoclonal antibodies. In order to evaluate the usefulness of the method and to determine the cut-off for metastatic disease, the CA 15.3 levels were determined in 78 patients (5 patients with breast fibroadenoma and 73 patients with breast cancer). The conclusions of the study are that the CA 15.3 is a useful parameter in the management of patients in different stages of the disease: levels above 36 U/ml are suggestive of metastasis, and above 86 U/ml are indicative of them. On the other hand, CA 15.3 does not seem to be helpful in the pre-operative differential diagnosis of breast lumps.
Assuntos
Antígenos Glicosídicos Associados a Tumores/sangue , Neoplasias da Mama/imunologia , Carcinoma Ductal de Mama/imunologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/secundário , Diagnóstico Diferencial , Feminino , Humanos , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
Analyzing the morphological and ultrastructural features of the mammary gland during the menstrual cycle, the authors observed that in the proliferative phase, the mammary gland consisted of few developed lobules and presented a relative absence of mitotic figures. In this phase, the great majority of the epithelial cells contained small, dark, irregular, rich heterochromatinic nuclei. The mammary stroma showed similar findings, presenting dense connective tissue with few enhanced fibroblasts. During the secretory phase, the lobules were well developed and mitotic figures were usually observed. In this phase, the great majority of the epithelial cells presented clear voluminous, rich euchromatinic nuclei; the stroma consisted of fibroblasts with voluminous nuclei full of euchromatin. There are evident modifications of the mammary tissue according to the phase of the menstrual cycle. The morphological and ultrastructural modifications indicate higher metabolical and mitotic activities during the secretory phase.