Difficulties in the differential diagnosis of tuberculosis of the breast

An analysis of the own material and of literature data permits to note alterations in the clinical course of mammary gland tuberculosis, which is the manifestation of tuberculosis pathomorphism under modern conditions. The lesion of the mammary gland is most commonly an isolated disease. This interferes with the differential diagnosis between tuberculous mastitis and tumors of the mammary gland and supports the opinion that the spreading of infection from other old tuberculous foci via hematogenic path plays the main part in the pathogenesis of tuberculosis of the mammary gland.     

32例乳腺结核临床分析

本文报告了我院20年来收治的32例乳腺结核。结核菌主要通过乳头或邻近的结核病灶侵入乳腺。病理上分为结节型、硬化型和弥散型。本病临床上较少见,极易误诊为乳腺其他疾病,尤其是乳腺癌。确诊主要依靠病理学检查。治疗主要采用手术治疗和抗结核治疗。     

Mammary tuberculosis: analysis of thirty-eight patients

Thirty-eight patients with mammary gland tuberculosis were evaluated over a 5-year period presenting to the surgical unit of our institution. Unilateral involvement of the breast in a woman presenting at an average age of 29 years was the commonest observation. A lump in the breast with or without discharging sinuses was the most common clinical presentation. Ten (26%) of these patients had breast pain with or without increased breast nodularity. Axillary lymph nodal involvement was evident in 14 (36%) of our patients. Only five patients had associated pulmonary tuberculosis, the rest having an isolated involvement of the breast. Fine-needle aspiration cytology was the most reliable diagnostic modality. Medical therapy with antitubercular drugs ranging from 6 to 9 months was the mainstay of treatment. Surgical intervention was reserved for selected refractory cases.     

Diagnostic tactics in localized fibroadenomatosis of the breast

Results of the examination and treatment of 203 patients with localized fibroadenomatosis of the mammary gland are described. The authors give an estimation of diagnostic algorithms used when detecting the physical signs of the disease. It was shown that the examination of patients with the palpation signs of nodular mastopathy should necessarily include mammography which can eliminate unwarranted risk of hypodiagnosing carcinoma of the mammary gland and determine the group of patients in whom the emergency operation is not necessary.     

乳腺积乳囊肿的病因及诊治

本文报告乳腺积乳囊肿56例。年龄23～52岁,平均27.5岁。术前50例诊断正确,误诊6例。特别提出局部肿块波动感试验阳性,A超显示液平段,B起显示无回声,试穿抽出乳汁,对诊断有一定价值。治疗以手术切除为主;仅有7例穿刺抽吸乳汁得以治愈。     

Local production of estrogen via aromatase and estrone sulfatase in breast cancer tissue

The activities of aromatase and estrone sulfatase which are important enzymes involved in the local production of estrogen in breast cancer tissue were measured to examine their availability in endocrine therapy and their clinical significance. The materials obtained were breast cancer tissue, noncancerous mammary gland and breast fat tissue from twenty eight patients with breast cancer, and mammary gland tissue from eight patients with benign breast disease. After centrifugation of homogenized tissue at 1000 X g, the supernatant of breast cancer tissue or mammary gland and the subnatant of breast fat tissue were used as enzyme sources. Aromatase activity was measured by 3H2O release assay using (1 beta-3H) androstenedione as the substrate, while estrone sulfatase activity was estimated from the conversion rate of (6,7-3H)estrone-3-sulfate to estrone. Aromatase activities were 25.1 +/- 12.4 (mean +/- S.D.) fmol/mg protein/h in twenty seven breast cancer tissue specimens, 11.0 +/- 6.1 fmol/mg protein/h in sixteen noncancerous mammary gland tissue specimens, 9.3 +/- 10.0 fmol/mg protein/h in twenty seven breast fat tissue specimens, and 7.7 +/- 5.5 fmol/mg protein/h in eight mammary gland tissue specimens from patients with benign breast disease. The aromatase activity in breast cancer tissue was significantly higher than that in noncancerous mammary gland, breast fat tissue and benign breast lesions (p less than 0.001). Estrone sulfatase activity was 4.0 +/- 3.5 nmol/mg protein/h in nineteen breast cancer tissue specimens, but was almost undetectable in eleven noncancerous mammary tissue specimens and eight benign breast lesions. These results suggest the relatively high local production of estrogen, mediated by aromatase or estrone sulfatase in breast cancer tissue.(ABSTRACT TRUNCATED AT 250 WORDS)     

Progesterone Receptors in Mammary Gland Development and Tumorigenesis

The steroid hormone, progesterone (P), is a central coordinator of all aspects of female reproductive activity and plays a key role in pregnancy-associated mammary gland morphogenesis and mammary tumorigenesis. The effects of P on the mammary gland are mediated by two structurally and functionally distinct nuclear receptors PR-A and PR-B that arise from a single gene. Null mutation of both receptors in PR knockout (PRKO) mice has demonstrated a critical role for PRs in mediating pregnancy-associated mammary ductal branching and lobuloalveolar differentiation and in initiation of mammary tumors in response to carcinogen. Analysis of the molecular genetic pathways disrupted in PRKO mice has recently yielded important insights into the molecular mechanisms of regulation of mammary gland morphogenesis by PRs. In addition to its essential role in regulating proliferative and differentiative responses of the adult mammary gland during pregnancy, P plays a critical role in the protection against mammary tumorigenesis afforded by early parity. Thus, the effects of P on postnatal developmental plasticity of the mammary gland differ between young and adult glands. This review will summarize recent advances in our understanding of 1) the molecular mechanisms by which PRs mediate pregnancy-associated mammary gland morphogenesis, 2) the role of PRs in mediating tumorigenic responses of the adult mammary gland to carcinogen, and 3) the role of P in long-term protection of the juvenile mammary gland against tumorigenesis. In addition, we will summarize recent insights into the isoform selective contributions to some of these activities of PRs obtained from comparative analysis of P-dependent mammary gland development in PR isoform specific knockout mice lacking either the PR-A (PRAKO) or PR-B (PRBKO).     

Immune Cell Location and Function During Post-Natal Mammary Gland Development

Post-natal mammary gland development requires complex interactions between the epithelial cells and various cell types within the stroma. Recent studies have illustrated the importance of immune cells and their mediators during the various stages of mammary gland development. However, the mechanisms by which these immune cells functionally contribute to mammary gland development are only beginning to be understood. This review provides an overview of the localization of immune cells within the mammary gland during the various stages of post-natal mammary gland development. Furthermore, recent studies are summarized that illustrate the mechanisms by which these cells are recruited to the mammary gland and their functional roles in mammary gland development.     

Surgical treatment of breast neoplasms in early stages

Analysis of literary data and own investigation results for the modern surgical methods of treatment of mammary gland cancer in early stages was performed. Indexes of patients survival after surgical removal of mammary gland (MG) and quadranthectomy did not differ. Preservation of MG constitutes great social and psycho-emotional significance for women-patients.     

A comparative analysis of effectiveness of surgical treatment of fibroadenomas in young girls

Results of the examination of young girls (13-17 years of age) who came to consult a doctor for different complaints of the state of their mammary glands are described. Age-dependent peculiarities of the mammary gland tissue in this category of patients imply the thorough preoperative examination. The ultrasonic investigation of the mammary gland is the method of choice. Fibroadenoma was diagnosed in 50 patients, fibrocystic mastopathy in 27, mastopathia cystica in 81, mastitis and other diseases in 5 patients. In 54 patients no pathology of the mammary glands was revealed. A comparative analysis of two groups of patients operated upon is given: a control group (25) with the operations in the volume of a classical sectoral resection and a main group (25) with a sectoral resection performed by a modified method. In the control group the cosmetic effect after the traditional sectoral resection was estimated as dissatisfactory in 76%: there were signs of keloidization of the scar, hypertrophic scar with pigmentation. In the majority of patients there was an atrophic scar with a pronounced deficiency of the volume of the mammary gland and its asymmetry. In the main group patients the complete absence of the signs of postoperative scar was noted in 16 (64%) patients. They were operated on by the modified method (periareolar resection). A conclusion is made that when the operation is thought to be inevitable, the low degree of risk of breast cancer requires a transformation of the surgical strategy towards the reduction of the volume of ablated tissues and employment of modified variants of surgery resulting in the maximum cosmetic effect.     

Attenuation of Mammary Gland Dysplasia and Feeding Difficulties in <Emphasis Type="Italic">Tabby</Emphasis> Mice by Fetal Therapy

Hypohidrotic ectodermal dysplasias (HED) are hereditary differentiation disorders of multiple ectodermal structures including the mammary gland. The X-linked form of HED (XLHED) is caused by a lack of the secreted signaling molecule ectodysplasin A1 (EDA1) which is encoded by the gene EDA and belongs to the tumor necrosis factor (TNF) superfamily. Although male patients (hemizygous) are usually more severely affected by XLHED, heterozygous female carriers of an EDA mutation may also suffer from a variety of symptoms, in particular from abnormal development of their breasts. In Tabby mice, a well-studied animal model of XLHED, EDA1 is absent. We investigated the effects of prenatal administration of Fc-EDA, a recombinant EDA1 replacement protein, on mammary gland development in female Tabby mice. Intra-amniotic delivery of Fc-EDA to fetal animals resulted later in improved breastfeeding and thus promoted the growth of their offspring. In detail, such treatment led to a normalization of the nipple shape (protrusion, tapering) that facilitated sucking. Mammary glands of treated female Tabby mice also showed internal changes, including enhanced branching morphogenesis and ductal elongation. Our findings indicate that EDA receptor stimulation during development has a stable impact on later stages of mammary gland differentiation, including lactation, but also show that intra-amniotic administration of an EDA1 replacement protein to fetal Tabby mice partially corrects the mammary gland phenotype in female adult animals.     

丘状小乳症的临床治疗探讨

目的:探讨丘状小乳症的病因及手术治疗方法。方法:对我科近一年来4例采用乳房假体矫正丘状小乳的病案进行总结,比较假体置入时同期行乳腺后放射状切开、梯田状切开及乳晕双环法缩小后的治疗效果。结果:单纯假体隆乳术后双乳呈葫芦状,形态不佳;假体置入同时行腺体后放射状切开的1例患者术后乳房仍呈葫芦形,程度较轻;假体置入同时行乳腺后梯田状切开的1例患者术后疗效与放射状切开相似;2例假体置入同时行乳晕旁双环法上提的患者获得满意的疗效。结论:丘状小乳症是比较少见的乳房畸形,此类患者未生育前乳腺覆盖胸壁的面积小(远小于正常乳房基底面积),生育时哺乳期乳腺增生、增大导致乳头、乳晕四周皮肤小面积被牵张,又因哺乳导致乳头、乳晕及四周皮肤小面积松弛下垂,这样就导致乳晕及其旁侧的皮肤松弛度大于基底轮廓线外的胸壁皮肤。此类患者最佳的手术治疗方法是行乳房假体置入的同时用双环法矫正乳晕四周的皮肤松弛畸形。     

Neuregulin 3 and Erbb Signalling Networks in Embryonic Mammary Gland Development

We review the role of Neuregulin 3 (Nrg3) and Erbb receptor signalling in embryonic mammary gland development. Neuregulins are growth factors that bind and activate its cognate Erbb receptor tyrosine kinases, which form a signalling network with established roles in breast development and breast cancer. Studies have shown that Nrg3 expression profoundly impacts early stages of embryonic mammary development. Network analysis shows how Nrg/Erbb signals could integrate with other major regulators of embryonic mammary development to elicit the morphogenetic processes and cell fate decisions that occur as the mammary lineage is established.     

内窥镜双平面假体隆乳术的临床应用

目的：探讨应用内窥镜技术进行双平面假体隆乳术的优缺点及可行性。方法：自2010年6月至2011年5月,应用内窥镜开展双平面隆乳21例,6例为未婚女性,15例为哺乳后乳腺萎缩,其中6例伴轻度或中度的乳腺松垂。结果：21例就医者术后随访1～11个月,除1例乳房轻度欠对称外,其余就医者术后乳房形态良好,手感及动感好,无包膜挛缩,无血肿及感染。结论：采用内窥镜微创技术,可通过腋窝切口完成双平面隆乳手术,切口隐蔽,手术在直视下进行,安全性高,手术创伤小,恢复较快,就医者术后疼痛减轻,包膜挛缩发生率降低。由于结合了乳腺后及胸大肌下两个平面的优势,乳房形态更加自然,手感及动感逼真。适用于大多数需要隆乳者,尤其适用于哺乳后乳腺一定程度松垂的就医者。     

A Mouse Mammary Gland Involution mRNA Signature Identifies Biological Pathways Potentially Associated with Breast Cancer Metastasis

Mouse mammary gland involution resembles a wound healing response with suppressed inflammation. Wound healing and inflammation are also associated with tumour development, and a ‘wound-healing’ gene expression signature can predict metastasis formation and survival. Recent studies have shown that an involuting mammary gland stroma can promote metastasis. It could therefore be hypothesised that gene expression signatures from an involuting mouse mammary gland may provide new insights into the physiological pathways that promote breast cancer progression. Indeed, using the HOPACH clustering method, the human orthologues of genes that were differentially regulated at day 3 of mammary gland involution and showed prolonged expression throughout the first 4 days of involution distinguished breast cancers in the NKI 295 breast cancer dataset with low and high metastatic activity. Most strikingly, genes associated with copper ion homeostasis and with HIF-1 promoter binding sites were the most over-represented, linking this signature to hypoxia. Further, six out of the ten mRNAs with strongest up-regulation in cancers with poor survival code for secreted factors, identifying potential candidates that may be involved in stromal/matrix-enhanced metastasis formation/breast cancer development. This method therefore identified biological processes that occur during mammary gland involution, which may be critical in promoting breast cancer metastasis that could form a basis for future investigation, and supports a role for copper in breast cancer development. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. An erratum to this article can be found at     

Mammary Gland Involution as an Immunotherapeutic Target for Postpartum Breast Cancer

Postpartum mammary gland involution has been identified as tumor-promotional and is proposed to contribute to the increased rates of metastasis and poor survival observed in postpartum breast cancer patients. In rodent models, the involuting mammary gland microenvironment is sufficient to induce enhanced tumor cell growth, local invasion, and metastasis. Postpartum involution shares many attributes with wound healing, including upregulation of genes involved in immune responsiveness and infiltration of tissue by immune cells. In rodent models, treatment with non-steroidal anti-inflammatory drugs (NSAIDs) ameliorates the tumor-promotional effects of involution, consistent with the immune milieu of the involuting gland contributing to tumor promotion. Currently, immunotherapy is being investigated as a means of breast cancer treatment with the purpose of identifying ways to enhance anti-tumor immune responses. Here we review evidence for postpartum mammary gland involution being a uniquely defined ‘hot-spot’ of pro-tumorigenic immune cell infiltration, and propose that immunotherapy should be explored for prevention and treatment of breast cancers that arise in this environment.     

The Tension Mounts: Mechanics Meets Morphogenesis and Malignancy

The tissue microenvironment regulates mammary gland development and tissue homeostasis through soluble, insoluble and cellular cues that operate within the three dimensional architecture of the gland. Disruption of these critical cues and loss of tissue architecture characterize breast tumors. The developing and lactating mammary gland are also subject to a plethora of tensional forces that shape the morphology of the gland and orchestrate its functionally differentiated state. Moreover, malignant transformation of the breast is associated with dramatic changes in gland tension that include elevated compression forces, high tensional resistance stresses and increased extracellular matrix stiffness. Chronically increased mammary gland tension may influence tumor growth, perturb tissue morphogenesis, facilitate tumor invasion, and alter tumor survival and treatment responsiveness. Because mammary tissue differentiation is compromised by high mechanical force and transformed cells exhibit altered mechanoresponsiveness, malignant transformation of the breast may be functionally linked to perturbed tensional-homeostasis. Accordingly, it will be important to define the role of tensional force in mammary gland development and tumorigenesis. Additionally, it will be critical to identify the key molecular elements regulating tensional-homeostasis of the mammary gland and thereafter to characterize their associated mechanotransduction pathways.     

Immunopathology of Mastitis: Insights into Disease Recognition and Resolution

Mastitis is an inflammation of the mammary gland commonly caused by bacterial infection. The inflammatory process is a normal and necessary immunological response to invading pathogens. The purpose of host inflammatory responses is to eliminate the source of tissue injury, restore immune homeostasis, and return tissues to normal function. The inflammatory cascade results not only in the escalation of local antimicrobial factors, but also in the increased movement of leukocytes and plasma components from the blood that may cause damage to host tissues. A precarious balance between pro-inflammatory and pro-resolving mechanisms is needed to ensure optimal bacterial clearance and the prompt return to immune homeostasis. Therefore, inflammatory responses must be tightly regulated to avoid bystander damage to the milk synthesizing tissues of the mammary gland. The defense mechanisms of the mammary gland function optimally when invading bacteria are recognized promptly, the initial inflammatory response is adequate to rapidly eliminate the infection, and the mammary gland is returned to normal function quickly without any noticeable clinical symptoms. Suboptimal or dysfunctional mammary gland defenses, however, may contribute to the development of severe acute inflammation or chronic mastitis that adversely affects the quantity and quality of milk. This review will summarize critical mammary gland defense mechanisms that are necessary for immune surveillance and the rapid elimination of mastitis-causing organisms. Situations in which diminished efficiency of innate or adaptive mammary gland immune responses may contribute to disease pathogenesis will also be discussed. A better understanding of the complex interactions between mammary gland defenses and mastitis-causing pathogens should prove useful for the future control of intramammary infections.