Significance of hyperprolactinemia for cytomorphologic features of breast secretions

Abstract

Background/Aim. Nipple discharge syndrome is a clinical entity capable of presenting various disorders such is mammary infection (nonpuerperal and puerperal mastitis), intraductal papillomas, fibrodenoma, breast cancer and hyperprolactinemia syndrome. The aim of the study was to determine differencies in cytological features of mammary secretion in patients with hyperprolactinemia and those with normal serum prolactin levels and to define the role of growth hormone, follicle-stimulating hormone, luteinizing hormone and thyroid-stimulating hormone in creating cellular profile of breast secretion. Methods. The study included 50 patients with nipple discharge syndrome. The patients were devided into the clinical group (27 patients with hyperprolactinemia and nipple discharge) and the control group I (23 patients with normal serum prolactin and nipple discharge). The control group II included the patients of the clinical group achiving normalised serum prolactin levels after the treatment of hyperprolactinemia. Serum prolactin, follicle-stimulating hormone and luteinizing hormone levels were assessed by RIA using commercial kits IRMA hPRL, hLH and hFSH, (INEP, Zemun, Serbia) while serum growth hormone and thyroid-stimulating hormone levels were assessed by RIA using commercial kits LKB-wallac. Cytologic evaluation of samples, taken from all the patients with mammary secretion, was done using standard techniques of staining Haemathoxilin-eozine and May- Gr?nwald/Giemsa. Results. Our results showed a significantly higher presence of lipid and protein material in clinical group, in comparison with the control group I (p < 0.01). Also, our data demonstrated significantly higher number of ductal epithelial cells (p < 0.05) and ductal histiocities (p < 0.001) in the clinical group, compared with the control group I. Macrophagies frequency was proportionally higher in clinical group (44.44%) compared the control group I (17.39%). Erythrocites were significantly lower in the clinical group (p < 0.001) than in the control group I. Significantly decreased mammary secretion (p < 0.01), lower lipid (p < 0.01) and protein synthesis (p < 0.01), and less presence of all cellular categories (p < 0.01) were obtained after normalization of serum prolactin levels. Conclusion. Growth hormone, follicle-stimulating hormone, luteinizing hormone and thyroid-stimulating hormone did not show significant influence on creating cytological features of mammary secretion. The most expressive role, hyperprolactinemia demonstrated in the domain of mammary ductal secretory activity, making mammary secretion reach in lipid and protein material and simultaneously increasing number of ductal epithelial cells, ductal histiocytes and 'foam cells'- macrophages. These cytological findings indicate that hyperprolactinemia promote periductal and intraductal steril inflammation which withdraws after serum prolactin normalization.Uvod/Cilj. Sindrom sekretne dojke je klinicki entitet kojim se mogu prezentovati razlicite bolesti poput infekcija dojki (nepuerperalni i puerperalni mastitisi), intraduktusnih papiloma, fibroadenoma, karcinoma dojke i hiperprolaktinemijskog sindroma. Cilj prospektivne klinicke studije bio je da se odrede citoloske karakteristike mamarnog sekreta kod bolesnika sa hiperprolaktinemijom i uloga hormona rasta, folikostimulirajuceg, luteinizirajuceg i tireostimulisuceg hormona u njihovom kreiranju. Metode. Pedeset bolesnica sa sindromom sekretne dojke bilo je podeljeno na klinicku grupu (27 bolesnica sa hiperprolaktinemijmom i sindromom sekretne dojke) i kontrolnu grupu I (23 bolesnice sa normalnim prolaktinom i sindromom sekretne dojke). Kontrolnu grupu II cinile su bolesnice klinicke grupe nakon normalizacije serumskog prolaktina posle sprovedene terapije. Serumske koncentracije prolaktina, folikostimulirajuceg i luteinizirajuceg hormona odredjivane su radioimunoloskim analizama, koriscenjem komercijalnih kompleta IRMA hPRL, hLH i hFSH, (INEP, Zemun, Srbija), a koncentracije hormona rasta i tireostimulisuceg hormona komercijalnim kompletima LKB-wallac. Za citolosko ispitivanje mamarnog sekreta koriscene su standardne tehnike bojenja hematoksilin-eozin i May-Gr?nwald/Giemsa. Rezultati. U mamarnom sekretu bolesnika klinicke grupe zabelezeno je statisticki znacajno cesce prisustvo lipidnog i proteinskog materijala nego kod bolesnica kontrolne grupe I (p < 0,01). Znacajno cesce vidjene su duktusne epitelne celije (p < 0,05) i duktusni histiociti (p < 0,001) u klinickoj grupi nego u kontrolnoj grupi I. Makrofagi su bili procentualno cesce zastupljeni (44,44%) u klinickoj grupi, nego u kontrolnoj grupi I (17,39%). Prisustvo eritrocita bilo je znacajno nize u klinickoj grupi, nego u kontrolnoj grupi I (p < 0,001). Nakon normalizacije serumskog prolaktina, pored znacajne redukcije mamarne sekrecije (p < 0,01), utvrdjeno je i smanjeno prisustvo lipidne (p < 0,01) i proteinske komponente (p < 0,01), kao i svih ostalih celularnih kategorija (p < 0,01). Zakljucak. Tropni hormoni poput hormona rasta, tireostimulisuceg, folikulostimulirajuceg i luteinizirajuceg hormona, nisu pokazali znacajnu ulogu u kreiranju citoloskih karakteristika mamarnog sekreta. Najizrazeniju ulogu prolaktin je ispoljio u domenu sekretorne aktivnosti duktusnog sistema dojke, cineci sekret bogatim lipidnim i proteinskim materijalom. Kao posledica sinteze i sekrecije mleka, pod uticajem hiperprolaktinemije, celularnost mamarnog sekreta se povecava prisustvom duktusnih epitelnih celija, duktusnih histiocita i 'penusavih celija' - makrofaga. Ove citoloske kategorije dovode do indirektnog zakljucka da hiperprolaktinemija moze inicirati periduktusnu i intraduktalnu sterilnu inflamaciju koja se stisava sa normalizacijom serumskog prolaktina.