Association of Connective Tissue Fibers with Estrogen Expression in Breast Lesions among Sudanese Females

Abstract

Background: Breast cancer is a major cause of morbidity and mortality worldwide. Immunohistochemical typing is important to understand the biological behavior of this disease. High mammographic density, which mostly attributed to collagen fibers, is among the strongest risk factors for developing breast cancer. Our objectives are to determine the type of connective tissue fibers in different breast lesions and to evaluate the relation between connective tissue fibers and estrogen expression. Methods: A total of 60 samples of breast lesions (35 were malignant and 25 were benign) was evaluated retrospectively. All specimens were diagnosed in the histopathology department of Laboratory Administration in Khartoum State, Sudan. The specimens were then re-examined for estrogen receptor status by immunohistochemistry and connective tissue fibers by Vangieson and Masson Trichrome (for collagen fibers), Silver stain (for reticular fibers) and Verhoeff (for elastic fibers) methods of staining. Findings: For the 35 malignant samples, immunohistochemical staining for estrogen receptors revealed positive expression in 12/35(34.3%) and negative in 23/35(65.7%) specimens. Benign samples showed 8/25(32%) estrogen receptors positive and 17/25(68%) estrogen receptors negative. Out of the total study subjects, there were 20/60(33.3%) estrogen receptors positive. Interpretation: A significant correlation between estrogen receptors positive and presence of collagenic fibers (P-value=0.000) was noticed. Furthermore, Elastic fibers were significantly associated with estrogen receptors positive (P-value=0.039), as well as, Reticulin fibers (P-value=0.020). Conclusion: The significant positive association between ER expression and all three types of connective tissue fibers suggests an underlying molecular relation and that the estrogen receptors expression might be predicted using histochemical demonstration as screening step for tissue biopsy. To the best of our knowledge, no study investigated the association between estrogen receptors and connective tissue fibers.