Association of Carbohydrates and Connective Tissue Fibres with Estrogen Expression in Breast Lesions Among Sudanese Females

Abstract

This is a retrospective descriptive study conducted in Khartoum State to find out (if any) association between ER receptors and Carbohydrates or Connective tissue fibres in specimens obtained from 60 women presented with breast lesions (35 were with malignant lesions and 25 were benign lesions). All specimens were diagnosed at the histopathology department of Laboratory Administration in Khartoum State, Sudan. Malignant tumors include, DCI, IDC and ILC representing 2/35(5.7%), 23/35(65.7%) and 10/35 (28.6%), per capita. Benign tumors include, Fibroadenoma, Fibrocystic changes and others representing 18/25(72%), 4/25(16%) and 3/25(12%) respectively. All specimens were immunohistochemistry, then re-examined Carbohydrates by for (Alcian ER blue, status Alcian by blue- methylation, PAS and PAS-diastase), Connective tissue fibres by (Vangieson, Masson Trichrome, Silver stain and Verhoeff) and Nucleolar Organizing regions by AgNOR. Of the 60 breast lesions, 35/60 (58.3%) were with malignant tumors. The remaining 25 samples were with benign breast lesions. Of the 35 malignant samples immunohistochemical staining for ER revealed positive expression in 12/35(34.3%) and negative in 23/35(65.7%) specimens. Regarding benign samples there were 8/25(32%) ER positive and 17/25(68%) ER negative. Out of the total study subjects there were 20/60(33.3%) ER positive. Regarding malignant samples, DCI, IDC and ILC ER positive expressions were identified among 1/2(50%), 7/23(30%) and 4/10(40%), respectively. Regarding benign samples, Fibroadenoma, Fibrocystic changes, and others ER positive expression were detected among 6/18(33.3%), 1/4 (25%) and 1/3(33.3%), in this order. To the best of our knowledge, there is no study investigated the association between ER, carbohydrate and connective tissue fibres. Thereafter, and according to present study there is a strong relationship between ER positivity and presence of acid mucin (P =0.000), but not with sulphated mucin. Furthermore, a strong relationship was found between ER positivity status and PAS positive materials (P value = 0.000), but not with glycogen. Since, there is a significant correlation between ER and Carbohydrates, these positive PAS materials might be PAS positive acid mucin. Regarding connective tissue fibres there is a significant correlation between ER+ and presence of collagenic fibres (P value = 0.000). Furthermore, Elastic fibres were significantly associated with ER+ (P value = 0.039), as well as, Reticulin fibres (P value = 0.020). The mean number of AgNORs was relatively similar in malignant and benign breast lesions. The significant positive association between ER expression and carbohydrate and also between ER expression and connective tissue fibres suggest that the ER expression could be predicted in histopathology laboratory using histochemical demonstration of carbohydrates and connective tissue fibres of female breast tissue. The histochemical prediction of ER receptor status may be helpful, cost effective and time saving more than that of more sophisticated investigations. Further studies with large sample size and more sophisticated techniques are required to strength the findings of this study.