Abstract
Fibroadenomas (FA) and phyllodes tumors (PT) are fibroepithelial lesions in the breast, which until now the relationship between the pathogenesis of both have not been ascertained yet. Epithelial cells are thought to be involved in the regulation of changes in the stromal cells in the PT, so it can be estimated that this process is involved in epithelial-mesenchymal transition (EMT). This study aims to compare of snail family transcriptional repressor 1 (Snail-1) and estrogen receptor (ER) impression as EMT factors among tumor type (FA, benign PT, boderline PT and malignant PT). This study was an observational analysis with the cross-sectional method. After the histologic grade of the samples was reviewed, immunohistochemistry examination for ER and Snail-1 was performed. Statistical analysis for categorical data was tested by chi-square test. There were 66 samples, consists of 20 FA, 17 benign PT, 16 borderlines PT, and 13 malignant PT. A significant difference in the loss of ER expression in borderline and malignant PT was found compared to FA and benign PT. This is inversely proportional to the snail-1 expression, where the expression was high in borderline PT and malignant PT stromal cells. This could support the consideration of the pathomechanism regulation of epithelial-mesenchymal cell transition changes in FA with PT, where Snail-1 is one of the proteins in the regulation of the EMT and RE processes acting as an inhibiting factor in transcription factors in the mechanism of EMT occurrence.
Highlights
Fibroepithelial breast lesions are a group of breast neoplasms ranging from benign to malignant, in which each shows a different level of stromal proliferation in relation to the epithelial compartment [1]
Several studies have shown that Snail causes metabolic reprogramming, affects tumor cells with traits such as cancer stem cells, and increases tumor recurrence, drug resistance, stem cell biology, and in the pathogenesis of metastases [11,12]
The presence of snail-1 expression in phyllodes tumor (PT) malignant stromal cells is in accordance with epithelialmesenchymal transition (EMT) theory about the mechanism of morphogenesis that converts epithelial cells into transient or permanent mesenchymal cells
Summary
Fibroepithelial breast lesions are a group of breast neoplasms ranging from benign to malignant, in which each shows a different level of stromal proliferation in relation to the epithelial compartment [1]. Fibroadenoma (FA) and phyllodes tumor (PT) are fibroepithelial lesions in the breast that, until now, the relationship between the pathogenesis of both has not been confirmed. FA has several variants, most of which do not pose a diagnostic challenge, but cellular FA and juvenile FA types can have features similar to PT and, admittedly, often have different assessments. Phyllodes tumors represent a spectrum of lesions with various clinical behaviors and are assessed as benign, borderline or malignant based on histological feature variants according to the World Health Organization (WHO) recommendations. Several recent studies have significantly enhanced our understanding of the pathogenesis of fibroepithelial lesions, highlighting FA as a true neoplasm [2,4]
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