Abstract
In female breast cancer (BC), elastosis is strongly related to estrogen receptor alpha (ERα) expression. Male breast cancers almost invariably express ERα; so, the aim of this study was to investigate elastosis frequency in invasive male BC as well as clinicopathological correlations, in comparison with females. A total of 177 male BC cases and 135 female BC cases were included, all ERα-positive and invasive carcinoma of no special type. Elastosis on H&E-stained slides was scored in a four-tiered system as elastosis grade (EG) 0 (no elastosis) to EG3 (high amount of elastosis). EG scores in male BC were correlated to histopathological characteristics and overall surviva and compared with female BC EG scores. Male BC showed some degree of elastosis in 26/117 cases (22.2%) with none showing EG3, while female BC cases showed elastosis in 89/135 cases (65.9%) with 21.5% showing EG3 (p < 0.001). This difference retained its significance in multivariate logistic regression. In male BC cases, no significant correlations were found between the amount of elastosis and age, grade, mitotic activity index, and PgR. In addition, no significant prognostic value of elastosis was seen. In conclusion, despite high ERα expression, male BC showed significantly less elastosis than female BC. Elastosis did not show clinicopathological correlations or prognostic value. Therefore, elastosis seems to be a less useful ERα tissue biomarker with less clinical significance in male BC compared with females, pointing towards important BC sex differences.
Highlights
Elastic fibers are composed of two important components: elastin and small microfibrils
Shivas and Douglas categorized elastosis in 1972 into four grades with grade 0 corresponding to no elastosis and grade 3 corresponding to numerous dense aggregates of elastic fibers and found a favorable survival in female breast cancers showing a high amount of elastosis [3]
Male breast cancer (BC) was more frequently graded as a histologic grade 2 (55.6%) compared with female BC (34.1%), which showed a higher percentage of grade 1 and grade 3 cases (p = 0.008 for grade 1 versus grade 2, p = 0.02 for grade 2 versus grade 3, p = 0.600 for grade 1 versus grade 3)
Summary
Elastic fibers are composed of two important components: elastin and small microfibrils. The biological background of elastosis in the breast is not well understood but it is suggested that the elastic fibers are not produced by only fibroblasts, and by endothelial cells and neoplastic epithelial cells [2] It can be observed in the periductal and perivascular spaces or diffusely in the tumor stroma. Shivas and Douglas categorized elastosis in 1972 into four grades with grade 0 corresponding to no elastosis and grade 3 corresponding to numerous dense aggregates of elastic fibers and found a favorable survival in female breast cancers showing a high amount of elastosis [3] This correlation of elastosis with survival or favorable tumor characteristics such as low grade and Ki67 index has later been confirmed by different groups, other groups could not confirm this [4,5,6]. In ERα-positive tumors, a high amount of elastosis can be found, compared with ERα-negative tumors that show less elastosis [4, 5, 7]
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