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The ratio of potassium to sodium concentrations in breast fluids has led investigators to the subclassification of cysts into two types:

1. apocrine (secretory) cysts with high potassium and low sodium, and
2. attenuated (flattened) cell cysts with low potassium and high sodium content.

Apocrine cells are thought by some to actively secrete potassium. Cell typing is considered important as apocrine cysts are more likely to be bilateral, multiple, recurrent, and serve as markers for epithelial cell atypia.

A retrospective study of the biochemical analyses of 58 cyst fluids and 28 duct secretions obtained by nipple aspiration was conducted. Potassium and sodium concentrations were statistically correlated with creatinine concentrations.

Micro cysts are initially apocrine in cell type and are more likely in continuity with the terminal ductal-lobular unit. Apocrine cysts may undergo cellular desquamation and lysis, becoming attenuated cysts. The ratio of potassium to sodium is altered by cell degradation rather than active secretory processes.

Sartorius OW: The biochemistry of breast cyst fluids and duct secretions. Breast Cancer Res Treat, 1995 Sep, 35:3, 255-66.

Chronic Cystic Mastitis

Chronic Cystic Mastitis

Most patients who consult their physician for "breast "lesions"" do not have a malignancy of the breast. The benign lesions of the breast include fibrocystic condition, macrocyst fibroadenomas, and intraductal papillomas.

Nipple discharge is a common condition, and the diagnosis and treatment is discussed.

Rarer benign "tumors" such as adenoid tumors, lipomas, neurofibromatosis, benign fibrous histiocytoma, and glandular "cell" tumors are briefly discussed.

Benign tumors of the breast. Isaacs-JH. Obstet-Gynecol-Clin-North-Am. 1994 Sep; 21(3): 487-97.

Cystic Mastitis

Cystic Mastitis [Finland)

Total frequency of mastitis in this population was much higher than generally reported in literature: 24% as opposed to 3%.

If a multiparous woman has had mastitis during a previous puerperium, the probability of mastitis during a subsequent puerperium is threefold. Mothers under 21 and over 35 years of "age" had a decreased incidence of mastitis. If the women had "sore" nipples, the frequency increased. The treatment advised by midwives and physicians was primarily conservative, but 38% received antibiotics; some of the antibiotics were not effective against staphylococcal "infection".

"Mastitis today: incidence, prevention and treatment." Jonsson, S & Pulkkinen, M.O. Ann. Chir. Gynaecol. Supp. 1994; 208: 84-7.



Women with palpable breast cysts may have a higher risk of developing breast cancer. High concentrations of androgens and estrogens have been found in breast cyst fluid, some of which may be implicated in mammary carcinogenesis.

Investigated whether breast cysts were capable of metabolizing radiolabeled dehydroepiandrosterone sulphate and, if so, to identify the metabolites formed.

Breast cysts were found to possess the enzyme systems required for converting DHEA-S to DHEA, androstenedione, androstenediol, and testosterone. Steroid metabolism by breast cysts may play a role in the development of breast cancer.

Lai LC: Metabolism of dehydroepiandrosterone sulphate by breast cysts: possible role in the development of breast cancer. Cancer Detect Prev, 1995, 19:5, 441-5.

Epithelial Cells

Epithelial Cells

The diagnosis of breast carcinoma tumor invasion by fine-needle aspiration (FNA) cytology continues to be controversial. Assessed the reliability of predicting tumor invasion by FNA.

Epithelial cellularity in dispersed fat was semiquantitatively scored. The cytologic diagnosis of the epithelial cells in all cases was recorded as benign, malignant, or indeterminant for malignancy.

Findings showed that 96% of invasive carcinomas, 100% of ductal carcinomas in situ (DCIS), and 68% of benign lesions contained epithelial cells in dispersed fat; 81% of invasive carcinomas, 67% of DCIS, and 61% of benign lesions contained epithelial cells in intact fibrofatty connective tissue. Corrected score of epithelium within fat was 0.781 for invasive carcinoma, 0.727 for DCIS, and 0.562 for benign lesions. The difference reached significance between invasive carcinoma and benign lesions.

The presence of epithelial cells either admixed within dispersed fatty droplets or seemingly within fragments of fibrofatty connective tissue is not a reliable indicator of tumor invasion in FNA of the breast, and is frequently found in both benign and malignant breast lesions. The presence of epithelial cells in intact or dispersed fat is most likely a mechanical artifact of aspiration and/or smear preparation.

Maygarden SJ et al., Are epithelial cells in fat or connective tissue a reliable indicator of tumor invasion in fine-needle aspiration of the breast? Diagn Cytopathol, 1997 Feb, 16:2, 137-42.

Luteal Heat Cycle of the Breast

Luteal Heat Cycle

Wearing a special thermometric brassiere, selected women self-measured their breast surface temperature. These measurements were made during 1 hour each evening at home for a menstrual cycle under standard conditions of overclothing and room temperature. To stage their cycle they also collected daily samples of saliva in their freezer for immuno-assay of progesterone concentration in the laboratory.

Included four groups, a control group (N = 25) and three 'disease' groups, namely: family history of breast cancer (14); benign breast disease (12); and a 'cancer-associated' group (31) who had had previous cancer surgery.

A significant breast temperature rhythm with a period at or about 28 days was found not only in the controls but also in the 3 groups of breasts designated 'disease'. Nevertheless, consistent rhythm abnormalities were found in all the disease groups. Most evident was a hyperthermia throughout the cycle, a reduction in the rhythm amplitude, and a tendency for the breast temperature rhythm to be manifest 1-2 days earlier in the menstrual cycle.

Simpson HW et al., The luteal heat cycle of the breast in disease. Breast Cancer Res Treat, 1996, 37:2, 169-78.

Premenopausal Bilateral Breast Cancer

Premenopausal Bilateral Breast Cancer

Premenopausal bilateral breast cancer is characterized by a strong family risk, and, consequently, a high probability that inherited susceptibility genes may be segregating in these families.

Conducted a case-control analysis of reproductive variables, benign breast disease, alcohol, and smoking. Cases had premenopausal bilateral breast cancer, and their unaffected sisters served as controls.

In general, risk factors previously identified for breast cancer (usually postmenopausal, unilateral cases) appear also to increase the risk for premenopausal, bilateral breast cancer.

Haile RW et al., A case-control study of reproductive variables, alcohol, and smoking in premenopausal bilateral breast cancer. Breast Cancer Res Treat, 1996, 37:1, 49-56.

PSA (1)

PSA (1)

Demonstrate that prostate specific antigen (PSA) is a component of breast cyst fluid.

PSA presence was also characterized in cyst fluid by Western blot analysis.

Data suggest that PSA is a frequent component of breast cyst fluid. More studies are needed to establish the role of this serine protease in normal breast, gross breast cystic disease, and breast cancer.

Diamandis EP et al., Prostate specific antigen--a new constituent of breast cyst fluid. Breast Cancer Res Treat, 1996, 38:3, 259-64.

PSA (2)

PSA (2)

The frequency of gross cystic breast disease in premenopausal women and its possible association with increased breast cancer risk emphasises the importance of investigating breast cyst fluid composition.

Measured the presence of prostate-specific antigen immuno-reactivity in human breast cyst fluids (# 64).

Breast epithelium of gross cysts produces, secretes, and accumulates large amounts of prostate-specific antigen, a glycoprotein produced by prostatic tissue but recently detected in breast tumours, normal tissues, and during pregnancy. The production and intracystic accumulation of this serine protease in biosynthetically active apocrine type cyst can play a feasible role in the natural history gross cystic breast disease as well as in the mechanism of cyst formation, enlargement, and transformation.

Quantification of prostate-specific antigen immunoreactivity in human breast cyst fluids. Breast Cancer Res Treat, 1996, 38:3, 247-52

Risk of Breast Cancer

Risk of Breast Cancer

Assessed correlation between type of breast cyst and risk of breast cancer in women with gross cystic disease of the breast.

Women (# 802) with aspirated breast cysts.

The incidence of breast cancer in women with type I cysts was significantly higher than that in women with type II cysts (relative risk 4.62.

Bruzzi P et al., Cohort study of association of risk of breast cancer with cyst type in women with gross cystic disease of the breast. BMJ, 1997 Mar 29, 314:7085, 925-8.

Seat Belt Injuries

Seat Belt Injuries

Determined the mammographic and sonographic findings of injuries of the breast caused by seat belts in automobile accidents. The imaging findings of such injuries must be differentiated from those of carcinoma, so that inappropriate treatment is avoided.

At 1-2 months after breast injury caused by a seat belt, mammograms showed thin-walled fat-density cysts in a linear distribution and, in less dense breasts, an associated 2-3-cm band of increased density. The band of increased density was not seen in more dense breasts. These findings correlated with the line of contusion across the breast and resultant fat necrosis, which ultimately led to the formation of lipid cysts.

By 3-4 months after the injury, the lipid cysts and contusion were less apparent, and a line of fibrosis had developed. On sonography, the lipid cysts were smoothly marginated; such cysts may be either anechoic or hypoechoic. Parenchymal calcification may develop 3.5-4 years after such an injury.

DiPiro PJ et al., Seat belt injuries of the breast: findings on mammography and sonography. AJR Am J Roentgenol, 1995 Feb, 164:2, 317-20.

Thyroid (Chronic Cystic Mastitis)


Evaluated the role of thyroid hormones in fibrocystic breast disease.

Possible relationships between thyroid hormones and estradiol, dehydroepiandrosterone sulfate, testosterone, progesterone and 17-hydroxyprogesterone in the BCF also were analyzed.

Cysts were divided according to their K+/Na+ ratio because a ratio above 3 represents a predictor of malignant transformation. Free T3 concentrations were higher in BCF than in serum, in both low K+/Na+ cysts and in cysts with a K+/Na+ ratio above 3; those cysts with a high K+/Na+ ratio had the highest free T3 concentration. Free T3 in cysts correlated positively to the K+/Na+ ratio.

Data suggest an important role of free T3 in the physiology of fibrocystic breast disease.

Martinez L et al., Thyroid hormones in fibrocystic breast disease. Eur J Endocrinol, 1995 Jun, 132:6, 673-6.

Traditional Chinese Medicine

Traditional Chinese Medicine

Patients (# 280) with hyperplasia of mammary gland were treated by Ru He Chong Ji, a breast nodule granular dissolvable agent.

31 were cured, 117 markedly improved, 119 improved, and 13 showed no change. The rate of cure and marked effectiveness was 53%, with a total effective rate of 95%.

The agent is also effective for treatment of depression of liver-energy and menoxenia.

Zhuo B et al., 280 cases of hyperplasia of mammary gland treated by ru he chong ji. J Tradit Chin Med, 1995 Dec, 15:4, 256-8.

Breast-feeding & Support

Breast-feeding & Support

Primary care physicians can integrate breast-care through a woman's life cycle.

Neonatal jaundice, poor weight gain, mastitis, and candidiasis should be recognized and managed correctly.

Outside the puerperium, fibrocystic change, nonlactational mastitis, and benign breast masses are encountered commonly.

Problems related to silicone augmentation are discussed.

Bedinghaus JM: Care of the breast and support of breast-feeding. Prim Care, 1997 Mar, 24:1, 147-60.


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