Article

Estrogen receptor-β is expressed in stromal cells of fibroadenoma and phyllodes tumors of the breast

Department of Biomedical Science and Human Oncology, University of Torino, Torino, Italy.
Modern Pathology (Impact Factor: 6.36). 05/2006; 19(4):599-606. DOI: 10.1038/modpathol.3800574
Source: PubMed

ABSTRACT An estrogen dependency has been suggested for the growth of fibroadenomas: however, thus far, none of the steroid hormone receptors acting on breast tissues has been demonstrated in the stroma of breast fibroepithelial lesions. In this study, the expression of estrogen receptor (ER)-alpha and -beta was investigated by immunohistochemistry in 33 fibroadenomas and in 30 benign, three borderline and seven malignant phyllodes tumors, all with spindle cell growth and in one distant metastasis. In addition, the presence of ER-beta mRNA and its variants was evaluated by RT-PCR in microdissected stroma. The possible correlation between hormone receptor expression and differentiation processes of stromal cells was investigated by smooth muscle actin and calponin immunostaining. ER-beta was the only hormone receptor expressed by stroma of fibroadenomas and phyllodes tumors, both at protein and mRNA level. The highest percentage of ER-beta was observed in fibroadenomas with cellular stroma and in phyllodes tumors. In both lesions, ER-beta-positive stromal cells showed expression of smooth muscle actin and/or calponin, as demonstrated by double immunostaining. In addition, the mean age at diagnosis was significantly lower in patients with ER-beta-positive vs ER-beta-negative fibroadenomas. In contrast, in phyllodes tumors, ER-beta expression was higher in older patients. In conclusion, (i) only ER-beta is detected in the stroma of fibroadenomas and phyllodes tumors; (ii) its expression correlates with the expression of smooth muscle markers and suggests a role of ER-beta in myofibroblastic differentiation of stromal cells. These two results, together with the young age of patients carrying fibroadenomas with highly ER-beta-positive stroma cells, may further indicate a hormone-receptor mechanism involved in regulating the growth of fibroadenomas. Conversely, the older age of patients with ER-beta-rich phyllodes tumors suggests that mechanisms, probably independent from estrogen stimulation, act on the growth of these tumors.

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    • "Our patient was diagnosed at perimenopausal period (49 years old), in agreement with the eight previous cases (median age at diagnosis: 52.7 ± 14.8 years), roughly similar to the median age of diagnosis of phyllode tumor, near 44 years [15]. Unlike breast carcinoma, where IGF-2 can activate estrogen receptor in a crosstalk manner [17], there is no established link between estrogen exposition and the growth of phyllode tumors [18] [19]. Thus, only few cases have reported hormonal therapy in phyllode therapy, without significative effect. "
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