Chronic mastitis manifest as complex breast cyst in ultrasound and the role of elastography: A case series.

This case series aims to describe the clinical presentation of mastitis, the conventional sonography and elastography findings, and histopathological features in the diagnosis of chronic mastitis. We present 3 cases of breast swelling in young ladies with one of the cases is related to breastfeeding with similar imaging appearance of complex breast cyst and the histopathology finding of chronic mastitis. We will describe the role of elastography in evaluating and differentiating the benign and malignant complex breast cyst.

Breast cylindroma: A rare and unexpected diagnosis.

Cylindroma is a benign adnexal tumor histologically characterized by clusters of small basaloid cells arranged in a pattern resembling a jigsaw puzzle. Breast cylindromas are extremely rare with approximately 20 reported cases throughout literature. We present a case of a 71-year-old female with a slow growing cystic breast mass, originally identified 8 years prior to biopsy. Mammography and ultrasound demonstrated features of a simple cyst with circumscribed margins and anechoic internal echogenicity, respectively. Biopsy was performed due to increase in size, revealing the pathologic entity of cylindroma. The patient ultimately underwent surgical excision, which confirmed the diagnosis. We discuss the radiology, pathology and clinical course of breast cylindroma.

First case report of ruptured giant expanding breast oil cyst.

Background: Fat necrosis is a common sequelae of breast trauma. Its many presentations have been described in the literature. Oil cyst is one of the less common presentations of fat necrosis. Giant oil cyst is rare and may take many years to mature in an unstable environment of the women's breast. To our best knowledge, rupture of a giant oil cyst has never been reported. Yet, it should be included on the list of differential diagnoses along with hematoma, infection, or neoplasm. When a patient presents with an expanding breast lump, clinicians should be aware of the potential for oil cyst rupture and its features. Case Description: A 51-year-old woman presented to a breast clinic with concern of an expanding painless left breast lump for the last 4 months. The lump first appeared 12 years ago shortly after a car accident and was stable for many years. The initial left breast ultrasound was inconclusive, but diagnostic mammogram revealed a giant ruptured calcified oil cyst. Due to the availability of prior diagnostic images, we were able to retrospectively follow the unique sequelae of fat necrosis from the development of giant oil cyst shortly after the breast trauma and up to the final outcome of ruptured calcified oil cyst. Conclusions: Trauma to a woman's breast can lead to the formation of a large oil cyst which can remain present for years, peripherally calcify, and is susceptible to rupture. Clinicians should be aware of this potential complication when presented with the case of expanding breast lump. Diagnostic mammogram is a study of choice and demonstrates benign pathognomonic features of an oil cyst.

Clustered Microcysts Detected on Breast US in Asymptomatic Women.

Purpose: To investigate the incidence, outcomes, and imaging characteristics of clustered microcysts detected on breast US in asymptomatic women, and suggest appropriate management guidelines. Materials and Methods: We identified and reviewed the lesions recorded as "clustered microcysts" on breast US performed in asymptomatic women between August 2014 and December 2019. The final diagnosis was based on pathology and imaging follow-up results for at least 12 months. Results: The incidence was 1.5% and 100 patients with 117 lesions were included. Among 117 lesions, 3 (2.6%), 2 (1.7%), and 112 (95.7%) were malignant, high-risk benign, and benign lesions, respectively. The malignant lesions included two cases of ductal carcinoma in situ and one invasive ductal carcinoma. Two of them were assessed as category 4, showing mammographic suspicious microcalcifications and internal vascularity on Doppler US. The remainder was a false negative case and showed echo pattern change on the 12-month follow-up US. Conclusion: The incidence of clustered microcysts on breast US in asymptomatic women was 1.5% and malignancy rate was 2.6% (3 of 117). Knowledge of outcomes and imaging features of benign and malignant clustered microcysts may be helpful for radiologists, thereby aiding categorization and management recommendations.

HPLC fractionation with immunoassay of steroids from nipple aspirate fluid.

Fractionation of steroids allows for multiple assays to be run on a single low volume liquid biopsy, whereas performing the same number of assays without fractionation would require increasing the sample volume by dilution, rendering the concentration of steroids below the level of detection for most, if not all, downstream assays. Briefly, steroids are extracted from a biofluid sample using solvent phase extraction to separate the aqueous (conjugated) steroids from the non-aqueous (non-conjugated) steroids in the organic phase. The latter is further separated by high-performance liquid chromatography (HPLC) and collected in an automated fraction collector based on the UV detection of internal standards. Commercially available immunoassays are then used to quantify the < ng/ml concentrations of steroids in each fraction. This protocol was designed for small samples of nipple aspirate fluid (minimum 2 µL), but it can be modified to fractionate steroids from homogenized solid tissue samples or other liquid biopsies. Included in this protocol are precautions to help ensure reproducibility and minimize matrix effects and other errors of measurement, given that samples requiring fractionation are fundamentally precious and, like other quantitative procedures of small samples, can be prone to contamination by solvent residues and other factors.•The method permits quantitative analysis of multiple steroids from very small volumes of biofluid.•Fractionation by HPLC provides a highly purified sample for quantification.•The immunoassay end point provides specificity without expensive equipment.

Invasive cystic hypersecretory carcinoma of the breast.

Cystic hypersecretory carcinoma (CHC) of the breast is a rare variant of ductal carcinoma, characterized by variably sized cysts lined by micropapillary fronds to proliferative pseudostratified columnar epithelium. It includes a spectrum of morphological features ranging from clearly benign cystic hypersecretory hyperplasia (CHH), CHH with atypia to invasive CHC. Only 20 cases of invasive CHC have been reported to date. We report a case of a 49-year-old female who presented with a palpable breast lump and nipple discharge. Gross examination showed variable-sized cysts lined by solid grey white tumors. On microscopic examination, cysts were lined by micropapillary fronds with eosinophilic colloid-like secretion with a focus of invasion. A diagnosis of invasive CHC was made. Since there are limited case reports, our understanding of its biological behavior, prognostic factors, and genetic basis is limited.

Invasive cystic hypersecretory carcinoma of the breast

ABSTRACT Cystic hypersecretory carcinoma (CHC) of the breast is a rare variant of ductal carcinoma, characterized by variably sized cysts lined by micropapillary fronds to proliferative pseudostratified columnar epithelium. It includes a spectrum of morphological features ranging from clearly benign cystic hypersecretory hyperplasia (CHH), CHH with atypia to invasive CHC. Only 20 cases of invasive CHC have been reported to date. We report a case of a 49-year-old female who presented with a palpable breast lump and nipple discharge. Gross examination showed variable-sized cysts lined by solid grey white tumors. On microscopic examination, cysts were lined by micropapillary fronds with eosinophilic colloid-like secretion with a focus of invasion. A diagnosis of invasive CHC was made. Since there are limited case reports, our understanding of its biological behavior, prognostic factors, and genetic basis is limited.

Complex Fibroadenoma: a Cystic Neoplasia Report Case / Fibroadenoma Complexo: Relato de Caso de uma Neoplasia Cística

Abstract Fibroadenoma is the most common breast tumor in young woman. It is considered a non-malignant tumor, showing hyaline component and a biphasic stroma and epithelial process, thus, it is similar to phyllode tumor revealing intralobular stroma. The cystic changes in a complex fibroadenoma may mimic a carcinoma, therefore it may represent some problems in images interpretation, and it may enlarge the risk of cancer development. This is a description of a case report with literature review. A 21-year-old female patientwith no history of breast cancer in family, presented a palpable lump in her right breast and clinical examination revealed a mobile, firm, circumscribed lesion in the right inner quadrant, measuring around 8 x 7 cm. An excision had been done under a stereotactic surgery and the structure revealed a nodular surface, measuring 8 x 6.5x 5.5cm. Cut section revealed heterogeneous aspect: cysts with colloid content and white-gray compact fibroblastic areas. Histopathological examination shows hypocellular stroma and few hypercellular areas, without atypia. Epithelial components presenting proliferation of intracanalicular and pericanalicular pattern ducts. Cystic proliferation with epithelial lining and apocrine characteristics without atypia. Because of the variation may be present inside the lesion it is difficult to establish the diagnosis without a biopsy, and a histopathological analysis. Moreover, it is necessary to know the microscope difference between fibroadenoma and the other sort of lesions; furthermore, that heterogeneity represent why that tumor is considered complex. (AU)

Resumo Fibroadenoma é o tumor de mama mais comum em mulheres jovens. É considerado um tumor não-maligno, apresentando um componente hialino e um estroma bifásico, e processo epitelial, por isso, é similar ao tumor filoide, revelando estroma intralobular. As alterações císticas no fibroadenoma complexo pode mimetizar um carcinoma, isso acarreta alguns problemas na interpretação das imagens, e pode aumentar o risco de desenvolvimento de câncer. Trata-se de um relato de caso de paciente de 21 anos de idade, sem histórico de câncer de mama na família, apresenta uma massa palpável em seio direito. Exame clinico revelou lesão móvel, firme, circunscrita no quadrante interno do seio. Excisão por cirurgia estereotáctica e a estrutura se mostra com superfície multinodular, medindo 8 x 6,5 x 5,5 cm. com aspecto heterogêneo, cistos com conteúdo coloide, e áreas fibrobásticas branco-acinzentada. Exame histológico demonstra-se estroma hipercelular, com áreas hipocelularizadas, sem atipia. Componentes epiteliais apresentando proliferação intercanalicular e intracanicular dos ductos. Proliferação cística com revestimento epitelial e características apócrinas sem atipia. Por conta da variação presente na lesão, pode ser difícil a estabelecimento de um diagnóstico se biópsia e análise histopatológica. Além disso, é fundamental o conhecimento das diferenças microscópicas entre o fibroadenoma e outros tipos de lesões; além disso, a heterogeneidade representa o motivo do tumor ser considerado complexo. (AU)

Hydatid cyst of the breast: case report.

INTRODUCTION: The hydatid cyst of the breast is a rare pathology even in countries endemic to tuberculosis, however there remains a differential diagnosis evoked in front of any breast tumor. The clinic, mammography and ultrasound sometimes allow us to suspect the hydatid nature of the lesion. The definitive diagnosis remains histological and the treatment is always surgical. From one case, we recall the important role that cytology can play in preoparatory diagnosis. CASE PRESENTATION: We report an observation of 59-year-old patient who lives in a tuberculosis endemic area of morocoo. the patient presented to our institute with palpable nodule in the right breast associated with pain of long duration. Clinical examination shows 2 masses occuping the entire upper outer quadrant of the right breast. Radiological explorations (mammography + ultrasound) objectified: A voluminous opacity of the QSE of the right breast corresponding on ultrasound to two cystic with anechoic content. the first classified ACR2 BIRADS. the second has ultimately echogenic content with a sloping portion producing the appearance of pseudo vegetation,classified ACR3 BIRADS. A fine needle aspiration of the cyst only showed the presence of altered polynuclear, without evidence of tumor cells. Treatment consisted of surgical excision such as perikystectomy and pathology examination demonstrated breast hydatidosis.postoperative evolution was favourable. Patient was put on medical treatment based on albendazole immediately.The patient was monitored for one year without local or distant recurrences. CONCLUSION: Although hydatid disease of the breast remains a rare localization of tuberculosis disease, it should nevertheless be considered as a differential diagnosis of breast tumors. Ultrasound, cytology and MRI play an important preoperative diagnostic role. Treatment is essentially based on surgical pericystectomy associated with medical treatment based on albendazole.

SVM-Enabled Intelligent Genetic Algorithmic Model for Realizing Efficient Universal Feature Selection in Breast Cyst Image Acquired via Ultrasound Sensing Systems.

In recent years, there are several cost-effective intelligent sensing systems such as ultrasound imaging systems for visualizing the internal body structures of the body. Further, such intelligent sensing systems such as ultrasound systems have been deployed by medical doctors around the globe for efficient detection of several diseases and disorders in the human body. Even though the ultrasound sensing system is a useful tool for obtaining the imagery of various body parts, there is always a possibility of inconsistencies in these images due to the variation in the settings of the system parameters. Therefore, in order to overcome such issues, this research devises an SVM-enabled intelligent genetic algorithmic model for choosing the universal features with four distinct settings of the parameters. Subsequently, the distinguishing characteristics of these features are assessed utilizing the Sorensen-Dice coefficient, T-test, and Pearson's R measure. It is apparent from the results of the SVM-enabled intelligent genetic algorithmic model that this approach aids in the effectual selection of universal features for the breast cyst images. In addition, this approach also accomplishes superior accuracy in the classification of the ultrasound image for four distinct settings of the parameters.

Breast Cyst Fluid Analysis Correlations with Speed of Sound Using Transmission Ultrasound.

RATIONALE AND OBJECTIVES: The purpose of this work is to determine if the speed of sound value of a breast cyst can aid in the clinical management of breast masses. Breast macrocysts are defined as fluid-filled tissue masses >1 cm in diameter and are thought to be aberrations of normal development and involution, often associated with apocrine metaplasia. The benign natural history of breast cysts is well known, and it is important to obtain high specificity in breast imaging to avoid unnecessary biopsies in women who have benign diseases, particularly those with dense breast tissue. Transmission ultrasound is a tomographic imaging modality that generates high-resolution, 3D speed of sound maps that could be used to identify breast tissue types and act as a biomarker to differentiate lesions. We performed this study to investigate the microanatomy of macrocysts observed using transmission ultrasound, as well as assess the relationship of speed of sound to the physical and biochemical parameters of cyst fluids. MATERIALS AND METHODS: Cyst fluid samples were obtained from 37 patients as part of a case-collection study for ultrasound imaging of the breast. The speed of sound of each sample was measured using a quantitative transmission ultrasound scanner in vivo. Electrolytes, protein, cholesterol, viscosity, and specific gravity were also measured (in the aspirated cyst fluid) to assess their relationship to the speed of sound values obtained during breast imaging. RESULTS: We found positive correlations between viscosity and cholesterol (r = 0.71) and viscosity and total protein × cholesterol (r = 0.78). Additionally, we performed direct cell counts on cyst fluids and confirmed a positive correlation of number of cells with speed of sound (r = 0.74). The speed of sound of breast macrocysts, as observed using transmission ultrasound, correlated with the cytological features of intracystic cell clumps. CONCLUSION: On the basis of our work with speed as a classifier, we propose a spectrum of breast macrocysts from fluid-filled to highly cellular. Our results suggest high-speed cysts are mature macrocysts with high cell counts and many cellular clumps that correlate with cyst microanatomy as seen by transmission ultrasound. Further studies are needed to confirm our findings and to assess the clinical value of speed of sound measurements in breast imaging using transmission ultrasound.

The Effects of Phytosterols Extracted from Diascorea alata on the Antioxidant Activity, Plasma Lipids, and Hematological Profiles in Taiwanese Menopausal Women.

The efficacy of phytosterols extracted from Diascorea alata on antioxidant activities, plasma lipids and hematological profiles was assessed in postmenopausal women. Gas chromatography and mass spectrophotometry was employed to determine the steroid content of Taiwanese yam (Diascorea alata cv. Tainung No. 2). A two-center, randomized, double-blind, placebo-controlled clinical investigation on 50 postmenopausal women randomly assigned to two groups treated for 12 months with placebo or two sachets daily of Diascorea extracts containing 12 mg/dose was carried out. The main outcome measures were the plasma antioxidant activities, hematological profiles, and the concentrations of plasma lipids, including cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, very low density lipoprotein,, and apolipoprotein A1 and B. A one-way analysis of covariance (ANCOVA) test was performed to investigate the significance. Beta-sitosterol, stigmasterol, 22-23-dihydro-, and γ-sitosterol were major phytosterols determined from Diascorea extracts. At six months in those receiving Diascorea, there were significantly decreased leukocyte counts (p < 0.01) and improvement on antioxidant activity of malondialdehyde (p < 0.001). After 12 months' treatment, elevations of hematocrit and mean corpuscular volume (p < 0.01) were noted in those receiving Diascorea. Moreover, the low dose Diascorea consumption in menopausal women for one year generally did not present positive effects on lipid profiles.

Galactocele in a Prepubertal Girl.

BACKGROUND: Galactoceles have been previously described as an unusual cause of benign breast enlargement in male infants and children. CASE: A 3-year-old prepubertal girl presented with a right-sided breast mass and was found to have a 4.4-cm hypoechoic cyst on ultrasound imaging with otherwise normal endocrine studies including prolactin levels. She underwent cyst aspiration which revealed milky fluid. Fat globules were identified with microscopic examination, confirming the diagnosis of a galactocele. Aspiration resolved the mass. SUMMARY AND CONCLUSION: The etiology of galactoceles in nonlactating women is poorly understood. Traditionally, treatment of these benign cysts in male children has been surgical excision. In prepubertal girls, conservative management by surveillance or needle aspiration is warranted to prevent damage to developing breast tissue.

Birads 3: correlacion histopatologica de bajo potencial de malignidad, con conglomerados quisticos imagenologicos en pacientes de tegucigalpa / Birads 3: correlation of low histopathological potential for malignancy with breast clustered microcysts in patients from tegucigalpa

La categoría 3 del Breast Imaging Reporting and Data System (BIRADS) son hallazgos probablemente benignos y en menos del 2% de estos existe la posibilidad de carcinoma. El establecimiento de esta categoría precisa la realización de pruebas complementarias de imagen que incluye: proyecciones mamográficas adicionales, la ecografía, comparar las imágenes actuales con los estudios previos de la paciente y en casos especiales se recurre a la biopsia. Dentro de esta categoría se incluyen los conglomerados quísticos en los que se centró este estudio. Objetivo: Correlacionar hallazgos ecográficos y mamográficos, con estudio histopatológico de lesiones categorizadas como conglomerados quísticos (en imagenología). Población y Métodos: Pacientes que acuden al Hospital de Especialidades del Instituto Hondureño de Seguridad Social a quienes se les realizó mamografía y ecografía categorizadas como BIRADS 3 a las cuales se les confirmó diagnóstico mediante biopsia. Resultados: De las pacientes categorizadas BI-RADS 3, a 55(100%) se les realizó biopsia, el reporte histopatológico corroboró patología benigna en 55(100%) y no se encontró patología maligna. Discusión: Los conglomerados quísticos de mama son relativamente comunes, observados en ecografía en el 5,8% de los casos, ecográficamente, se observa un nódulo circunscrito, microlobulado u oval, compuesto de múltiples quistes pequeños adyacentes separados por tabiques delgados. Se encuentra generalmente como hallazgo incidental en mamografía, ecografía o en ambos.

Category 3 of the Breast Imaging Reporting and Data System (BIRADS) are probably benign findings and in less than 2% of these there is the possibility of carcinoma. The establishment of this category requires the performance of complementary imaging tests that include: additional mammographic projections, ultrasound, compare current images with previous studies of the patient and in special cases, biopsy is used. This category includes the cystic conglomerates that this study focused on. Objective: To correlate ultrasound and mammographic findings, with histopathological study of lesions categorized as cystic conglomerates (in imaging). Population and Methods: Patients who attend the Specialties Hospital of the Honduran Social Security Institute, who underwent mammography and ultrasound categorized as BIRADS 3, which were confirmed by biopsy. Results: Of the patients categorized BI-RADS 3, to 55 (100%) a biopsy was performed, the histopathological report corroborated benign pathology in 55 (100%) and no malignant pathology was found. Discussion: The breast cystic conglomerates are relatively common, observed in ultrasound in 5.8% of cases, ultrasound, we can observe a circumscribed, microlobulated or oval nodule, composed of multiple small adjacent cysts separated by thin septa. It is usually found as an incidental finding on mammography, ultrasound or both.

Application of Ultrasound Guided Drainage Combined with Different Hardeners for Treatment of Simple Breast Cysts / 中国医学影像学杂志

Purpose To investigate the clinical effect of ultrasound guided drainage combined with different hardeners for simple breast cysts,and to further provide reference for individual treatment.Materials and Methods Clinical data of 117 cases breast simple cysts were analyzed retrospectively,of which 42 cases were routine ultrasound-guided puncture combined with fluid injection of hypertonic sugar (group A),40 cases were routine ultrasound guided drainage combined with ethanol injection therapy (group B),and 35 cases were routine ultrasound guided therapy alone (control group).The clinical efficacy and adverse reactions were compared among the three groups after treatment.Results The total effective rate of group A was 95.24％,group B was 97.50％,and control group was 82.86％.Total effective rate of group A and B had no significant difference (P＞0.05),which were both higher than control group (P＜0.05).The adverse reactions rate of group B was higher than group A and control group,which had statistical significance (P＜0.05).Conclusion Ultrasound guided injection of hypertonic sugar or ethanol after drainage treatment for simple breast cysts can both obtain satisfactory clinical results,but adverse reactions of the former one are mild,it should be widely applied.

[Management of a breast cystic syndrome: Guidelines]. / Exploration d'un syndrome kystique mammaire: recommandations.

OBJECTIVE: Breast cysts are common, often discovered incidentally or subsequently to pain or palpable mass. The purpose of these recommendations is to describe the sonographic findings for classifying breast cystic lesions, to analyze the value and contribution of various imaging techniques and sampling and to provide a management strategy. MATERIALS AND METHODS: Literature review conducted by a small group and then reviewed and validated by the group designated by the Collège national des gynécologues et obstétriciens français (CNGOF) to make recommendations for clinical practice for benign breast lesions. RESULTS: Breast cysts are classified in 3 categories: simple cysts, complicated cysts and complex cysts. For simple cysts, after ultrasound, no further imaging is necessary, cytology is to consider only as analgesic. For complicated cysts, a control at 4-6 months is recommended; the use of cytology depends on the context (familial risk, difficulty of follow-up). In case of complex cyst, sampling by cytology or biopsy is recommended. More assessments of other imaging tests are reported. CONCLUSION: The sonographic characterization is essential for management of breast cyst.

The importance of breast elastography added to the BI-RADS® (5th edition) lexicon classification / A importância da elastografia mamária adicionada à classificação, segundo o léxico BI-RADS® (5ª edição)

SummaryObjective:the aim of this study was to investigate the addition of elastography to the BI-RADS® lexicon for the classification of breast lesions.Methods:a total of 955 consecutive patients who were subjected to breast percutaneous biopsy from January 2010 to December 2012 were retrospectively assessed. Overall, 26 patients who did not present with masses on conventional ultrasound were excluded. The patients were classified according to the fifth edition of the breast imaging and reporting data system (BI-RADS®) lexicon, which includes elastographic findings. The BI-RADS®classification is based on the same classification principles that have been suggested by the author, which classify lesions as soft, intermediate, or hard.Results:the addition of elastographic findings to the BI-RADS® lexicon improved the sensitivity (S), specificity (SP), and diagnostic accuracy (DA) of ultrasound in the assessment of breast lesions, which increased from 93.85, 72.07, and 76.64 to 95.90, 80.65, and 91.39%, respectively.Conclusion:these findings suggest that the addition of elastography to the BIRADS ® lexicon will improve the SP and DA of ultrasound in the screening of breast lesions.

ResumoObjetivo:investigar o impacto da adição da descoberta da elastografia das lesões mamárias à classificação segundo o léxico BI-RADS®.Métodos:estudo retrospectivo com 955 pacientes consecutivas, submetidas à biópsia mamária percutânea no período de janeiro de 2010 a dezembro de 2012. Foram excluídas 26 pacientes que apresentaram lesão não nodular ao ultrassom convencional. As lesões foram classificadas conforme proposta da 5ª edição do léxico BI-RADS®, que inclui os achados de elastografia. A classificação BI- -RADS® é baseada nos mesmos critérios propostos pelo autor, que classifica as lesões como macias, intermediárias e rígidas.Resultados:a adição dos achados da elastografia ao léxico BI-RADS® melhorou a sensibilidade (S), a especificidade (E) e a acurácia diagnóstica (AD) do ultrassom na avaliação das lesões mamárias, de 93.85, 72.07 e 76.64% para 95.90, 80.65 e 91.39%, respectivamente.Conclusão:os achados sugerem que a adição dos achados da elastografia ao léxico BI-RADS® pode melhorar a S, a E e a AD do ultrassom no rastreamento de lesões mamárias.

Breast cyst fluid heparan sulphate is distinctively N-sulphated depending on apocrine or flattened type.

Breast cyst fluid (BCF) contained in gross cists is involved with its many biomolecules in different stages of breast cystic development. Type I apocrine and type II flattened cysts are classified based on biochemical, morphological and hormonal differences, and their different patterns of growth factors and active biocompounds may require different regulation. In a previous paper, hyaluronic acid in a very low content and chondroitin sulphate/dermatan sulphate were identified and characterized in BCF. In this new study, various apocrine and flattened BCFs were analyzed for HS concentration and disaccharide pattern. Apocrine HS was found specifically constituted of N-acetyl groups contrary to flattened HS richer in N-sulphate disaccharides with an overall N-acetylated/N-sulphated ratio significantly increased in apocrine compared with flattened (13.5 vs 3.7). Related to this different structural features, the charge density significantly decreased (~-30%) in apocrine versus flattened BCFs. Finally, no significant differences were observed for HS amount (~0.9-1.3 µg ml(-1) ) between the two BCF types even if a greater content was determined for flattened samples. The specifically N-sulphated sequences in flattened BCF HS can exert biologic capacity by regulating growth factors activity. On the other hand, we cannot exclude a peculiar regulation of the activity of biomolecules in apocrine BCF by HS richer in N-acetylated disaccharides. In fact, the different patterns of growth factors and active biocompounds in the two types of cysts may require different regulation by specific sequences in the HS backbone possessing specific structural characteristics and distinctive chemical groups.

Characterization of oversulfated chondroitin sulfate rich in 4,6-O-disulfated disaccharides in breast cyst fluids collected from human breast gross cysts.

Glycosaminoglycans (GAGs) from breast cyst fluid (BCF) of gross cysts, subdivided into apocrine and flattened, directly collected from 27 gross-cystic-breast-disease (GCBD)-affected women were analysed. Heparan sulfate, not further investigated, and chondroitin sulfate were identified. This last polysaccharide, in a content of 25-27 µg ml(-1) BCF and having a high molecular mass (~20 000-22 000), was found rich in glucuronic acid (~96%-98%) and mainly sulfated in position 4 of the N-acetyl-galactosamine (~60%-64%). Moreover, the presence of ~19%-24% of uncommon 4,6-O-disulfated disaccharides CS-E inside the polysaccharide chains with a high charge density of ~1.15-1.20 was determined. No substantial differences between apocrine and flattened cysts were observed. The current study describes the first effort to examine the yield and distribution of complex macromolecules like GAGs in BCF, and the understanding of their structure may help explain some functions associated with physiological and pathological conditions.