Histochemical Patterns of Collagenic Fibers in the Benign and Malignant Breast Lesions

Cancer is one of the leading causes of death worldwide and breast cancer is the most commonly diagnosed cancer among women. An increased incidence of different types of breast cancer has been reported. This study was designed to evaluate the different types of breast cancer and its possible risk of neoplasmic transformation to an advanced malignant stage from a benign tumor. The histochemical patterns of collagen fibers in the benign and malignant breast lesions were evaluated. From the 50 tissue samples, 25 were malignant breast lesions and 25 were benign breast tumor. Hematoxylin and Eosin (HE), Van Gieson staining were performed to detect a benign and malignant tumor as well as collagen fibers. We found that significant cases after age of 35 were associated with ductal carcinoma while most of the cases within the age of 25 years were associated with fibrocystic changes. The intensity of collagen fiber was higher to Ductal Carcinoma while negative and less intense for Fibroblastic changes. Furthermore, a consistent association of other lesions, such as Lobular Carcinoma, Fibroadenoma, Papilloma and Fat necrosis and noticeable staining for collagen was observed for the different lesion. Our study suggested that women with age of 25 with benign lesion of fibrocystic change and ductal carcinoma are highly susceptible to develop advanced malignant tumor with age. Therefore, quantitative measurement of collagen fiber and regular follow-up are recommended to avoid the possible risk of developing advanced malignant lesions.

Advances in Breast Cancer Research 600,000 new cases per year [1]. Furthermore, it is also the most common cancer and the principal cause of cancer death among females worldwide [2]. In addition, breast cancer is the second leading cause of cancer death among women, causing more than 39,000 deaths every year in the United States alone [3]. In 2015, cancer was accounting for 429.16 million new cases and 281.42 million deaths in China [4] [5]. Although in the last years, the early diagnosis of this disease has improved overall survival [6].
According to Cancer Research UK, more than 90% of women diagnosed with breast carcinoma at the earliest stage survive for at least 5 years compared to about 15% of women diagnosed with the most advanced stage of cancer [7] [8].
Breast cancer remains a very serious problem for public health and there are still many research areas to open.
The extracellular matrix (ECM) of the tumor plays an important role in the development of cancer through its ability to modify some of the vital signals perceived by cancer cells associated with cancer [9]. Experimental evidence has demonstrated that the structure and composition of the extracellular matrix (ECM) of tumor-affected breast tissue undergoes alteration [10], especially its collagenous component [11]. Collagen is a major component of the ECM and is increasingly recognized to play a critical role in regulating breast cancer progression. Although most research on collagen in breast cancer has focused on type I collagen (Col1), and many reports have documented a negative correlation between Col1 expression and prognosis in breast cancer patients, collagen types IV, V, VI, and XVIII have also been implicated in modulation of breast cancer cell activities and fate [12] [13]. There are many types of breast cancer; most common types are ductal carcinoma in situ, invasive ductal carcinoma and invasive lobular carcinoma. Most breast cancers are carcinomas. There are other less common types of breast cancers, such as sarcomas, phyllodes, Paget disease, and angiosarcomas which start in the cells of the muscle, fat, or connective tissue [14].
However, there is a frequent intervening between these different breast cancer entities. Also, the components of some of these malignant lesions mimic the components of some benign breast lesions. Consequently, sometimes, the precise diagnosis requires the application of extra more sophisticated techniques, which might not be available in some settings, particular for inclusion and exclusion criteria for some researches. Thus, there is a need for an easy and cost-effective method to fulfill this. Therefore, the present study aimed to assess the histochemical pattern of collagen fibers in the benign and malignant breast lesions, to use it to classify breast lesions, as well as, to stimulate the future concept of changing the qualitative consideration of collagen fibers to quantitative measurement.

Materials and Methods
This study involved 50 samples collected from women with breast lesions. All

Ethical Consent
The study was approved by Ethical Review Board, College of Applied Medical Science, University of Hail, Saudi Arabia. In addition to the fact, the authors followed the tenants of the Declaration of Helsinki.

Statistical Analysis
For all statistical analyses including frequencies and cross-tabulations, the SPSS statistical software version 16 was used. Pearson chi-square test was used and P.
values of 0.05 or less were regarded as statistically significant.

Results
This study investigated 50 patients with different breast lesions, their ages ranging from 17 to 85 years with a mean age of 39 years. All study subjects were fe-   found with + intensity, as shown in Figure 3, Photomicrographs 1-3.

Discussion
Breast cancer is the most common cancer diagnosed among women worldwide.
It is also the second leading cause of death among women after lungs cancer.
Scientist, clinician and physician are putting huge efforts to overcome the incidences related to the all types of cancer and breast cancers as well. Breast cancer possesses a huge challenge to find out the effective molecular target because of its diverse types and complicated nature [16]. Fortunately, significant improve- In summary, from our study, we can conclude that young women within the age of 25 are prone to develop benign while with they are higher risk to develop a malignant lesion. Also, young women under the age of 25 found to develop collagen negative Fibrocystic changes compared to the women with age of 35 or more found to be suffered from ductal carcinoma that was collagen positive. Our study provides the insight of the possible risk of different types of breast cancer associated with different types of age groups leading to provide novel parameter for effective treatment, diagnostic and management of women breast cancers.
Our study also suggests that the patients who develop Ductal Carcinoma and Fibrocystic changes are at risk to develop, therefore, proper follow up are recommended to avoid further risk.

Conclusion
Collagen fiber is predominantly present in breast lesions compared to its benign breast lesions and might be helpful in differential diagnosis using cheap conventional methods. The findings of the present may stimulate further research in this context to develop a specific quantitative method for evaluation of collagen fibers in different breast lesions.