Complex sclerosing lesion: Difference between revisions

(10 intermediate revisions by the same user not shown)

Line 1:

~~#redirect~~ [[Breast_pathology~~#Complex_sclerosing_lesion~~]]

{{ Infobox diagnosis

| Name = {{PAGENAME}}

| Image = Radial scar of breast - intermed mag.jpg

| Width =

| Caption = Complex sclerosing lesion of breast. [[H&E stain]]. (WC)

| Synonyms = radial scar

| Micro = stellate lesion (low magnification), center of lesion has fibroelastosis (stroma light pink on H&E), scar like stroma with entrapped normal breast ducts and lobules - glands appear to enlarge with distance from center of lesion

| Subtypes =

| LMDDx = [[invasive ductal carcinoma]]

| Stains =

| IHC = myoepithelial cells preset (p63 +ve, calponin +ve)

| EM =

| Molecular =

| IF =

| Gross = spiculated mass

| Grossing =

| Staging =

| Site = [[breast]]

| Assdx =

| Syndromes =

| Clinicalhx =

| Signs =

| Symptoms =

| Prevalence =

| Bloodwork =

| Rads =

| Endoscopy =

| Prognosis = benign, increased risk of malignancy

| Other =

| ClinDDx = [[breast cancer]]

| Tx = excision

}}

'''Complex sclerosing lesion''' (abbreviated '''CSL'''), also '''radial scar''', is a benign [[breast pathology|lesion of the breast]] that is associated with an increased risk of subsequent [[breast cancer]].

==General==

*The term ''radial scar'' is a misnomer. It isn't a ''scar''. It isn't associated with prior trauma or surgery.<ref name=Ref_PBoD8_1072>{{Ref PBoD8|1072}}</ref>

*May appear malignant on imaging.<ref name=pmid11167596>{{cite journal |author=Ung OA, Lee WB, Greenberg ML, Bilous M |title=Complex sclerosing lesion: the lesion is complex, the management is straightforward |journal=ANZ J Surg |volume=71 |issue=1 |pages=35–40 |year=2001 |month=January |pmid=11167596 |doi= |url=}}</ref>

**Typically [[BI-RADS]] 4 - but may be BI-RADS 5.<ref name=pmid24936496>{{Cite journal | last1 = Myong | first1 = JH. | last2 = Choi | first2 = BG. | last3 = Kim | first3 = SH. | last4 = Kang | first4 = BJ. | last5 = Lee | first5 = A. | last6 = Song | first6 = BJ. | title = Imaging features of complex sclerosing lesions of the breast. | journal = Ultrasonography | volume = 33 | issue = 1 | pages = 58-64 | month = Jan | year = 2014 | doi = 10.14366/usg.13015 | PMID = 24936496 }}</ref>

*Associated with subsequent elevated risk of breast cancer.<ref>URL: [http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Radial_Scars.asp http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Radial_Scars.asp]. Accessed on: 4 May 2010.</ref>

*Management - usually surgical excision.<ref name=pmid14514771>{{cite journal |author=Kennedy M, Masterson AV, Kerin M, Flanagan F |title=Pathology and clinical relevance of radial scars: a review |journal=J. Clin. Pathol. |volume=56 |issue=10 |pages=721–4 |year=2003 |month=October |pmid=14514771 |pmc=1770086 |doi= |url=}}</ref>

**Risk of malignancy on surgical excision for biopsy diagnosed CSLs very small ~1%.<ref name=pmid26772402>{{Cite journal | last1 = Li | first1 = Z. | last2 = Ranade | first2 = A. | last3 = Zhao | first3 = C. | title = Pathologic findings of follow-up surgical excision for radial scar on breast core needle biopsy. | journal = Hum Pathol | volume = 48 | issue = | pages = 76-80 | month = Feb | year = 2016 | doi = 10.1016/j.humpath.2015.06.028 | PMID = 26772402 }}</ref>

*Rare - less than 0.1% of core needle biopsies.<ref name=pmid25578683>{{Cite journal | last1 = Nassar | first1 = A. | last2 = Conners | first2 = AL. | last3 = Celik | first3 = B. | last4 = Jenkins | first4 = SM. | last5 = Smith | first5 = CY. | last6 = Hieken | first6 = TJ. | title = Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution. | journal = Ann Diagn Pathol | volume = 19 | issue = 1 | pages = 24-8 | month = Feb | year = 2015 | doi = 10.1016/j.anndiagpath.2014.12.003 | PMID = 25578683 }}</ref>

==Gross==

*Spiculated mass.

*Usually small - 3-7 mm.

===Image===

Image:Radial_scar.jpg | Radial scar - gross. (WC)

</gallery>

==Microscopic==

Features:<ref name=pmid14514771>{{cite journal |author=Kennedy M, Masterson AV, Kerin M, Flanagan F |title=Pathology and clinical relevance of radial scars: a review |journal=J. Clin. Pathol. |volume=56 |issue=10 |pages=721–4 |year=2003 |month=October |pmid=14514771 |pmc=1770086 |doi= |url=}}</ref><ref name=Ref_BP91>{{Ref BP|91}}</ref>

*Stellate appearance (low magnification).

*Center of lesion has "fibroelastosis" - stroma light pink (on H&E) - '''key feature'''.

**Scar like stroma with entrapped normal breast ducts and lobules.

**Glands appear to enlarge with distance from center of lesion.

Notes:

*Histomorphologic appearance may mimic a [[desmoplastic reaction]] of the stroma - leading to a misdiagnosis of malignancy.

*"[[Hyaline]] - pink stuff on H&E - is the key."

DDx:

*[[Invasive ductal carcinoma]] - should be considered if the lesion is asymmetrical ''or'' glands are dilated centrally.

===Images===

Image: Radial scar of breast - low mag.jpg | RS - low mag. (WC)

Image: Radial scar of breast - intermed mag.jpg | RS - intermed. mag. (WC)

</gallery>

====www====

*[http://www.breastpathology.info/Images/Benign/Radial_scar/rs3a_700.jpg Radial scar (breastpathology.info)].

==IHC==

Features:

*p63 +ve.

*Calponin +ve.

Note:

*HMWK +ve/-ve. (???)

==Sign out==

<pre>

Right Breast, Partial Mastectomy:

- Complex sclerosing lesion / radial scar.

- Background breast with proliferative fibrocystic changes and apocrine metaplasia.

- NEGATIVE for malignancy.

</pre>

==See also==

*[[Breast pathology]].

==References==

[[Category:Diagnosis]]

[[Category:Breast_pathology]]

@@ Line 1: / Line 1: @@
-#redirect [[Breast_pathology#Complex_sclerosing_lesion]]
+{{ Infobox diagnosis
+| Name       = {{PAGENAME}}
+| Image      = Radial scar of breast - intermed mag.jpg
+| Width      =
+| Caption    = Complex sclerosing lesion of breast. [[H&E stain]]. (WC)
+| Synonyms   = radial scar
+| Micro      = stellate lesion (low magnification), center of lesion has fibroelastosis (stroma light pink on H&E), scar like stroma with entrapped normal breast ducts and lobules - glands appear to enlarge with distance from center of lesion
+| Subtypes   =
+| LMDDx      = [[invasive ductal carcinoma]]
+| Stains     =
+| IHC        = myoepithelial cells preset (p63 +ve, calponin +ve)
+| EM         =
+| Molecular  =
+| IF         =
+| Gross      = spiculated mass
+| Grossing   =
+| Staging    =
+| Site       = [[breast]]
+| Assdx      =
+| Syndromes  =
+| Clinicalhx =
+| Signs      =
+| Symptoms   =
+| Prevalence =
+| Bloodwork  =
+| Rads       =
+| Endoscopy  =
+| Prognosis  = benign, increased risk of malignancy
+| Other      =
+| ClinDDx    = [[breast cancer]]
+| Tx         = excision
+}}
+'''Complex sclerosing lesion''' (abbreviated '''CSL'''), also '''radial scar''', is a benign [[breast pathology|lesion of the breast]] that is associated with an increased risk of subsequent [[breast cancer]].
+==General==
+*The term ''radial scar'' is a misnomer. It isn't a ''scar''. It isn't associated with prior trauma or surgery.<ref name=Ref_PBoD8_1072>{{Ref PBoD8|1072}}</ref>
+*May appear malignant on imaging.<ref name=pmid11167596>{{cite journal |author=Ung OA, Lee WB, Greenberg ML, Bilous M |title=Complex sclerosing lesion: the lesion is complex, the management is straightforward |journal=ANZ J Surg |volume=71 |issue=1 |pages=35–40 |year=2001 |month=January |pmid=11167596 |doi= |url=}}</ref>
+**Typically [[BI-RADS]] 4 - but may be BI-RADS 5.<ref name=pmid24936496>{{Cite journal  | last1 = Myong | first1 = JH. | last2 = Choi | first2 = BG. | last3 = Kim | first3 = SH. | last4 = Kang | first4 = BJ. | last5 = Lee | first5 = A. | last6 = Song | first6 = BJ. | title = Imaging features of complex sclerosing lesions of the breast. | journal = Ultrasonography | volume = 33 | issue = 1 | pages = 58-64 | month = Jan | year = 2014 | doi = 10.14366/usg.13015 | PMID = 24936496 }}</ref>
+*Associated with subsequent elevated risk of breast cancer.<ref>URL: [http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Radial_Scars.asp http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Radial_Scars.asp]. Accessed on: 4 May 2010.</ref>
+*Management - usually surgical excision.<ref name=pmid14514771>{{cite journal |author=Kennedy M, Masterson AV, Kerin M, Flanagan F |title=Pathology and clinical relevance of radial scars: a review |journal=J. Clin. Pathol. |volume=56 |issue=10 |pages=721–4 |year=2003 |month=October |pmid=14514771 |pmc=1770086 |doi= |url=}}</ref>
+**Risk of malignancy on surgical excision for biopsy diagnosed CSLs very small ~1%.<ref name=pmid26772402>{{Cite journal  | last1 = Li | first1 = Z. | last2 = Ranade | first2 = A. | last3 = Zhao | first3 = C. | title = Pathologic findings of follow-up surgical excision for radial scar on breast core needle biopsy. | journal = Hum Pathol | volume = 48 | issue =  | pages = 76-80 | month = Feb | year = 2016 | doi = 10.1016/j.humpath.2015.06.028 | PMID = 26772402 }}</ref>
+*Rare - less than 0.1% of core needle biopsies.<ref name=pmid25578683>{{Cite journal  | last1 = Nassar | first1 = A. | last2 = Conners | first2 = AL. | last3 = Celik | first3 = B. | last4 = Jenkins | first4 = SM. | last5 = Smith | first5 = CY. | last6 = Hieken | first6 = TJ. | title = Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution. | journal = Ann Diagn Pathol | volume = 19 | issue = 1 | pages = 24-8 | month = Feb | year = 2015 | doi = 10.1016/j.anndiagpath.2014.12.003 | PMID = 25578683 }}</ref>
+==Gross==
+*Spiculated mass.
+*Usually small - 3-7 mm.
+===Image===
+<gallery>
+Image:Radial_scar.jpg | Radial scar - gross. (WC)
+</gallery>
+==Microscopic==
+Features:<ref name=pmid14514771>{{cite journal |author=Kennedy M, Masterson AV, Kerin M, Flanagan F |title=Pathology and clinical relevance of radial scars: a review |journal=J. Clin. Pathol. |volume=56 |issue=10 |pages=721–4 |year=2003 |month=October |pmid=14514771 |pmc=1770086 |doi= |url=}}</ref><ref name=Ref_BP91>{{Ref BP|91}}</ref>
+*Stellate appearance (low magnification).
+*Center of lesion has "fibroelastosis" - stroma light pink (on H&E) - '''key feature'''.
+**Scar like stroma with entrapped normal breast ducts and lobules.
+**Glands appear to enlarge with distance from center of lesion.
+Notes:
+*Histomorphologic appearance may mimic a [[desmoplastic reaction]] of the stroma - leading to a misdiagnosis of malignancy.
+*"[[Hyaline]] - pink stuff on H&E - is the key."
+DDx:
+*[[Invasive ductal carcinoma]] - should be considered if the lesion is asymmetrical ''or'' glands are dilated centrally.
+===Images===
+<gallery>
+Image: Radial scar of breast - low mag.jpg | RS - low mag. (WC)
+Image: Radial scar of breast - intermed mag.jpg | RS - intermed. mag. (WC)
+</gallery>
+====www====
+*[http://www.breastpathology.info/Images/Benign/Radial_scar/rs3a_700.jpg Radial scar (breastpathology.info)].
+==IHC==
+Features:
+*p63 +ve.
+*Calponin +ve.
+Note:
+*HMWK +ve/-ve. (???)
+==Sign out==
+<pre>
+Right Breast, Partial Mastectomy:
+	- Complex sclerosing lesion / radial scar.
+	- Background breast with proliferative fibrocystic changes and apocrine metaplasia.
+        - NEGATIVE for malignancy.
+</pre>
+==See also==
+*[[Breast pathology]].
+==References==
+{{Reflist|2}}
+[[Category:Diagnosis]]
+[[Category:Breast_pathology]]

Complex sclerosing lesion: Difference between revisions

Navigation menu

Search