Complex sclerosing lesion: Difference between revisions
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{{ 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]]. | '''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]]. | ||
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*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> | *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> | *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> | *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 - | *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== | ==Gross== | ||
*Spiculated mass. | *Spiculated mass. | ||
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===Images=== | ===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)]. | *[http://www.breastpathology.info/Images/Benign/Radial_scar/rs3a_700.jpg Radial scar (breastpathology.info)]. | ||
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Note: | Note: | ||
*HMWK +ve/-ve. (???) | *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== | ==See also== | ||