Difference between revisions of "Complex sclerosing lesion"

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      =  
| Image      = Radial scar of breast - intermed mag.jpg
| Width      =
| Width      =
| Caption    =  
| Caption    = Complex sclerosing lesion of breast. [[H&E stain]]. (WC)
| Synonyms  = radial scar
| 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
| 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
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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 - usu. 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>  
*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==

Latest revision as of 21:16, 31 January 2022

Complex sclerosing lesion
Diagnosis in short

Complex sclerosing lesion of breast. H&E stain. (WC)
Synonyms radial scar
LM 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
LM DDx invasive ductal carcinoma
IHC myoepithelial cells preset (p63 +ve, calponin +ve)
Gross spiculated mass
Site breast
Prognosis benign, increased risk of malignancy
Clin. DDx breast cancer
Treatment excision

Complex sclerosing lesion (abbreviated CSL), also radial scar, is a benign 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.[1]
  • May appear malignant on imaging.[2]
  • Associated with subsequent elevated risk of breast cancer.[4]
  • Management - usually surgical excision.[5]
    • Risk of malignancy on surgical excision for biopsy diagnosed CSLs very small ~1%.[6]
  • Rare - less than 0.1% of core needle biopsies.[7]

Gross

  • Spiculated mass.
  • Usually small - 3-7 mm.

Image

  • Radial scar - gross. (WC)

Microscopic

Features:[5][8]

  • 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:

Images

  • RS - low mag. (WC)

  • RS - intermed. mag. (WC)

www

IHC

Features:

  • p63 +ve.
  • Calponin +ve.

Note:

  • HMWK +ve/-ve. (???)

Sign out

Right Breast, Partial Mastectomy:
	- Complex sclerosing lesion / radial scar.
	- Background breast with proliferative fibrocystic changes and apocrine metaplasia.
        - NEGATIVE for malignancy.

See also

References

  1. ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1072. ISBN 978-1416031215.
  2. ↑ Ung OA, Lee WB, Greenberg ML, Bilous M (January 2001). "Complex sclerosing lesion: the lesion is complex, the management is straightforward". ANZ J Surg 71 (1): 35–40. PMID 11167596.
  3. ↑ Myong, JH.; Choi, BG.; Kim, SH.; Kang, BJ.; Lee, A.; Song, BJ. (Jan 2014). "Imaging features of complex sclerosing lesions of the breast.". Ultrasonography 33 (1): 58-64. doi:10.14366/usg.13015. PMID 24936496.
  4. ↑ URL: http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Radial_Scars.asp. Accessed on: 4 May 2010.
  5. ↑ 5.0 5.1 Kennedy M, Masterson AV, Kerin M, Flanagan F (October 2003). "Pathology and clinical relevance of radial scars: a review". J. Clin. Pathol. 56 (10): 721–4. PMC 1770086. PMID 14514771. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770086/.
  6. ↑ Li, Z.; Ranade, A.; Zhao, C. (Feb 2016). "Pathologic findings of follow-up surgical excision for radial scar on breast core needle biopsy.". Hum Pathol 48: 76-80. doi:10.1016/j.humpath.2015.06.028. PMID 26772402.
  7. ↑ Nassar, A.; Conners, AL.; Celik, B.; Jenkins, SM.; Smith, CY.; Hieken, TJ. (Feb 2015). "Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution.". Ann Diagn Pathol 19 (1): 24-8. doi:10.1016/j.anndiagpath.2014.12.003. PMID 25578683.
  8. ↑ O'Malley, Frances P.; Pinder, Sarah E. (2006). Breast Pathology: A Volume in Foundations in Diagnostic Pathology series (1st ed.). Churchill Livingstone. pp. 91. ISBN 978-0443066801.
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