Difference between revisions of "Complex sclerosing lesion"
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'''Complex sclerosing lesion''', also '''radial scar''', is a benign [[breast pathology|lesion of the breast]] that is associated with an increased risk of malignancy. | |||
==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> | |||
*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> | |||
==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=== | |||
*[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. (???) | |||
==See also== | |||
*[[Breast pathology]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Breast_pathology]] | |||
Revision as of 04:23, 1 May 2016
Complex sclerosing lesion, also radial scar, is a benign lesion of the breast that is associated with an increased risk of malignancy.
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.[3]
- Management - usu. surgical excision.[4]
Gross
- Spiculated mass.
- Usually small - 3-7 mm.
Image
Radial scar - gross. (WC)
Microscopic
- 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
IHC
Features:
- p63 +ve.
- Calponin +ve.
Note:
- HMWK +ve/-ve. (???)
See also
References
- ↑ 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.
- ↑ 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.
- ↑ URL: http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Radial_Scars.asp. Accessed on: 4 May 2010.
- ↑ 4.0 4.1 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/.
- ↑ 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.