Difference between revisions of "Complex sclerosing lesion"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      =
| Width      =
| Caption    =
| 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]].



Revision as of 18:00, 1 January 2017

Complex sclerosing lesion
Diagnosis in short

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.[3]
  • Management - usu. surgical excision.[4]

Gross

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

Image

Microscopic

Features:[4][5]

  • 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

IHC

Features:

  • p63 +ve.
  • Calponin +ve.

Note:

  • HMWK +ve/-ve. (???)

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. URL: http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Radial_Scars.asp. Accessed on: 4 May 2010.
  4. 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/.
  5. 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.