Complex sclerosing lesion

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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.

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

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. (???)

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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