Complex sclerosing lesion
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| 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
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.