radial slerosing lesion

Definition: Radial sclerosing lesion has radiating fibroelastic tissue with intermixed tubular glands with the characteristic two cell layers.

Images

 sclerosing lesion / radial scar of the breast

• https://twitter.com/otromicroscopio/status/803227455809056768
• https://twitter.com/ycioannidis/status/797128032116998144
• https://twitter.com/AJPerricone/status/868998322362732544
• https://twitter.com/Patholwalker/status/949374612961296384
• https://twitter.com/Patholwalker/status/1097469556744843265

Microscopy

 Radial sclerosing lesion has radiating fibroelastic tissue with intermixed tubular glands with the characteristic two cell layers.
 Central fibroelastotic core and radiating ducts with peripheral dilatation.
 Fibrosis begins to occur in the center of ductal hyperplasia causing a radiating patter of the ducts.
 Marked fibrosis and elastosis occur in the ductal hyperplasia.

Management

Optimal management of a lesion yielding radial scar (RS) without epithelial atypia on breast biopsy is controversial. In the setting of multidisciplinary agreement and careful radiologic-pathologic correlation, it may be appropriate for patients with a biopsy diagnosis of RS without atypia to forego surgical excision in favor of imaging follow-up. (25634748)

In a series, of 48 patients who underwent surgical excision after a diagnosis of RS on biopsy, only 1 had an "upgrade" diagnosis of malignancy (2%). (25634748)

Differential diagnosis

 mammary small glandular proliferation

• mammary tubular carcinoma (MTC)
• microglandular adenosis (MGA)
• radial scar
• low-grade adenosquamous carcinoma (LGASC)
• displaced epithelium
• syringomatous adenoma

 mammary sclerozing anomalies / lesions

References

 Radial Scar at Image-guided Needle Biopsy: Is Excision Necessary? Conlon N, D’Arcy C, Kaplan JB, Bowser ZL, Cordero A, Brogi E, Corben AD. Am J Surg Pathol. 2015 Jan 28. PMID: 25634748