Radial scars

- see also Immunohistochemistry and 'Other Sclerosing Lesions"

Clinical basics:

• Usually detected as stellate shadows on mammograms
• Therefore common in screening
• Radiologically very similar to cancers
• Note: both low grade cancers (especially tubular cancers) and radial scars may remain unchanged between screening rounds so a lack of growth is no guarantee that the lesion is a radial scar
• > 10mm called "Complex sclerosing lesions"

Key pathology points:

• Excised specimens show central scarring with entrapped benign glands
• Radiating 'legs' containing ductal structures often showing usual type hyperplasia and/or apocrine metaplasia
• Elastosis (wiggly or granular eosinophilic ++ material in stroma) is a hallmark feature (see below) but also seen in the centre of some cancers - so NOT specific
• Immunostains for myoepithelial markers helpful to distinguish entrapped benign glands from a coexistent (or overlooked) tubular carcinoma - see Immuno link above
• 10% + cases may harbour coexistent CIS or invasive carcinoma
• Report core biopsy with caution - suggest use phrase like 'consistent with a radial scar' because of the frequency of additional pathology on excision

Low power view of small (approx 3mm) radial scar - original magnification x1.25

Low power views of part of a radial scar - note foci of usual type hperplasia (arrows, left)

Low power view of core biopsy of a radial scar - note area of elastosis (A) and entrapped glands within area of scarring (arrow)

Further view from core biopsy above with area of elastosis (A)

Detail of area of elastosis with calc (arrow)

Positive CK 5/6 staining around entrapped benign glands in a core biopsy from a radial scar

Radial scar - original magnification x1.25

Medium power views of part of a radial scar - usual type hyperplasia (left) & elastosis (right)

Radial scar with co-existent DCIS

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