Breast nonmalignant
Nonneoplastic changes
Radial scar

Topic Completed: 1 June 2010

Minor changes: 4 September 2019

Copyright: 2002-2019,, Inc.

PubMed Search: Radial scar [title] breast

Hind Warzecha, M.D.
Page views in 2019: 8,874
Page views in 2020 to date: 3,516
Cite this page: Warzecha H. Radial scar. website. Accessed May 27th, 2020.
Definition / general
  • Benign lesion with stellate architecture, prominent fibroelastosis and epithelial hyperplasia
  • Initially described in 1977 (Am J Surg Pathol 1977;1:155)
  • Also called complex sclerosing lesion (CSL, larger lesions), sclerosing ductal lesion, sclerosing adenosis with pseudoinfiltration, radial sclerosing lesion
  • Recommended to not use the term infiltrative epitheliosis (Semin Diagn Pathol 2010;27:5)
Clinical features
Radiology description
  • Stellate abnormalities ("black star") may resemble invasive ductal carcinoma or tubular carcinoma
  • Often bilateral
Radiology images

Contributed by Mark R. Wick, M.D.

Mammogram, spot film

Images hosted on other servers:

Characteristic findings

Case reports
Gross description
  • Stellate with central sclerosis and elastosis, resembles invasive ductal carcinoma, usually 1 cm or less
  • May be firm, irregular, with yellow streaks and flecks (due to elastotic stroma)
Gross images

AFIP images

Central sclerosis and elastosis resembling carcinoma

Microscopic (histologic) description
  • "Flower head" pattern on low power
  • High power shows central fibroelastotic zone of basophilic elastic material in walls of obliterated ducts and elsewhere, with radiation of compressed tubular structures with 2 cell layers (including myoepithelium) and hyalinized stroma
  • Variable amounts of epithelial hyperplasia, adenosis and cysts
  • Perineural invasion occasionally noted
Microscopic (histologic) images

Contributed by Emily S. Reisenbichler, M.D.

Central sclerosis with fibroelastotic stroma and entrapped glands radiating outward with variable usual hyperplasia at the periphery

Contributed by Mark R. Wick, M.D.

Various images

AFIP images

Adenosis surrounds central
area of fibrosis and elastosis
with entrapped ducts; cysts are
commonly present at periphery

Squamous metaplasia

Elastic stain highlights central elastosis

Central angular glands are
suggestive of tubular carcinoma
but peripheral duct hyperplasia
and cysts are not typical

Images hosted on other servers:

Small size, stellate shape, central fibrosis

Densely fibrotic

Ductal hyperplasia

Radiating pattern of the ducts

Central fibroelastotic core

Central fibrosis and elastosis with radiating fibrous bands and dilated ducts

Fibrosis, elastosis and ductal hyperplasia

Various images

With tubulolobular carcinoma

Cytology description
  • Fine needle aspiration often inadequate (J BUON 2002;7:137)
  • Bland epithelial clusters and bipolar naked nuclei
  • Also frequent apocrine cells, papillary clusters, foam cells and fibrillary elastoid material
  • Features are nonspecific but suggest benign diagnosis (Diagn Cytopathol 1997;17:353)
  • May also be atypical / malignant features if additional lesions present
Differential diagnosis
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