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Radial Scar of the Breast: Radiologic-Pathologic Correlation in 22 Cases¹

¹ From the Departments of Radiology (D.Q.A., D.H.S., G.J.C.) and Pathology (G.H.F.), Ochsner Clinic, 1514 Jefferson Hwy, New Orleans, LA 70121. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received March 19, 1999; revision requested April 13 and received May 7; accepted May 7. Address reprint requests to D.H.S.

View larger version (92K): [in a new window]   Figure 1.   Schematic illustrates the typical "black star" mammographic appearance of radial scar at mammography.

View larger version (144K): [in a new window]   Figure 2a.   Radial scar in a 77-year-old woman. Mediolateral oblique (a), mediolateral oblique spot compression (b), and craniocaudal spot compression (c) mammograms show no discrete central mass (arrow in a and b) as well as long radiating spicules against a radiolucent background of fat (arrowheads) and demonstrate the varying appearances of radial scar on orthogonal views. These entities demonstrate architectural distortion that may be indistinguishable from architectural distortion associated with carcinoma. Pathologic analysis confirmed the diagnosis.

View larger version (113K): [in a new window]   Figure 2b.   Radial scar in a 77-year-old woman. Mediolateral oblique (a), mediolateral oblique spot compression (b), and craniocaudal spot compression (c) mammograms show no discrete central mass (arrow in a and b) as well as long radiating spicules against a radiolucent background of fat (arrowheads) and demonstrate the varying appearances of radial scar on orthogonal views. These entities demonstrate architectural distortion that may be indistinguishable from architectural distortion associated with carcinoma. Pathologic analysis confirmed the diagnosis.

View larger version (142K): [in a new window]   Figure 2c.   Radial scar in a 77-year-old woman. Mediolateral oblique (a), mediolateral oblique spot compression (b), and craniocaudal spot compression (c) mammograms show no discrete central mass (arrow in a and b) as well as long radiating spicules against a radiolucent background of fat (arrowheads) and demonstrate the varying appearances of radial scar on orthogonal views. These entities demonstrate architectural distortion that may be indistinguishable from architectural distortion associated with carcinoma. Pathologic analysis confirmed the diagnosis.

View larger version (105K): [in a new window]   Figure 3a.   Radial scar in a 44-year-old woman. (a) Craniocaudal mammogram (magnification view) shows the typical stellate appearance of these lesions. (b) Low-power photomicrograph (original magnification, x25; hematoxylin-eosin [H-E] stain) demonstrates characteristic histologic features including a central sclerotic core (arrowhead), radiating bands of stroma (black arrows), and peripheral ductal and lobular elements (white arrow).

View larger version (160K): [in a new window]   Figure 3b.   Radial scar in a 44-year-old woman. (a) Craniocaudal mammogram (magnification view) shows the typical stellate appearance of these lesions. (b) Low-power photomicrograph (original magnification, x25; hematoxylin-eosin [H-E] stain) demonstrates characteristic histologic features including a central sclerotic core (arrowhead), radiating bands of stroma (black arrows), and peripheral ductal and lobular elements (white arrow).

View larger version (148K): [in a new window]   Figure 4a.   Radial scar without proliferative changes in a 42-year-old woman. (a) Mediolateral oblique mammogram (magnification view) demonstrates radiating spicules (arrowheads) and no central mass, findings that are consistent with radial scar. (b) Photograph of the pathologic specimen (H-E stain) shows radiating bands of connective tissue with entrapped cystic glandular components having an intact myoepithelial layer. (c) Low-power photomicrograph (original magnification, x25; H-E stain) reveals nonproliferative cystic glandular elements and dense collagen. (d) High-power photomicrograph (original magnification, x200; H-E stain) demonstrates benign nonproliferative duct units and sclerotic bands.

View larger version (145K): [in a new window]   Figure 4b.   Radial scar without proliferative changes in a 42-year-old woman. (a) Mediolateral oblique mammogram (magnification view) demonstrates radiating spicules (arrowheads) and no central mass, findings that are consistent with radial scar. (b) Photograph of the pathologic specimen (H-E stain) shows radiating bands of connective tissue with entrapped cystic glandular components having an intact myoepithelial layer. (c) Low-power photomicrograph (original magnification, x25; H-E stain) reveals nonproliferative cystic glandular elements and dense collagen. (d) High-power photomicrograph (original magnification, x200; H-E stain) demonstrates benign nonproliferative duct units and sclerotic bands.

View larger version (194K): [in a new window]   Figure 4c.   Radial scar without proliferative changes in a 42-year-old woman. (a) Mediolateral oblique mammogram (magnification view) demonstrates radiating spicules (arrowheads) and no central mass, findings that are consistent with radial scar. (b) Photograph of the pathologic specimen (H-E stain) shows radiating bands of connective tissue with entrapped cystic glandular components having an intact myoepithelial layer. (c) Low-power photomicrograph (original magnification, x25; H-E stain) reveals nonproliferative cystic glandular elements and dense collagen. (d) High-power photomicrograph (original magnification, x200; H-E stain) demonstrates benign nonproliferative duct units and sclerotic bands.

View larger version (197K): [in a new window]   Figure 4d.   Radial scar without proliferative changes in a 42-year-old woman. (a) Mediolateral oblique mammogram (magnification view) demonstrates radiating spicules (arrowheads) and no central mass, findings that are consistent with radial scar. (b) Photograph of the pathologic specimen (H-E stain) shows radiating bands of connective tissue with entrapped cystic glandular components having an intact myoepithelial layer. (c) Low-power photomicrograph (original magnification, x25; H-E stain) reveals nonproliferative cystic glandular elements and dense collagen. (d) High-power photomicrograph (original magnification, x200; H-E stain) demonstrates benign nonproliferative duct units and sclerotic bands.

View larger version (123K): [in a new window]   Figure 5a.   Radial scar with a focus of ductal carcinoma in situ in a 71-year-old woman. (a-c) Standard craniocaudal (a), craniocaudal (magnification view) (b), and 90° mediolateral (c) mammograms demonstrate the varying appearances of these lesions on orthogonal views. (d) Photograph of the pathologic specimen (H-E stain) illustrates typical entrapped peripheral ductal and lobular elements and a central focus of ductal carcinoma in situ (arrow). (e) Intermediate power photomicrograph (original magnification, x100; H-E stain) displays clusters of intraductal neoplastic cells, a finding that is compatible with low-nuclear-grade cribriform and micropapillary ductal carcinoma in situ.

View larger version (120K): [in a new window]   Figure 5b.   Radial scar with a focus of ductal carcinoma in situ in a 71-year-old woman. (a-c) Standard craniocaudal (a), craniocaudal (magnification view) (b), and 90° mediolateral (c) mammograms demonstrate the varying appearances of these lesions on orthogonal views. (d) Photograph of the pathologic specimen (H-E stain) illustrates typical entrapped peripheral ductal and lobular elements and a central focus of ductal carcinoma in situ (arrow). (e) Intermediate power photomicrograph (original magnification, x100; H-E stain) displays clusters of intraductal neoplastic cells, a finding that is compatible with low-nuclear-grade cribriform and micropapillary ductal carcinoma in situ.

View larger version (130K): [in a new window]   Figure 5c.   Radial scar with a focus of ductal carcinoma in situ in a 71-year-old woman. (a-c) Standard craniocaudal (a), craniocaudal (magnification view) (b), and 90° mediolateral (c) mammograms demonstrate the varying appearances of these lesions on orthogonal views. (d) Photograph of the pathologic specimen (H-E stain) illustrates typical entrapped peripheral ductal and lobular elements and a central focus of ductal carcinoma in situ (arrow). (e) Intermediate power photomicrograph (original magnification, x100; H-E stain) displays clusters of intraductal neoplastic cells, a finding that is compatible with low-nuclear-grade cribriform and micropapillary ductal carcinoma in situ.

View larger version (186K): [in a new window]   Figure 5d.   Radial scar with a focus of ductal carcinoma in situ in a 71-year-old woman. (a-c) Standard craniocaudal (a), craniocaudal (magnification view) (b), and 90° mediolateral (c) mammograms demonstrate the varying appearances of these lesions on orthogonal views. (d) Photograph of the pathologic specimen (H-E stain) illustrates typical entrapped peripheral ductal and lobular elements and a central focus of ductal carcinoma in situ (arrow). (e) Intermediate power photomicrograph (original magnification, x100; H-E stain) displays clusters of intraductal neoplastic cells, a finding that is compatible with low-nuclear-grade cribriform and micropapillary ductal carcinoma in situ.

View larger version (172K): [in a new window]   Figure 5e.   Radial scar with a focus of ductal carcinoma in situ in a 71-year-old woman. (a-c) Standard craniocaudal (a), craniocaudal (magnification view) (b), and 90° mediolateral (c) mammograms demonstrate the varying appearances of these lesions on orthogonal views. (d) Photograph of the pathologic specimen (H-E stain) illustrates typical entrapped peripheral ductal and lobular elements and a central focus of ductal carcinoma in situ (arrow). (e) Intermediate power photomicrograph (original magnification, x100; H-E stain) displays clusters of intraductal neoplastic cells, a finding that is compatible with low-nuclear-grade cribriform and micropapillary ductal carcinoma in situ.

View larger version (85K): [in a new window]   Figure 6a.   Tubular carcinoma in a 65-year-old woman. (a) Craniocaudal mammogram (magnification view) demonstrates the classic "black star" appearance of architectural distortion (arrows). (b) Low-power photomicrograph (original magnification, x25; H-E stain) depicts radiating bands of reactive stroma (arrows). (c) High-power photomicrograph (original magnification, x200; H-E stain) shows irregularly distributed neoplastic ducts in a background of reactive stroma, a finding that is characteristic of tubular carcinoma.

View larger version (204K): [in a new window]   Figure 6b.   Tubular carcinoma in a 65-year-old woman. (a) Craniocaudal mammogram (magnification view) demonstrates the classic "black star" appearance of architectural distortion (arrows). (b) Low-power photomicrograph (original magnification, x25; H-E stain) depicts radiating bands of reactive stroma (arrows). (c) High-power photomicrograph (original magnification, x200; H-E stain) shows irregularly distributed neoplastic ducts in a background of reactive stroma, a finding that is characteristic of tubular carcinoma.

View larger version (198K): [in a new window]   Figure 6c.   Tubular carcinoma in a 65-year-old woman. (a) Craniocaudal mammogram (magnification view) demonstrates the classic "black star" appearance of architectural distortion (arrows). (b) Low-power photomicrograph (original magnification, x25; H-E stain) depicts radiating bands of reactive stroma (arrows). (c) High-power photomicrograph (original magnification, x200; H-E stain) shows irregularly distributed neoplastic ducts in a background of reactive stroma, a finding that is characteristic of tubular carcinoma.

View larger version (109K): [in a new window]   Figures 7, 8.   (7) Lobular carcinoma in a 55-year-old woman. (a, b) Mediolateral oblique (a) and craniocaudal (b) mammograms (magnification view) reveal the typical radiolucent center of radial scar. It is often difficult to distinguish superimposed background fat from the central radiolucent core of these entities at mammography. (c) High-power photomicrograph (original magnification, x200; H-E stain) demonstrates infiltrating neoplastic cells in a single file pattern (arrows), a finding that is characteristic of lobular carcinoma. (8) Infiltrating ductal carcinoma in a 70-year-old woman. (a) Craniocaudal mammogram (magnification view) shows architectural distortion with no obvious central mass. (b) Radiograph of the excised pathologic specimen more clearly depicts a central mass (arrow). (c) High-power photomicrograph (original magnification, x200; H-E stain) shows islands of neoplastic cells in a background of fat and reactive stroma, a finding that is consistent with invasive ductal carcinoma.

View larger version (110K): [in a new window]   Figures 7, 8.   (7) Lobular carcinoma in a 55-year-old woman. (a, b) Mediolateral oblique (a) and craniocaudal (b) mammograms (magnification view) reveal the typical radiolucent center of radial scar. It is often difficult to distinguish superimposed background fat from the central radiolucent core of these entities at mammography. (c) High-power photomicrograph (original magnification, x200; H-E stain) demonstrates infiltrating neoplastic cells in a single file pattern (arrows), a finding that is characteristic of lobular carcinoma. (8) Infiltrating ductal carcinoma in a 70-year-old woman. (a) Craniocaudal mammogram (magnification view) shows architectural distortion with no obvious central mass. (b) Radiograph of the excised pathologic specimen more clearly depicts a central mass (arrow). (c) High-power photomicrograph (original magnification, x200; H-E stain) shows islands of neoplastic cells in a background of fat and reactive stroma, a finding that is consistent with invasive ductal carcinoma.

View larger version (188K): [in a new window]   Figures 7, 8.   (7) Lobular carcinoma in a 55-year-old woman. (a, b) Mediolateral oblique (a) and craniocaudal (b) mammograms (magnification view) reveal the typical radiolucent center of radial scar. It is often difficult to distinguish superimposed background fat from the central radiolucent core of these entities at mammography. (c) High-power photomicrograph (original magnification, x200; H-E stain) demonstrates infiltrating neoplastic cells in a single file pattern (arrows), a finding that is characteristic of lobular carcinoma. (8) Infiltrating ductal carcinoma in a 70-year-old woman. (a) Craniocaudal mammogram (magnification view) shows architectural distortion with no obvious central mass. (b) Radiograph of the excised pathologic specimen more clearly depicts a central mass (arrow). (c) High-power photomicrograph (original magnification, x200; H-E stain) shows islands of neoplastic cells in a background of fat and reactive stroma, a finding that is consistent with invasive ductal carcinoma.

View larger version (99K): [in a new window]   Figures 7, 8.   (7) Lobular carcinoma in a 55-year-old woman. (a, b) Mediolateral oblique (a) and craniocaudal (b) mammograms (magnification view) reveal the typical radiolucent center of radial scar. It is often difficult to distinguish superimposed background fat from the central radiolucent core of these entities at mammography. (c) High-power photomicrograph (original magnification, x200; H-E stain) demonstrates infiltrating neoplastic cells in a single file pattern (arrows), a finding that is characteristic of lobular carcinoma. (8) Infiltrating ductal carcinoma in a 70-year-old woman. (a) Craniocaudal mammogram (magnification view) shows architectural distortion with no obvious central mass. (b) Radiograph of the excised pathologic specimen more clearly depicts a central mass (arrow). (c) High-power photomicrograph (original magnification, x200; H-E stain) shows islands of neoplastic cells in a background of fat and reactive stroma, a finding that is consistent with invasive ductal carcinoma.

View larger version (128K): [in a new window]   Figures 7, 8.   (7) Lobular carcinoma in a 55-year-old woman. (a, b) Mediolateral oblique (a) and craniocaudal (b) mammograms (magnification view) reveal the typical radiolucent center of radial scar. It is often difficult to distinguish superimposed background fat from the central radiolucent core of these entities at mammography. (c) High-power photomicrograph (original magnification, x200; H-E stain) demonstrates infiltrating neoplastic cells in a single file pattern (arrows), a finding that is characteristic of lobular carcinoma. (8) Infiltrating ductal carcinoma in a 70-year-old woman. (a) Craniocaudal mammogram (magnification view) shows architectural distortion with no obvious central mass. (b) Radiograph of the excised pathologic specimen more clearly depicts a central mass (arrow). (c) High-power photomicrograph (original magnification, x200; H-E stain) shows islands of neoplastic cells in a background of fat and reactive stroma, a finding that is consistent with invasive ductal carcinoma.

View larger version (168K): [in a new window]   Figures 7, 8.   (7) Lobular carcinoma in a 55-year-old woman. (a, b) Mediolateral oblique (a) and craniocaudal (b) mammograms (magnification view) reveal the typical radiolucent center of radial scar. It is often difficult to distinguish superimposed background fat from the central radiolucent core of these entities at mammography. (c) High-power photomicrograph (original magnification, x200; H-E stain) demonstrates infiltrating neoplastic cells in a single file pattern (arrows), a finding that is characteristic of lobular carcinoma. (8) Infiltrating ductal carcinoma in a 70-year-old woman. (a) Craniocaudal mammogram (magnification view) shows architectural distortion with no obvious central mass. (b) Radiograph of the excised pathologic specimen more clearly depicts a central mass (arrow). (c) High-power photomicrograph (original magnification, x200; H-E stain) shows islands of neoplastic cells in a background of fat and reactive stroma, a finding that is consistent with invasive ductal carcinoma.