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Findings: A small irregular density with subtle architectural distortion is present on the craniocaudal view in the medial left breast. A diagnostic mammogram (repeat views with spot magnification) confirms the presence of a 7 x 5 mm irregular mass with architectural distortion in the inner central left breast.

Diagnosis: 0.7 cm radial sclerosing lesion.

Discussion: Radial scar is a benign entity. It is almost always an asymptomatic lesion incidentally detected on mammography. It is not related to prior surgery or trauma. Typical radiological features are spiculated masses or areas of architectural distortion. Absence of central density (central lucency) and presence of multiple long thin spicules radiating centrally should suggest the diagnosis. Other findings which suggest this diagnosis include a varying appearance in different projections and absence of a palpable abnormality despite a marked mammographic abnormality. Nonspecific microcalcifications may be visible mammographically as well. Reliable differentiation between radial scar and breast carcinoma is not possible with imaging and excisional biopsy should be performed routinely. Excisional, not core biopsy, is recommended because radial scars have been shown to be associated with tubular carcinoma, DCIS, LCIS, atypical hyperplasia and invasive breast carcinoma.

Pathologically radial scars are common incidental findings encountered in breast biopsy specimens. The frequency of radial scars is the same in patients with a diagnosis of carcinoma as it is in patients with benign biopsies. On gross examination the size of radial scar ranges from .5 to 1.3 cm. They are firm to palpation with a stellate pattern of gray-yellow streaks. On gross inspection they may be difficult to distinguish from carcinoma. Microscopically there is epithelial proliferation that extends in a spoked-wheel pattern from a central fibroelastic core. Fat may become centrally trapped giving rise to the radiolucent center seen mammographically.

References:
Ciatto S, Morrone P, Catarzi S, Rosselli Del Turco M, Bianchi S, Amkogetti D,
Cariddi A. Radial Scars of the Breast: Review of 38 Consecutive Mammographic
Diagnoses. Radiology 1993; 187:757-760.

Fechner RE, Mills SE. Breast Pathology: Benign Proliferations Atypias and
In Situ Carcinomas. ASCP Press, Chicago 1990. pp 51-53.

Bassett LW, Jackson VP, Jahon R, Fu YS, Gold RH. Diagnosis of Diseases of the
Breast. W. B. Saunders Co. 1994. pp 420-424.

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