[Complex sclerosing adenosis of the breast: benign or precancerous?]

ABSTRACT

The proliferative center of Aschoff, better known as radial scar, resembles carcinoma mammographically and histologically. It is a begnin condition even if some authors suggested that the radial scar is an early stage in mammary carcinogenesis. We report the case of a 31 year old women who complained during four months from breast pain and palpable mass on the same breast. Examination showed a 1,5 cm mass on the right upper quadrant, hard without axillary lymph nodes. Mammography showed an irregular opacity, suggestive of a breast malignancy. A fine needle biopsy showed an infiltrating ductal carcinoma. Patient underwent surgery. We performed a conservative treatement with large tumor excision and dissection of sentinel lymph node. Hystological examination showed a 18 /15mm radial scar with safe margins and no sign of malignancy. The sentinel lymph node was normal. Only twenty five percent of radial scars are palpable and most of them are asymptomatic. Good quality mammography is essential to identify those lesions, whereas, ultrasonography has no role in the diagnosis. Pathological appearance is similar to small invasive cancers. Thus, the uses of immunohistochemistry techniques are necessary to distinguish radial scars from carcinomas. The questions are about whether radial scar is a premalignant lesion or not and if wide local excision is always necessary. We report herein the case of a young woman with radial scar which illustrates all the difficulties of this rare breast condition