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Case of the Month

by Dr K C Choy AM (Mal), MBBS, M.Med, FRCR

Answer to Case Of the Month 

Discussion
There is a spiculated lesion in the upper outer quadrant in the left MLO view but not seen on the CC view except in the extended CC view (not shown). Paddle compression view confirms a stellate lesion. Hook wire localisation using stereo tactic guidance was followed by surgical excision. Specimen radiograph confirmed the complete removal of the mammographic abnormality. Histopathological examination revealed the diagnosis of radial scar.

 

Radial Scar

  • A radial scar is seen as a stellate lesion on mammograms. Such a “scar” is not due to trauma, surgery or inflammation but is a pathologic condition in which ductal elements are surrounded by bands of fibrous tissue radiating from a central sclerotic focus. It is also known by such names as radial sclerosing lesion, sclerosing duct hyperplasia or indurative mastopathy. Radial scars are benign but are associated with tubular carcinomas.

  • On mammograms, radial scars are spiculated and may have radiolucent centres.  Calcifications when seen are usually of the benign adenosis type.

  • Even when findings are suggestive of radial scar, it is not possible to exclude an invasive breast carcinoma, which commonly presents as a spiculated mass. Thus, biopsy is required in such lesions.

  • Other conditions which can present as a spiculated lesion on mammogram include:

  1. Postsurgical scar

  2. Fat necrosis

  3. Sclerosing adenosis

About the Author 
Dr K C Choy is currently attached to the Mahkota Medical Centre, Melaka as Radiologist.

 

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Last Updated:
Thursday, 21 August, 2003