Objective: The diagnosis of radial scar (RS) is often difficult, especially when associated with proliferative changes, pseudoinvasion and necrosis. Method: A 41-year-old woman was referred to the Surgery Department for a palpable mass in her left breast, regarded as a possible fibroadenoma on ultrasonography. Results: Lumpectomy was performed and the macroscopy revealed a tan-white 11 mm diameter lesion, with irregular margins and firm consistency. On light microscopy, a sclerosing lesion, with a stellate arrangement of ducts surrounding a central fibro-collagenous zone was identified. Haphazardly arranged, distorted ducts associated with massive intraductal proliferation, highly suspicious of infiltrative were also present in the center of the lesion. The proliferating ducts showed slit-like, irregular, secondary lumens, several containing central necrosis and a heterogenous cell population. The presence of central necrosis and pseudoinvasion were, however, worrisome. Immunohistochemistry for p63 demonstrated the presence of myoepithelial cells surrounding all the areas with pseudoinfiltrating features, while CK 5/6 displayed a heterogenous, mosaic-like positivity, characteristic for usual ductal hyperplasia (UDH). Conclusion: Because pseudoinvasion in benign RS can easily be misinterpreted as invasive carcinoma, immunohistochemistry is mandatory to establish the presence of myoepithelial cells. Although rare, central necrosis may occur in UDH and should not be used as a single diagnostic criterion of malignancy.