Difference between revisions of "High-grade prostatic intraepithelial neoplasia"

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High-grade prostatic intraepithelial neoplasia (view source)

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| Caption    = High-grade prostatic intraepithelial neoplasia. [[H&E stain]].
| Caption    = High-grade prostatic intraepithelial neoplasia. [[H&E stain]].
| Synonyms  = prostatic intraepithelial neoplasia
| Synonyms  = prostatic intraepithelial neoplasia
| Micro      = nuclear changes (hyperchromatic nuclei, nucleoli present, +/-increased NC ratio, mild-to-moderate nuclear enlargement), medium-to-large glands with the architecture of HGPIN (tufted, micropapillary, cribriform, flat)
| Micro      = nuclear changes (hyperchromatic nuclei, nucleoli present, +/-increased NC ratio, mild-to-moderate nuclear enlargement), medium-to-large glands with the architecture of HGPIN (tufted, micropapillary, flat)
| Subtypes  =
| Subtypes  =
| LMDDx      = [[basal cell hyperplasia]], [[prostatic adenocarcinoma]], [[PIN-like prostatic ductal adenocarcinoma]], [[atypical small acinar proliferation]] (biopsy only)  
| LMDDx      = [[basal cell hyperplasia]], [[prostatic adenocarcinoma]], [[PIN-like prostatic ductal adenocarcinoma]], [[atypical small acinar proliferation]] (biopsy only), [[atypical intraductal proliferation]]
| Stains    =
| Stains    =
| IHC        = AMACR +ve, basal cells present (p63 +ve, CK34betaE12 +ve)
| IHC        = AMACR +ve, basal cells present (p63 +ve, CK34betaE12 +ve)
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==General==
==General==
*Thought to be a precursor lesion for prostate adenocarcinoma.
*Thought to be a precursor lesion for prostate adenocarcinoma.
**Multifocal HGPIN considered a risk for prostate cancer on re-biopsy.<ref name=pmid21191509>{{Cite journal  | last1 = Srigley | first1 = JR. | last2 = Merrimen | first2 = JL. | last3 = Jones | first3 = G. | last4 = Jamal | first4 = M. | title = Multifocal high-grade prostatic intraepithelial neoplasia is still a significant risk factor for adenocarcinoma. | journal = Can Urol Assoc J | volume = 4 | issue = 6 | pages = 434 | month = Dec | year = 2010 | doi =  | PMID = 21191509 }}</ref><ref name=pmid19524976>{{Cite journal  | last1 = Merrimen | first1 = JL. | last2 = Jones | first2 = G. | last3 = Walker | first3 = D. | last4 = Leung | first4 = CS. | last5 = Kapusta | first5 = LR. | last6 = Srigley | first6 = JR. | title = Multifocal high grade prostatic intraepithelial neoplasia is a significant risk factor for prostatic adenocarcinoma. | journal = J Urol | volume = 182 | issue = 2 | pages = 485-90; discussion 490 | month = Aug | year = 2009 | doi = 10.1016/j.juro.2009.04.016 | PMID = 19524976 }}</ref>
*Incidence ~5-8% on core biopsy.<ref name=pmid16469560/>
*Multifocal HGPIN considered a risk for prostate cancer on re-biopsy.<ref name=pmid21191509>{{Cite journal  | last1 = Srigley | first1 = JR. | last2 = Merrimen | first2 = JL. | last3 = Jones | first3 = G. | last4 = Jamal | first4 = M. | title = Multifocal high-grade prostatic intraepithelial neoplasia is still a significant risk factor for adenocarcinoma. | journal = Can Urol Assoc J | volume = 4 | issue = 6 | pages = 434 | month = Dec | year = 2010 | doi =  | PMID = 21191509 }}</ref><ref name=pmid19524976>{{Cite journal  | last1 = Merrimen | first1 = JL. | last2 = Jones | first2 = G. | last3 = Walker | first3 = D. | last4 = Leung | first4 = CS. | last5 = Kapusta | first5 = LR. | last6 = Srigley | first6 = JR. | title = Multifocal high grade prostatic intraepithelial neoplasia is a significant risk factor for prostatic adenocarcinoma. | journal = J Urol | volume = 182 | issue = 2 | pages = 485-90; discussion 490 | month = Aug | year = 2009 | doi = 10.1016/j.juro.2009.04.016 | PMID = 19524976 }}</ref>
**A small focus of HGPIN does not appear to be associated with an increased risk for prostate cancer on re-biopsy at one year if the initial biopsy had 8 or more cores.<ref name=pmid16406886>{{Cite journal  | last1 = Herawi | first1 = M. | last2 = Kahane | first2 = H. | last3 = Cavallo | first3 = C. | last4 = Epstein | first4 = JI. | title = Risk of prostate cancer on first re-biopsy within 1 year following a diagnosis of high grade prostatic intraepithelial neoplasia is related to the number of cores sampled. | journal = J Urol | volume = 175 | issue = 1 | pages = 121-4 | month = Jan | year = 2006 | doi = 10.1016/S0022-5347(05)00064-9 | PMID = 16406886 }}</ref>
**A small focus of HGPIN does not appear to be associated with an increased risk for prostate cancer on re-biopsy at one year if the initial biopsy had 8 or more cores.<ref name=pmid16406886>{{Cite journal  | last1 = Herawi | first1 = M. | last2 = Kahane | first2 = H. | last3 = Cavallo | first3 = C. | last4 = Epstein | first4 = JI. | title = Risk of prostate cancer on first re-biopsy within 1 year following a diagnosis of high grade prostatic intraepithelial neoplasia is related to the number of cores sampled. | journal = J Urol | volume = 175 | issue = 1 | pages = 121-4 | month = Jan | year = 2006 | doi = 10.1016/S0022-5347(05)00064-9 | PMID = 16406886 }}</ref>
*Interrater variability is moderate (kappa ~ 0.45) for benign versus HGPIN.<ref name=pmid8832557>{{Cite journal  | last1 = Allam | first1 = CK. | last2 = Bostwick | first2 = DG. | last3 = Hayes | first3 = JA. | last4 = Upton | first4 = MP. | last5 = Wade | first5 = GG. | last6 = Domanowski | first6 = GF. | last7 = Klein | first7 = MA. | last8 = Boling | first8 = EA. | last9 = Stilmant | first9 = MM. | title = Interobserver variability in the diagnosis of high-grade prostatic intraepithelial neoplasia and adenocarcinoma. | journal = Mod Pathol | volume = 9 | issue = 7 | pages = 742-51 | month = Jul | year = 1996 | doi =  | PMID = 8832557 }}</ref>


Low-grade prostatic intraepithelial neoplasia:
Low-grade prostatic intraepithelial neoplasia:
*Not reported and generally believed to be irrelevant biologically/clinically.
*Should ''not'' be reported.<ref name=pmid16469560>{{Cite journal  | last1 = Epstein | first1 = JI. | last2 = Herawi | first2 = M. | title = Prostate needle biopsies containing prostatic intraepithelial neoplasia or atypical foci suspicious for carcinoma: implications for patient care. | journal = J Urol | volume = 175 | issue = 3 Pt 1 | pages = 820-34 | month = Mar | year = 2006 | doi = 10.1016/S0022-5347(05)00337-X | PMID = 16469560 }}</ref>
*Believed to be irrelevant biologically/clinically.
**''PIN'' not otherwise specified refers to ''HGPIN''.
**''PIN'' not otherwise specified refers to ''HGPIN''.
**Low-grade PIN has the architecture of HGPIN but lacks the nuclear atypia.
**Low-grade PIN has the architecture of HGPIN but lacks the nuclear atypia.
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**Nucleoli present - '''key (high power) feature'''.
**Nucleoli present - '''key (high power) feature'''.
**Often increased NC ratio.
**Often increased NC ratio.
**Nuclear enlargement.
**Nuclear enlargement - usually subtle/appreciated at high magnification only.
*Tinctorial changes of the cytoplasm - usually amphophilic (red) or basophilic (blue).


Notes:
Notes:
*Nucleoli should be visible with the 20x objective.
*[[Nucleoli]] should be visible with the 20x objective.
**If one uses the 40x objective... one over calls.
**If one uses the 40x objective... one over calls.
*May need IHC for cancer versus HGPIN.
*May need IHC for cancer versus HGPIN.
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*[[Prostatic adenocarcinoma]] - glands with HGPIN have two or more distinct cells layers.
*[[Prostatic adenocarcinoma]] - glands with HGPIN have two or more distinct cells layers.
**[[PIN-like prostatic ductal adenocarcinoma]] - glands crowded.
**[[PIN-like prostatic ductal adenocarcinoma]] - glands crowded.
*Benign prostate - HPGIN has nuclear changes.
*Benign prostate - HGPIN has nuclear changes.
**Central zone typically has small nucleoli;<ref>{{Cite journal  | last1 = Egevad | first1 = L. | title = Cytology of the central zone of the prostate. | journal = Diagn Cytopathol | volume = 28 | issue = 5 | pages = 239-44 | month = May | year = 2003 | doi = 10.1002/dc.10275 | PMID = 12722118 }}</ref> however, the glands are larger.
*[[Atypical intraductal proliferation]] - a [[waffle diagnosis]] when criteria insufficient for [[intraductal carcinoma of the prostate]].


===HGPIN architecture===
===HGPIN architecture===
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*Tufting - common.
*Tufting - common.
*Micropapillary - common.
*Micropapillary - common.
*Cribriform - rare.


Note:  
Notes:  
*The architectural pattern is '''not''' thought to have any prognostic significance; however, it may be useful for differentiating it from benign prostate.
*The architectural pattern is '''not''' thought to have any prognostic significance; however, it may be useful for differentiating it from benign prostate.
*"Cribriform HGPIN" previously existed; it is now classified as [[atypical intraductal proliferation]].<ref name=pmid35758185>{{cite journal |authors=Kench JG, Amin MB, Berney DM, Compérat EM, Cree IA, Gill AJ, Hartmann A, Menon S, Moch H, Netto GJ, Raspollini MR, Rubin MA, Tan PH, Tsuzuki T, Turjalic S, van der Kwast TH, Zhou M, Srigley JR |title=WHO Classification of Tumours fifth edition: evolving issues in the classification, diagnosis, and prognostication of prostate cancer |journal=Histopathology |volume=81 |issue=4 |pages=447–458 |date=October 2022 |pmid=35758185 |pmc=9542779 |doi=10.1111/his.14711 |url=}}</ref>


===Images===
===Images===
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*HGPIN: AMACR +ve, p63 +ve, HMWCK +ve.
*HGPIN: AMACR +ve, p63 +ve, HMWCK +ve.
*Cancer: AMACR +ve, p63 -ve, HMWCK -ve.
*Cancer: AMACR +ve, p63 -ve, HMWCK -ve.
*Normal: AMACR -ve, p63 +ve, HMWCK +ve.
*Normal: AMACR -ve‡, p63 +ve, HMWCK +ve.
 
Note:
*‡ May be positive in normal prostate.<ref name=pmid15602744>{{Cite journal  | last1 = Ananthanarayanan | first1 = V. | last2 = Deaton | first2 = RJ. | last3 = Yang | first3 = XJ. | last4 = Pins | first4 = MR. | last5 = Gann | first5 = PH. | title = Alpha-methylacyl-CoA racemase (AMACR) expression in normal prostatic glands and high-grade prostatic intraepithelial neoplasia (HGPIN): association with diagnosis of prostate cancer. | journal = Prostate | volume = 63 | issue = 4 | pages = 341-6 | month = Jun | year = 2005 | doi = 10.1002/pros.20196 | PMID = 15602744 }}
</ref>


==Sign out==
==Sign out==
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</pre>
</pre>


===Mostly lower case===
<pre>
A. Left Apex:
-  Focal high grade prostatic intraepithelial neoplasia, chronic
  inflammation
B. Left Middle Zone:
-  Benign prostatic tissue
C. Left Base:
-  Benign prostatic tissue
D. Right Apex:
-  Benign prostatic tissue
E. Right Middle Zone:
-  Benign prostatic tissue
F. Right Base:
-  Benign prostatic tissue
</pre>
<pre>
Colour seen in tissue cores at sign-out: green
</pre>
===Comment for many cores with HGPIN===
If there is (isolated) HGPIN in more than 3 or 4 cores:
If there is (isolated) HGPIN in more than 3 or 4 cores:
<pre>
<pre>
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As high-grade prostatic intraepithelial neoplasia is found in multiple cores, close  
As high-grade prostatic intraepithelial neoplasia is found in multiple cores, close  
follow-up is suggested, with a re-biopsy when indicated.
follow-up is suggested, with a re-biopsy when indicated.
</pre>
===TURP===
<pre>
PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP):
- HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA (HGPIN), FOCAL.
- ACUTE AND CHRONIC INFLAMMATION.
- UROTHELIUM WITH MILD INFLAMMATION.
- NEGATIVE FOR MALIGNANCY.
</pre>
</pre>


Michael
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