Intraductal carcinoma of the prostate

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Intraductal carcinoma of the prostate
Diagnosis in short

Intraductal carcinoma of prostate. H&E stain.
LM see microscopic section
LM DDx invasive prostatic carcinoma, high grade prostatic intraepithelial neoplasia
IHC basal cells are present (CK34betaE12 +ve, p63 +ve)
Site prostate gland
Prevalence uncommon
Blood work PSA typically elevated
Prognosis poor, strongly suggestive invasion if not present

Intraductal carcinoma of the prostate, abbreviated IDC-P, is a proliferation of malignant prostate cells within glands that have an intact basal cell layer.

It should not be confused with ductal adenocarcinoma of the prostate gland.

General

  • May represent a precursor to invasive prostate carcinoma.[1]
  • Associated with a poor prognosis.[2]
  • Strong association with aggressive invasive carcinomas on prostatectomy when identified in isolation on biopsy.[3]
  • High interobserver variability among experts ~43% agreement.[4]
    • For comparison: HGPIN ~70% agreement, invasive carcinoma ~73% agreement.
  • Uncommon finding ~ 3% of cases in a series of 1176 prostate biopsies.[5]

Prevalence

Prevalence varies by risk/stage - based on a systematic review by Porter et al.:[6]

Group Prevalence
WHO1 † 2%
WHO2 † or WHO3 † 23%
WHO4 † or WHO5 † 37%
Metastasis or biochemical recurrence 56%

† WHO1 = WHO grade group 1 (Gleason score 6), WHO2 = WHO grade group 2 or 3 (Gleason score 7 (3+4 or 4+3), WHO3 = WHO grade group 4 or 5 (Gleason score 8, 9 or 10)

Microscopic

Epstein criteria

Epstein's IDCP criteria:[7]

  • "Large" acini or ducts with basal cells and one of the following:
  1. Solid growth pattern or "dense" cribriform pattern.
  2. Micropapillary pattern or "loose" cribriform pattern with one of the following:
    1. Marked atypia 6x normal (area).‡
    2. Non-focal comedonecrosis.

Notes:

  • † "Dense" is defined as "more solid than luminal areas"; >50% of the lesion area is cells, as opposed to empty space.
  • ‡ Epstein's paper does not explicitly state that it is the area; however, there is near consensus in an ENUP survey that this is the case.[8] The equivalent diameter multiplier is sqrt(6) ~ 2.45; 6x area ~= 2.45x diameter.

Zhou criteria

Major criteria

Required major criteria:[9][10]

  1. Glands 2x normal (peripheral zone) glands.
  2. Basal cells present (proven by IHC).
  3. "Cytologically malignant cells" = nuclear hyperchromasia, nuclear enlargement, nucleoli.
  4. Fills the lumen ("expansile") but does not have to be "solid".
    • Solid = no spaces between the cells.

Additional (major) criterion:[9]

Minor criteria

Minor criteria:[9]

  1. Branching of ducts at right angles.
  2. Rounded/smooth gland outlines.
  3. Two cell populations:
    • Malignant population (enlarged nuclei with hyperchromasia and nucleoli) = peripheral location in gland.
    • Benign population (smaller nuclei, no nucleoli) = central location in gland.

DDx

Images

Case 1

  • IDCP - low mag.

  • IDCP - intermed. mag.

  • IDCP - intermed. mag.

  • IDCP - high mag.

  • IDCP - very high mag.

  • IDCP - very high mag.

Case 2

  • IDCP - intermed. mag.

  • IDCP - high mag.

  • IDCP - very high mag.

  • IDCP - very high mag.

IHC

Features - basal cells present:

  • CK34betaE12 +ve.
  • p63 +ve.

See also

References

  1. ↑ Miyai, K.; Divatia, MK.; Shen, SS.; Miles, BJ.; Ayala, AG.; Ro, JY. (2014). "Heterogeneous clinicopathological features of intraductal carcinoma of the prostate: a comparison between "precursor-like" and "regular type" lesions.". Int J Clin Exp Pathol 7 (5): 2518-26. PMID 24966964.
  2. ↑ Henry, PC.; Evans, AJ. (Jul 2009). "Intraductal carcinoma of the prostate: a distinct histopathological entity with important prognostic implications.". J Clin Pathol 62 (7): 579-83. doi:10.1136/jcp.2009.065003. PMID 19246509.
  3. ↑ Robinson, BD.; Epstein, JI. (Oct 2010). "Intraductal carcinoma of the prostate without invasive carcinoma on needle biopsy: emphasis on radical prostatectomy findings.". J Urol 184 (4): 1328-33. doi:10.1016/j.juro.2010.06.017. PMID 20723921.
  4. ↑ Iczkowski, KA.; Egevad, L.; Ma, J.; Harding-Jackson, N.; Algaba, F.; Billis, A.; Camparo, P.; Cheng, L. et al. (Dec 2014). "Intraductal carcinoma of the prostate: interobserver reproducibility survey of 39 urologic pathologists.". Ann Diagn Pathol 18 (6): 333-42. doi:10.1016/j.anndiagpath.2014.08.010. PMID 25263387.
  5. ↑ Watts, K.; Li, J.; Magi-Galluzzi, C.; Zhou, M. (Oct 2013). "Incidence and clinicopathological characteristics of intraductal carcinoma detected in prostate biopsies: a prospective cohort study.". Histopathology 63 (4): 574-9. doi:10.1111/his.12198. PMID 23931616.
  6. ↑ Porter, LH.; Lawrence, MG.; Ilic, D.; Clouston, D.; Bolton, DM.; Frydenberg, M.; Murphy, DG.; Pezaro, C. et al. (Oct 2017). "Systematic Review Links the Prevalence of Intraductal Carcinoma of the Prostate to Prostate Cancer Risk Categories.". Eur Urol 72 (4): 492-495. doi:10.1016/j.eururo.2017.03.013. PMID 28342640.
  7. ↑ Guo, CC.; Epstein, JI. (Dec 2006). "Intraductal carcinoma of the prostate on needle biopsy: Histologic features and clinical significance.". Mod Pathol 19 (12): 1528-35. doi:10.1038/modpathol.3800702. PMID 16980940.
  8. ↑ Varma M, Egevad L, Berney D, Bubendorf L, Compérat EM, Hes O, van Leenders G, Kristiansen G, Intraductal Carcinoma of the Prostate (IDCP) Reporting Practice: A Survey of Practicing Pathologists. United States and Canadian Academy of Pathology Annual Meeting 2018. Available at: https://www.xcdsystem.com/uscap/program/2018/index.cfm?pgid=1&qfixed=1&SessionType=Platform%20Presentation.
  9. ↑ 9.0 9.1 9.2 Shah, RB.; Zhou, M. (Jul 2012). "Atypical cribriform lesions of the prostate: clinical significance, differential diagnosis and current concept of intraductal carcinoma of the prostate.". Adv Anat Pathol 19 (4): 270-8. doi:10.1097/PAP.0b013e31825c6c0e. PMID 22692290.
  10. ↑ Cohen, RJ.; Wheeler, TM.; Bonkhoff, H.; Rubin, MA. (Jul 2007). "A proposal on the identification, histologic reporting, and implications of intraductal prostatic carcinoma.". Arch Pathol Lab Med 131 (7): 1103-9. doi:10.1043/1543-2165(2007)131[1103:APOTIH]2.0.CO;2. PMID 17616999.
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