Difference between revisions of "Intraductal carcinoma of the prostate"

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#redirect [[Prostate_cancer#Intraductal_carcinoma of the prostate]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Intraductal carcinoma of prostate - 2 -- high mag.jpg
| Width      =
| Caption    = Intraductal carcinoma of prostate. [[H&E stain]].
| Synonyms  =
| Micro      = see ''microscopic'' section
| Subtypes  =
| LMDDx      = invasive [[prostatic carcinoma]], [[high grade prostatic intraepithelial neoplasia]]
| Stains    =
| IHC        = basal cells are present (CK34betaE12 +ve, p63 +ve)
| EM        =
| Molecular  = +/-BRCA2 mutation
| IF        =
| Gross      =
| Grossing  =
| Site      = [[prostate gland]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  = PSA typically elevated
| Rads      =
| Endoscopy  =
| Prognosis  = poor, strongly suggestive invasion if not present
| Other      =
| ClinDDx    =
| Tx        =
}}
'''Intraductal carcinoma of the prostate''', abbreviated '''IDC-P''', is a proliferation of [[malignant]] [[prostate gland|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]].<ref name=pmid24966964>{{Cite journal  | last1 = Miyai | first1 = K. | last2 = Divatia | first2 = MK. | last3 = Shen | first3 = SS. | last4 = Miles | first4 = BJ. | last5 = Ayala | first5 = AG. | last6 = Ro | first6 = JY. | title = Heterogeneous clinicopathological features of intraductal carcinoma of the prostate: a comparison between "precursor-like" and "regular type" lesions. | journal = Int J Clin Exp Pathol | volume = 7 | issue = 5 | pages = 2518-26 | month =  | year = 2014 | doi =  | PMID = 24966964 }}</ref>
*Associated with a poor prognosis.<ref name=pmid19246509>{{Cite journal  | last1 = Henry | first1 = PC. | last2 = Evans | first2 = AJ. | title = Intraductal carcinoma of the prostate: a distinct histopathological entity with important prognostic implications. | journal = J Clin Pathol | volume = 62 | issue = 7 | pages = 579-83 | month = Jul | year = 2009 | doi = 10.1136/jcp.2009.065003 | PMID = 19246509 }}</ref>
*Strong association with aggressive invasive carcinomas on prostatectomy when identified in isolation on biopsy.<ref name=pmid20723921>{{Cite journal  | last1 = Robinson | first1 = BD. | last2 = Epstein | first2 = JI. | title = Intraductal carcinoma of the prostate without invasive carcinoma on needle biopsy: emphasis on radical prostatectomy findings. | journal = J Urol | volume = 184 | issue = 4 | pages = 1328-33 | month = Oct | year = 2010 | doi = 10.1016/j.juro.2010.06.017 | PMID = 20723921 }}</ref>
*High interobserver variability among experts ~43% agreement.<ref name=pmid25263387>{{Cite journal  | last1 = Iczkowski | first1 = KA. | last2 = Egevad | first2 = L. | last3 = Ma | first3 = J. | last4 = Harding-Jackson | first4 = N. | last5 = Algaba | first5 = F. | last6 = Billis | first6 = A. | last7 = Camparo | first7 = P. | last8 = Cheng | first8 = L. | last9 = Clouston | first9 = D. | title = Intraductal carcinoma of the prostate: interobserver reproducibility survey of 39 urologic pathologists. | journal = Ann Diagn Pathol | volume = 18 | issue = 6 | pages = 333-42 | month = Dec | year = 2014 | doi = 10.1016/j.anndiagpath.2014.08.010 | PMID = 25263387 }}</ref>
**For comparison: HGPIN ~70% agreement, invasive carcinoma ~73% agreement.
*Uncommon finding ~ 3% of cases in a series of 1176 prostate biopsies.<ref name=pmid23931616>{{Cite journal  | last1 = Watts | first1 = K. | last2 = Li | first2 = J. | last3 = Magi-Galluzzi | first3 = C. | last4 = Zhou | first4 = M. | title = Incidence and clinicopathological characteristics of intraductal carcinoma detected in prostate biopsies: a prospective cohort study. | journal = Histopathology | volume = 63 | issue = 4 | pages = 574-9 | month = Oct | year = 2013 | doi = 10.1111/his.12198 | PMID = 23931616 }}</ref>
===Prevalence===
Prevalence varies by risk/stage - based on a systematic review by Porter ''et al.'':<ref name=pmid28342640>{{Cite journal  | last1 = Porter | first1 = LH. | last2 = Lawrence | first2 = MG. | last3 = Ilic | first3 = D. | last4 = Clouston | first4 = D. | last5 = Bolton | first5 = DM. | last6 = Frydenberg | first6 = M. | last7 = Murphy | first7 = DG. | last8 = Pezaro | first8 = C. | last9 = Risbridger | first9 = GP. | title = Systematic Review Links the Prevalence of Intraductal Carcinoma of the Prostate to Prostate Cancer Risk Categories. | journal = Eur Urol | volume = 72 | issue = 4 | pages = 492-495 | month = Oct | year = 2017 | doi = 10.1016/j.eururo.2017.03.013 | PMID = 28342640 }}</ref>
{| class="wikitable sortable"
! Group
! Prevalence
|-
| WHO1 †
| 2%
|-
| WHO2 † or WHO3 †
| 23%
|-
| WHO4 † or WHO5 †
| 37%
|-
| Metastasis or biochemical recurrence
| 56%
|}
† WHO1 = WHO [[prostate cancer grading|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:<ref name=pmid16980940>{{Cite journal  | last1 = Guo | first1 = CC. | last2 = Epstein | first2 = JI. | title = Intraductal carcinoma of the prostate on needle biopsy: Histologic features and clinical significance. | journal = Mod Pathol | volume = 19 | issue = 12 | pages = 1528-35 | month = Dec | year = 2006 | doi = 10.1038/modpathol.3800702 | PMID = 16980940 }}</ref>
*"Large" acini or ducts with basal cells and one of the following:
# Solid growth pattern or "dense"  cribriform pattern.
# Micropapillary pattern or "loose" cribriform pattern with one of the following:
##Marked atypia 6x normal (area).‡
##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.<ref>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 https://www.xcdsystem.com/uscap/program/2018/index.cfm?pgid=1&qfixed=1&SessionType=Platform%20Presentation].</ref> The equivalent diameter multiplier is ''sqrt(6)'' ~ 2.45; 6x area ~= 2.45x diameter.
===Zhou criteria===
====Major criteria====
Required major criteria:<ref name=pmid22692290>{{Cite journal  | last1 = Shah | first1 = RB. | last2 = Zhou | first2 = M. | title = Atypical cribriform lesions of the prostate: clinical significance, differential diagnosis and current concept of intraductal carcinoma of the prostate. | journal = Adv Anat Pathol | volume = 19 | issue = 4 | pages = 270-8 | month = Jul | year = 2012 | doi = 10.1097/PAP.0b013e31825c6c0e | PMID = 22692290 }}</ref><ref name=pmid17616999>{{Cite journal  | last1 = Cohen | first1 = RJ. | last2 = Wheeler | first2 = TM. | last3 = Bonkhoff | first3 = H. | last4 = Rubin | first4 = MA. | title = A proposal on the identification, histologic reporting, and implications of intraductal prostatic carcinoma. | journal = Arch Pathol Lab Med | volume = 131 | issue = 7 | pages = 1103-9 | month = Jul | year = 2007 | doi = 10.1043/1543-2165(2007)131[1103:APOTIH]2.0.CO;2 | PMID = 17616999 }}</ref>
#Glands 2x normal (peripheral zone) glands.
#Basal cells present (proven by IHC).
#"Cytologically malignant cells" = nuclear hyperchromasia, nuclear enlargement, nucleoli.
#Fills the lumen ("expansile") but does not have to be "solid".
#*Solid = no spaces between the cells.
Additional (major) criterion:<ref name=pmid22692290/>
*Comedo[[necrosis]].
====Minor criteria====
Minor criteria:<ref name=pmid22692290/>
#Branching of ducts at right angles.
#Rounded/smooth gland outlines.
#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===
*[[High-grade prostatic intraepithelial neoplasia]] (HGPIN).
*Invasive [[prostate adenocarcinoma]].
===Images===
====Case 1====
<gallery>
Image: Intraductal carcinoma of prostate - 2 -- low mag.jpg | IDCP - low mag.
Image: Intraductal carcinoma of prostate - 2a -- intermed mag.jpg | IDCP - intermed. mag.
Image: Intraductal carcinoma of prostate - 2b -- intermed mag.jpg | IDCP - intermed. mag.
Image: Intraductal carcinoma of prostate - 2 -- high mag.jpg | IDCP - high mag.
Image: Intraductal carcinoma of prostate - 2a -- very high mag.jpg | IDCP - very high mag.
Image: Intraductal carcinoma of prostate - 2b -- very high mag.jpg | IDCP - very high mag.
</gallery>
====Case 2====
<gallery>
Image: Intraductal carcinoma of prostate -- intermed mag.jpg | IDCP - intermed. mag.
Image: Intraductal carcinoma of prostate -- high mag.jpg | IDCP - high mag.
Image: Intraductal carcinoma of prostate -- very high mag.jpg | IDCP - very high mag.
Image: Intraductal carcinoma of prostate - alt -- very high mag.jpg | IDCP - very high mag.
</gallery>
==IHC==
Features - basal cells present:
*[[CK34betaE12]] +ve.
*[[p63]] +ve.
==Molecular==
*+/-[[BRCA2 mutation]].<ref name=pmid28067867>{{cite journal |authors=Taylor RA, Fraser M, Livingstone J, Espiritu SM, Thorne H, Huang V, Lo W, Shiah YJ, Yamaguchi TN, Sliwinski A, Horsburgh S, Meng A, Heisler LE, Yu N, Yousif F, Papargiris M, Lawrence MG, Timms L, Murphy DG, Frydenberg M, Hopkins JF, Bolton D, Clouston D, McPherson JD, van der Kwast T, Boutros PC, Risbridger GP, Bristow RG |title=Germline BRCA2 mutations drive prostate cancers with distinct evolutionary trajectories |journal=Nat Commun |volume=8 |issue= |pages=13671 |date=January 2017 |pmid=28067867 |pmc=5227331 |doi=10.1038/ncomms13671 |url=}}</ref>
Note:
*BRCA1 associated prostate cancer seems to be less common/less studied.<ref name=pmid29433453>{{cite journal |authors=Ibrahim M, Yadav S, Ogunleye F, Zakalik D |title=Male BRCA mutation carriers: clinical characteristics and cancer spectrum |journal=BMC Cancer |volume=18 |issue=1 |pages=179 |date=February 2018 |pmid=29433453 |pmc=5809938 |doi=10.1186/s12885-018-4098-y |url=https://bmccancer.biomedcentral.com/articles/10.1186/s12885-018-4098-y }}</ref>
==See also==
*[[Intraductal carcinoma]].
*[[Prostate carcinoma]].
*[[Ductal adenocarcinoma of the prostate]].
*[[Cribriform pattern within invasive prostate carcinoma]].
==References==
{{Reflist|2}}
[[Category:Prostate carcinoma]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]
Michael
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