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Difference between revisions of "High-grade prostatic intraepithelial neoplasia"
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High-grade prostatic intraepithelial neoplasia (view source)
Revision as of 17:21, 3 April 2024
, 3 Aprilno edit summary
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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 | | 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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*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> | *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: | ||
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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 - | *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. | ||
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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</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> | ||