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Atypical intraductal proliferation and intraductal carcinoma of the prostate on core needle biopsy: a comparative clinicopathological and molecular study with a proposal to expand the morphological spectrum of intraductal carcinoma
Author(s) -
Shah Rajal B,
Yoon Jiyoon,
Liu Gang,
Tian Wei
Publication year - 2017
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.13273
Subject(s) - intraepithelial neoplasia , pten , prostate , medicine , carcinoma , adenocarcinoma , biopsy , pathology , high grade prostatic intraepithelial neoplasia , prostate cancer , urology , cancer , biology , apoptosis , biochemistry , pi3k/akt/mtor pathway
Aims Atypical intraductal proliferation ( AIP ) of the prostate is histologically worse than high‐grade prostate intraepithelial neoplasia, but lacks the diagnostic criteria of intraductal carcinoma of the prostate ( IDC ‐P). The aim of this study was to compare the clinicopathological and molecular characteristics ( ERG overexpression and PTEN loss) of AIP and IDC ‐P in core needle biopsies. Methods and results One hundred and six [84 (5.6%) of 1480 consecutive and 22 retrospectively collected] cases met the criteria: AIP only (2.4%), IDC ‐P only (1.3%), and IDC ‐P coexisting with AIP (2%). Invasive adenocarcinoma [prostate adenocarcinoma ( PC a)] was present in 96% and 97% cases of AIP and IDC ‐P, respectively. The mean number of glands/focus and the largest gland diameter for AIP and IDC ‐P were 7.6 (range, 2–27) and 11.7 (range, 1–51), and 0.59 mm (range, 0.2–1.1 mm) and 0.75 mm (range, 0.2–1.8 mm), respectively. For AIP , loose cribriform architecture was the most common (93%) morphology. IDC ‐P‐associated PC a had more aggressive pathology, including the highest combined Gleason score ( GS ), high‐grade GS ≥ 4 + 3, and largest percentage involvement of core by PC a and percentage positive cores, than AIP ‐associated PC a ( P < 0.05). Within the AIP group, ERG status and PTEN status were similar to those of adjacent PC a in 97% and 88% of cases, respectively. Within the IDC ‐P group, ERG status and PTEN status were similar among IDC ‐P, AIP and PC a in 96% and 91% of cases, respectively. PTEN loss was frequently heterogeneous in PC a, and localized adjacent to AIP or IDC ‐P. Conclusions AIP represents a lower‐grade morphological spectrum of IDC ‐P, associated with intermediate‐risk PC a. Patients with only AIP need an immediate repeat biopsy to rule out clinically significant PC a.