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HGPINHigh-Grade Prostatic Intraepithelial Neoplasia
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Do not misinterpret intraductal carcinoma of the prostate as high-grade prostatic intraepithelial neoplasia! Eur Urol.
Mechanisms of disease: high-grade prostatic intraepithelial neoplasia and other proposed preneoplastic lesions in the prostate.
High-grade prostatic intraepithelial neoplasia (A and B), extensive intraductal carcinoma of the prostate (C) with PIN-4 (triple cocktail: p63, high-molecular-weight cytokeratin, P504S/racemase) highlighting the presence of basal cells (D), and atypical intraductal cribriform proliferation (ACP) with associated invasive carcinoma (E) and PIN-4 highlighting basal cells in ACP (F) (hematoxylin-eosin, original magnifications X200 [A, B, and E] and X40 [C]; original magnifications X40 [D] and X200 [F]).
Is repeat prostate biopsy for high-grade prostatic intraepithelial neoplasia necessary after routine 12-core sampling?
Morgentaler and his associates studied testosterone replacement therapy in 20 hypogonadal men who were considered to be at high risk for developing prostate cancer because biopsies found high-grade prostatic intraepithelial neoplasia (PIN), and in 55 hypogonadal men without PIN.
The main precursor lesion to invasive adenocarcinoma of the prostate is high-grade prostatic intraepithelial neoplasia (HGPIN), with abundant clinical, pathologic, and molecular evidence supporting this notion.
The term Paneth cell-like change has been used to describe distinctive eosinophilic neuroendocrine cells that can be seen in benign prostate glands, high-grade prostatic intraepithelial neoplasia, intraductal carcinoma, and usual acinar adenocarcinoma of the prostate (Figure 3, B).
(1) In contrast to IDC-P, high-grade prostatic intraepithelial neoplasia is considered a preneoplastic lesion, which does not require definitive therapy and, when isolated in an extended core biopsy, does not require rebiopsy.
of biopsies per ECPB, 9.1 (2.5) 7.7 (2.1) <.001 mean (SD) Rate of stains/biopsy, 0.1 (0.3) 0.3 (0.7) <.001 mean (SD) Abbreviations: ASAP, atypical acinar proliferation or suspicious for cancer; ECPB, extended core prostate biopsy; GU, genitourinary pathologist; HGPIN, high-grade prostatic intraepithelial neoplasia; non-GU, general pathologist.
(%) of Blocks Diagnosis (n = 295) (n = 539) Benign 37 (12.5) 120 (22.2) High-Grade PIN 21 (7.1) 67 (12.4) ATYP 32 (10.8) 58 (10.8) PINATYP 19 (6.4) 37 (6.9) Cancer 186 (63.1) 257 (47.7) Abbreviations: ATYP, Atypical, Suspicious; High-Grade PIN, High-Grade Prostatic Intraepithelial Neoplasia; PINATYP, Small Atypical Glands Adjacent to High-Grade PIN.
For example, in a prostate biopsy report with favorable-grade adenocarcinoma on one core and high-grade prostatic intraepithelial neoplasia on another core, patients may focus on and worry about high-grade prostatic intraepithelial neoplasia because they have read that high-grade tumors are bad.
These atypical cribriform/solid lesions with basal cells represent either cribriform high-grade prostatic intraepithelial neoplasia (HGPIN) or intraductal carcinoma of the prostate (IDC-P).