High-Grade Prostatic Intraepithelial Neoplasia
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High-grade prostatic intraepithelial neoplasia (HGPIN) is a neoplastic proliferation of secretory cells within preexisting ducts and acini, with cytological changes resembling those seen in cancer. HGPIN is the most likely precursor of prostatic adenocarcinoma, according to virtually all available evidence.
The mean incidence of HGPIN in prostatic needle biopsies is about 5%.
Patients aged 50–60 years.
The most commonly location is in the peripheral zone of the prostate.
Treatment is not indicated. Prophylactic RP or radiation is not an acceptable treatment. Patients with isolated HGPIN in needle biopsy may be considered for enrolment into clinical trials with chemoprevention agents. Men with a single core positive for HGPIN do not require routine repeat biopsy. In multifocal HGPIN, follow-up monitoring could include serum and urine tests or imaging.
HGPIN is not identified macroscopically.
The epithelial lining of the ducts and acini is darker than that of the surrounding normal ducts and acini.
It is thicker.
There may be a complex intraluminal pattern of growth.
Varying degrees of nuclear stratification and enlargement
Low-grade PIN (PIN 1).
High-grade PIN (PIN 2 and 3): The cells resemble those of a microacinar adenocarcinoma with Gleason pattern 3.
The basal cell markers p63 and 34βE12 show a fragmented basal cell layer. Immunostaining for AMACR is positive as in adenocarcinoma.
The differential diagnosis is with:
Benign mimickers: Central zone histology, clear cell cribriform histology, and basal cell hyperplasia.
References and Further Reading
- Moch, H., Humphrey, P. A., Ulbrigh, T. M., & Reutere, V. E. (Eds.). (2016). WHO classification of Tumours of the urinary system and male genital organs. Lyon: International Agency for Research on Cancer.Google Scholar