Prostate gland and seminal vesicles
Prostatic carcinoma variants
Intraductal carcinoma


Topic Completed: 23 July 2019

Revised: 25 July 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed search: Intraductal carcinoma of the prostate[TIAB]

Erica Vormittag-Nocito, M.D.
Andre Kajdacsy-Balla, M.D., Ph.D.
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Cite this page: Vormittag-Nocito E, Kajdacsy-Balla A. Intraductal carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/prostateidc.html. Accessed September 22nd, 2019.
Definition / general
Essential features
  • High degree of cytological atypia, commonly with necrosis that fills prostatic ducts and acini
  • Usually associated with high grade and high pT invasive carcinoma
  • Should not be included in Gleason pattern scoring
  • Appropriate to use immunohistochemistry to demonstrate presence of basal cells if grade of invasive component will be impacted
Terminology
  • Intraductal carcinoma of the prostate: currently recognized term
  • Ductal carcinoma in situ: less favorable term
  • Acinar carcinoma in situ: less favorable term
ICD coding
  • ICD-11: 2E67.5 - carcinoma in situ of prostate
Epidemiology
Sites
  • Prostate ducts and acini
Pathophysiology
Etiology
  • Familial prostatic adenocarcinoma with¬†BRCA2¬†mutations have higher proportion of intraductal carcinoma (Eur Urol 2015;67:496)
Diagnosis
  • Prostate core needle biopsy, prostatectomy or transurethral resection specimens
Laboratory
  • Elevated prostate specific antigen
Radiology description
  • In situ disease not identified by imaging; microscopic diagnosis only
Prognostic factors
Case reports
Treatment
  • Immediate rebiopsy (within 3 months) or definitive treatment by radiation or radical prostatectomy if only intraductal tumor is present (Yonsei Med J 2016;57:1054)
  • If concurrent invasive carcinoma is present, typically definitive treatment is recommended
Gross description
  • Not seen on gross examination; microscopic disease entity
Microscopic (histologic) description
  • Basal cells present at periphery of lesion
  • Dense cribriform, loose cribriform, solid and micropapillary patterns possible (Mod Pathol 2006;19:1528)
  • Various shapes also possible including round, irregular and branching; if diffuse, it is more likely invasive (Pathol Res Pract 2018;214:1681)
  • Major criteria (Arch Pathol Lab Med 2015;139:1234):
    • Markedly enlarged nuclei (6x normal)
    • Nonfocal comedonecrosis
    • Solid or dense cribriform architecture
  • Minor criteria (Arch Pathol Lab Med 2015;139:1234):
    • > 6 glands involved
    • Irregular shaped glands with right angle branching
    • Frequent / easily identifiable mitoses
    • 2 cell populations (mitotically active at periphery and quiescent cells in the center)
  • Important to distinguish from invasive carcinoma as this should not be graded
Microscopic (histologic) images

Contributed by Erica Vormittag-Nocito, M.D.

Cribriform architecture

p63

Comedonecrosis

p63

Gleason pattern 5

Gleason pattern 5, p63



Case of the Week #286

Diffuse intraductal carcinoma

Cribriform growth

CK903

Cytology description
  • Cytology not performed for the diagnosis of this disease entity
Positive stains
Negative stains
Electron microscopy description
  • Electron microscopy not used to diagnose this disease entity
Molecular / cytogenetics description
Sample pathology report
  • Prostate, core needle biopsy:
    • Intraductal carcinoma, involving 1 of 2 cores, 10 mm of 20 mm and 50% of the tissue (see comment)
    • Comment: No invasive carcinoma is present. Intraductal carcinoma without evidence of invasive carcinoma is associated with high grade invasive prostatic carcinoma at prostatectomy or repeat biopsy. Clinical and serologic follow up is recommended and a repeat biopsy may be clinically indicated.
  • Prostate, core needle biopsy:
    • Prostatic adenocarcinoma, Gleason score 3+4=7, involving 1 of 2 cores, measuring 8 mm of 16 mm and 50% of the tissue
    • Intraductal carcinoma is present
Differential diagnosis
Board review question #1
Which of the following is true regarding intraductal carcinoma of the prostate?

  1. A basal cell layer is not present in intraductal carcinoma
  2. Intraductal carcinoma is a common finding in prostate biopsies
  3. Intraductal carcinoma should be graded based on the Gleason pattern scoring system
  4. PTEN alterations are common in intraductal carcinoma
Board review answer #1
D. Intraductal carcinoma commonly has loss of PTEN expression seen by immunohistochemistry.

Reference: Intraductal carcinoma

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Board review question #2
A 65 year old man had a radical prostatectomy for invasive carcinoma found on prostate biopsy. What does the following finding on histology predict about this patient's clinical course?



  1. The patient has a higher probability of biochemical recurrence
  2. The patient is cured with prostatectomy alone
  3. The patient was overtreated as he did not need a prostatectomy
  4. The patient will do the same as other patients within his same grade group without this finding
Board review answer #2
A. This is prostatic intraductal carcinoma. The patient has a higher probability of biochemical recurrence. Patients with intraductal carcinoma have higher pT category, higher grade tumors with higher likelihood of biochemical recurrence when matched for grade group.

Reference: Intraductal carcinoma

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