Abstract

<h3>Aims</h3> To explore the distinction between Intraductal carcinoma of prostate (IDC-P) and high-grade prostatic intraepithelial neoplasia (HGPIN). <h3>Methods</h3> A case of IDC-P is presented with review of literature. <h3>Results</h3> Transurethral resection of prostate showed extensive IDC-P associated with a smaller component of Gleason pattern 5+5 adenocarcinoma. HGPIN was not identified. Prostate biopsies performed immediately prior were reported as HGPIN associated with Gleason pattern 5+5 adenocarcinoma. <h3>Discussion</h3> IDC-P is an uncommon entity characterised by malignant cells that fill and expand pre-existing prostatic ducts and glands, with an intact basal cell layer, featuring cribriform or solid pattern with or without comedonecrosis.<sup>1</sup> Morphological criteria have been proposed to distinguish IDC-P from several other lesions including HGPIN.<sup>1,2</sup> IDC-P and HGPIN are biologically distinct entities supported by emerging molecular data and leading to differences in patient management.<sup>1,2</sup> While HGPIN is postulated to be an early precursor lesion in some carcinomas, IDC-P almost always co-exists with aggressive prostate cancer in radical prostatectomy featuring higher Gleason score, larger tumour volume, greater risk of extra-prostatic extension, seminal vesicle invasion and pelvic lymph node metastasis.<sup>2–4</sup> It is crucial to recognise IDC-P, particularly as an isolated finding in prostate biopsies, in order to implement immediate definitive therapy for high grade carcinoma even in the absence of invasion.<sup>1–4</sup>

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