Fig. 1Morphologic subtypes of intraductal carcinoma of the prostate. Low power view of a prostate needle core biopsy showing expansion of the normal architecture by cytologically malignant cells that span the entire lumen (A). The micropapillary/trabecular subtype (B) and cribriform subtypes (C) are demonstrated here.
Fig. 2Additional morphologic subtypes of intraductal carcinoma of the prostate. (A, B) Sections show a both cribriform and focal solid architecture.
Fig. 3Intraductal carcinoma of the prostate showing expansion of the normal prostatic duct and acinar structures and complete spanning of the lumen with cytologically malignant cells with preservation of basal cells (p63 immunostain).
Fig. 4Proposed diagnostic algorithm for atypical cribriform lesions of the prostate. IDC-P, intraductal carcinoma of the prostate; HGPIN, high-grade prostatic intraepithelial neoplasia; PCa, prostatic carcinoma. Reproduced from Shah and Zhou,22 Adv Anat Pathol 2012; 19: 270-8, with permission from Wolters Kluwer/Lippincott Williams & Wilkins.
Fig. 5ERG immunohistochemical staining in intraductal carcinoma of the prostate shows strong nuclear positivity. Adjacent cancer acini are also positive. Note the vascular endothelial cells are strongly positive (head arrow), and stromal lymphocytes are weakly positive (arrow), for ERG immunostain.
Fig. 6High-grade prostatic intraepithelial neoplasia (HGPIN) composed of tall, columnar cells with uniform atypia in a tufted to micropapillary pattern. Micropapillary and cribriform HGPIN can overlap histologically with intraductal carcinoma of the prostate.
Fig. 7Intraductal spread of urothelial carcinoma consisting of highly pleomorphic urothelial cells with focal areas of comedo-type necrosis.
Fig. 8Prostate duct carcinoma composed of tall, pseudostratified columnar cells forming occasional true papillary structures. In contrast to intraductal carcinoma of the prostate, basal cells are typically absent.
Table 1.Distinguishing features between high-grade prostatic intraepithelial neoplasia (HGPIN) and intraductal carcinoma of the prostate (IDC-P)
HGPIN |
IDC-P |
Basal cells present |
Basal cells present |
Uniform nuclear atypia |
Marked nuclear pleomorphism |
No necrosis |
Non-focal comedonecrosis |
One tumor cell population |
2 tumor cell populations (peripheral and central) |
Non-distended ducts and/or acini |
Markedly distended ducts and/or acini |
No ERG mutations |
ERG mutations present |
Cytoplasmic retainment of PTEN |
Cytoplasmic loss of PTEN |
Table 2.Distinguishing features between intraductal spread of urothelial carcinoma (UC) and intraductal carcinoma of the prostate (IDC-P)
Intraductal spread of UC |
IDC-P |
Greater degree of pleomorphism |
Lesser degree of pleomorphism |
Rarely shows cribriform pattern |
Cribriform pattern common |
Negative for PSA and PSAP |
Positive for PSA and PSAP |
Positive for HMWCK, p63, GATA3 |
Negative for HMWCK, p63, GATA3 |
Table 3.Distinguishing features between ductal adenocarcinoma and intraductal carcinoma of the prostate (IDC-P)
Ductal adenocarcinoma |
IDC-P |
Tall, pseudostratified columnar cells |
Cuboidal-to-short columnar cells |
Occasional true papillary structures |
Occasional micropapillary architecture |
Basal cells usually absent |
Basal cells present |
Table 4.Recommendations for the reporting and diagnosis of cribriform lesions in prostate biopsies and radical prostatectomies
Diagnosis |
Reporting recommendations |
Cribriform HGPIN |
Document number of biopsy cores involved |
IDC-P associated with invasive, high-grade prostate carcinoma |
Document IDC-P (may provide additional prognostic value) |
IDC-P associated with Gleason pattern 3 prostate carcinoma |
Document IDC-P and its poor prognostic significance |
IDC-P without any invasive prostate carcinoma |
Diagnose IDC-P and document that IDC-P is usually associated with high-grade prostate carcinoma and advise immediate rebiopsy and/or definitive treatment |
Atypical cribriform lesions failing to meet the criteria for cribriform HGPIN and IDC-P |
Diagnose as atypical cribriform lesions with differential between HGPIN and IDC-P, and recommend immediate repeat biopsy |