Stanford School of Medicine

Surgical Pathology Criteria

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Prostatic Intraductal Adenocarcinoma


  • High grade primary prostatic adenocarcinoma involving pre-existing ducts

Diagnostic Criteria

  • Considered to represent high grade prostatic adenocarcinoma that has gained access to pre-existing large acini and ducts
    • Edges of tumor are smooth rather than raggedly infiltrating
  • Nearly always associated with high grade acinar carcinoma
    • Gleason pattern 5 present in about half
    • Very rare cases with no associated usual invasive carcinoma raise the possibility that in some cases this is a precursor lesion
  • Basal cells must be present at the periphery
    • May be patchy
  • Must fulfill one of the following three architectural/cytologic criteria
    • Solid or dense cribriform
      • Lumens comprise <50% of the total ductal lumen
    • Loose cribriform (>50% lumens) but with marked nuclear pleomorphism
      • Many nuclei at least 6 times larger than normal
      • Large cells may be peripherally located
    • Loose cribriform but with more than focal comedonecrosis
  • Differential diagnosis
    • High grade PIN must be excluded
  • Prostatic Intraductal Adenocarcinoma High Grade PIN
    Cribriform pattern common Cribriform pattern rare
    Mitotic figures common Mitotic figures rare
    Basal cells if present are usually patchy Basal cells widespread but may be fewer than normal
    Solid or dense cribriform patterns are definitional Solid and dense cribriform patterns not allowed
    Marked nuclear pleomorphism (6 x normal) or comedonecrosis are definitional Marked nuclear pleomorphism and comedonecrosis not allowed

    • The distinction from invasive cribriform acinar adenocarcinoma should be made
      • Although both are high grade carcinomas, intraductal carcinoma is more aggressive
    Prostatic Intraductal Adenocarcinoma Cribriform Acinar Adenocarcinoma
    May have marked cytologic atypia (6x normal) Nuclei atypical but not markedly enlarged
    Basal cells present Lacks basal cells
    Smooth edges without infiltration Frequently has ragged infiltration at edges

    • The distinction from ductal carcinoma is not as critical
      • Both are high grade carcinomas
      • Ductal carcinoma may have an intraductal component
        • Demonstrated by focal presence of basal cells
    Prostatic Ductal Adenocarcinoma Non-ductal Intraductal Adenocarcinoma
    Columnar cells with elongated nuclei Cuboidal cells with round nuclei
    Cribriform lumens frequently slit-like Cribriform lumens usually round
    Frequently has true papillae with vascular cores Tufts but no true papillae
    Usually lacks basal cells Basal cells always present
    Nuclear size 2-3 x normal Nuclear size may be 6 x normal

    • Intraductal adenocarcinoma with a solid pattern may be confused with urothelial carcinoma growth into prostatic ducts
    Prostatic Intraductal Adenocarcinoma Urothelial Carcinoma Involving Prostatic Ducts
    PSA and PAP positive PSA and PAP negative
    HMWCK and p63 negative HMWCK and p63 positive
  • Bibliography (for general references see Prostatic Acinar Adenocarcinoma)
    • Humphrey, P. A. (2012), Histological variants of prostatic carcinoma and their significance. Histopathology, 60: 59–74.
    • Herawi M, Epstein JI. Immunohistochemical antibody cocktail staining (p63/HMWCK/AMACR) of ductal adenocarcinoma and Gleason pattern 4 cribriform and noncribriform acinar adenocarcinomas of the prostate. Am J Surg Pathol. 2007 Jun;31(6):889-94.
    • Morgan TM, Welty CJ, Vakar-Lopez F, Lin DW, Wright JL. Ductal adenocarcinoma of the prostate: increased mortality risk and decreased serum prostate specific antigen. J Urol. 2010 Dec;184(6):2303-7.
    • Robinson B, Magi-Galluzzi C, Zhou M. Intraductal carcinoma of the prostate. Arch Pathol Lab Med. 2012 Apr;136(4):418-25.
    • Guo CC, Epstein JI. Intraductal carcinoma of the prostate on needle biopsy: Histologic features and clinical significance. Mod Pathol. 2006 Dec;19(12):1528-35.
    • Robinson BD, Epstein JI. Intraductal carcinoma of the prostate without invasive carcinoma on needle biopsy: emphasis on radical prostatectomy findings. J Urol. 2010 Oct;184(4):1328-33.

Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting/updates: 6/1/12


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