Patterns of differentiation and proliferation in intraductal carcinoma of the prostate: Significance for cancer progression

Cohen, Ronald J.; McNeal, John E.; Baillie, Tina

doi:10.1002/(sici)1097-0045(20000401)43:1<11::aid-pros3>3.0.co;2-b

Cited by 103 publications

(100 citation statements)

References 11 publications

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“…The presence of intraductal carcinoma has been associated with high-grade cancer and adverse outcome. [13][14][15] In our study, presence of cribriform pattern was significantly associated with intraductal carcinoma. Two hypotheses of intraductal carcinoma evolution have been proposed.…”

Section: Discussionsupporting

confidence: 58%

“…In addition, we assessed the presence of tertiary Gleason grade 5 and intraductal carcinoma of the prostate in each specimen as both have been associated with adverse clinical outcome. [13][14][15][16][17] The following Gleason grade 4 growth patterns, as defined by the ISUP-modified Gleason grading scheme, 2 were scored: (1) fused glands included fused well-and poorly formed glands ( Figure 1a). (2) Ill-defined glands comprised glands with poorly formed or absent glandular lumina (Figure 1b).…”

Section: Pathologic Evaluationmentioning

confidence: 99%

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Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancer

et al. 2015

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Patients with Gleason score 7 prostate cancer on radical prostatectomy demonstrate a wide range in clinical outcome. Gleason grade 4 prostate cancer encompasses a heterogeneous group of tumor growth patterns including fused, ill-defined, cribriform, and glomeruloid glandular structures. Our objective was to determine the prognostic value of different Gleason grade 4 growth patterns. We performed a nested case-control study among 535 patients with Gleason score 7 prostate cancer at radical prostatectomy, treated between March 1985 and July 2013 at a university hospital in the Netherlands. We analyzed 52 cases (with metastasis, diseasespecific mortality or both) and 109 controls, matched for age, PSA level, and pT stage. Presence of the following Gleason grade 4 patterns was recorded: fused, ill-defined, cribriform, and glomeruloid. Intraductal carcinoma of the prostate and tertiary Gleason grade 5 were additionally assessed. Outcomes were metastasis-free survival and disease-specific survival. We used Cox proportional hazards regression to determine the predictive value of Gleason grade 4 patterns for survival time. The overall prevalence of Gleason grade 4 patterns was as follows: fused 75% (n ¼ 121), ill-defined 64% (n ¼ 102), cribriform 48% (n ¼ 83), and glomeruloid 25% (n ¼ 40). Cribriform pattern was the only pattern with an unequal distribution between cases and controls. Forty-two out of 52 cases (81%) had cribriform growth pattern versus 41/109 controls (38%). In multivariate analysis, presence of cribriform growth was an adverse independent predictor for distant metastasis-free survival (HR 8.0, 95% CI 3.0-21; Po0.001) and disease-specific survival (HR 5.4, 95% CI 2.0-15, P ¼ 0.001). In conclusion, cribriform growth in Gleason grade 4 is a strong prognostic marker for distant metastasis and disease-specific death in patients with Gleason score 7 prostate cancer at radical prostatectomy.

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Section: Discussionsupporting

confidence: 58%

Section: Pathologic Evaluationmentioning

confidence: 99%

Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancer

et al. 2015

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“…Only the ring of secretory epithelial cells which is close to, or in contact with, the periglandular stroma was measured in high-grade PIN, histologically normal appearing secretory epithelium and adenocarcinoma. 7 This approach was adopted to avoid the fact that the 'maturation effect' 1 present in the central compartment of cribriform high-grade PIN could have influenced the results in the measurements. The basal cells, as identifiable by the morphology of the nuclei and by the degree of staining of the cytoplasm, were excluded from the evaluation.…”

Section: Karyometric and Statistical Analysesmentioning

confidence: 99%

“…The perimeter compartment refers to the ring of secretory epithelial cells, which is close to, or in contact with, the periglandular stroma. 7 The objective of this study was to determine whether the nuclei in these two architectural types of high-grade PIN reveal different phenotypes in terms of chromatin organization state. Also, it was the objective of this study to determine if any such differences are expressed in the adjacent normal looking secretory epithelium, and whether they might persist into the co-occurring adenocarcinoma.…”

mentioning

confidence: 99%

Karyometry detects subvisual differences in chromatin organization state between cribriform and flat high-grade prostatic intraepithelial neoplasia

et al. 2004

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This digital texture analysis-based study evaluates the chromatin organization state in flat and cribriform highgrade prostatic intraepithelial neoplasia (PIN), in the adjacent normal looking secretory epithelium and in the co-occurring adenocarcinoma. Digital texture analysis (karyometry) was carried out on hematoxylin and eosinstained sections from 24 radical prostatectomy specimens with high-grade PIN (12 with flat and 12 with cribriform architectural pattern, respectively) and cancer. Quantification was also conducted on the normal looking secretory epithelium. Discriminant analysis and the nonsupervised learning algorithm P-index were used to identify suitable subsets of features useful for the discrimination and classification of pathological groups and to explore multivariate data structure in the pathological subgroups. The average nuclear abnormality increases monotonically from the histologically normal appearing secretory epithelium to highgrade PIN and to adenocarcinoma. The nuclei from the so-called perimeter compartment of the flat high-grade PIN lesions show a higher nuclear abnormality compared to the nuclei of the cribriform high-grade PINs. Discriminant analysis shows that flat and cribriform high-grade PINs fall into two populations. Processing by the nonsupervised learning algorithm P-index revealed the existence of three well-defined, distinct subpopulations of nuclei of different chromatin phenotype. In the flat high-grade PIN lesions the proportions of nuclei in the three subpopulations are 16.5% (low abnormality), 25.0% (mid abnormality) and 58.5% (high abnormality), respectively. In the cribriform high-grade PIN lesions, 100% of the nuclei are in the midabnormality subpopulation. These differences are also discernible in the co-occurring adenocarcinoma and the histologically normal appearing secretory epithelium. To conclude, karyometry and statistical analysis detect the existence of distinct cell subpopulations of different chromatin packaging and phenotype, with the nuclei from the flat high-grade PIN lesions, adjacent normal looking epithelium and co-occurring adenocarcinoma expressing a greater nuclear abnormality than in the specimens with cribriform high-grade PIN.

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“…Criteria for distinguishing intraductal cancerization from HGPIN have been defined by McNeal and Yemoto. 9 It has been postulated that intraductal carcinoma is associated with aggressive prostate carcinoma, 10 but it remains controversial whether intraductal carcinoma actually can be separated from cribriform HGPIN. 11 The first years after its introduction, PIN was graded according to a three-tier system.…”

Section: Discussionmentioning

confidence: 99%

Current practice of diagnosis and reporting of prostatic intraepithelial neoplasia and glandular atypia among genitourinary pathologists

2006

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The criteria for diagnosing prostatic intraepithelial neoplasia (PIN) and lesions suspicious for cancer are described in the literature. However, it is unknown how these are applied in practice by experts in genitourinary (GU) pathology. A questionnaire was sent to 93 GU pathologists in countries around the world with the purpose of surveying current practices. The response rate was 69% including 40 North American pathologists and 24 from other continents. For preneoplastic lesions, the term PIN was universally endorsed by the respondents. PIN was graded by 83%, usually as low/high-grade PIN (LGPIN/HGPIN) or as HGPIN only. Most respondents would usually not report lesions that may qualify for LGPIN. A majority (81%) did not specify architectural patterns of PIN. With both HGPIN and invasive cancer present, 69% would still mention HGPIN. Among the diagnostic criteria for HGPIN were any nucleoli visible (52%), or nucleoli seen in at least 10% of cells (33%). However, 56% would diagnose HGPIN in the absence of prominent nucleoli, most commonly based on prominent pleomorphism, marked hyperchromasia or mitotic figures. The number of cores involved with HGPIN was specified by 50%. Lesions suspicious for but not diagnostic of carcinoma were reported by 45% as atypia, atypical glands or suspicious for cancer and by 42% as atypical small acinar proliferation. The degree of suspicion was further defined by 41%. Our survey data may serve as a guideline to general pathologists on how to diagnose and report atypia and PIN in prostate biopsies. Keywords: prostatic neoplasms; prostatic intraepithelial neoplasia; pathology; male; human We have recently surveyed current practices of Gleason grading of prostate cancer among experts in genitourinary (GU) pathology. 1 On some issues, there was a high level of consensus among respondents, while on others, there was a significant disagreement, calling for standardization. There are reasons to believe that diagnosis and reporting of prostatic intraepithelial neoplasia (PIN) and lesions suspicious for cancer may also suffer from lack of uniformity. Over the last decades there has been a shift in nomenclature for these diagnoses. Lesions that used to be diagnosed as atypical hyperplasia or dysplasia are now known as PIN. 2 For lesions suspicious of cancer, the term atypical small acinar proliferation (ASAP) has been suggested. 3,4 It is unclear to what extent new terminology has been adopted worldwide. Criteria for diagnosing PIN have also evolved in recent years, and definitions have focused on nucleolar prominence. 5 Grading of preneoplastic lesions has moved from a three-tier system (PIN 1-3) to a two-tier system (LGPIN and HGPIN). 5 The purpose of this study was to survey current practice among GU pathologists of diagnosing and reporting PIN and lesions suspicious of but not diagnostic for prostatic carcinoma.

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Patterns of differentiation and proliferation in intraductal carcinoma of the prostate: Significance for cancer progression

Cited by 103 publications

References 11 publications

Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancer

Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancer

Karyometry detects subvisual differences in chromatin organization state between cribriform and flat high-grade prostatic intraepithelial neoplasia

Current practice of diagnosis and reporting of prostatic intraepithelial neoplasia and glandular atypia among genitourinary pathologists

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