Intraductal Carcinoma of the Prostate: An Institutional Clinicopathologic Review with Follow Up
Thomas M Schneider, Adeboye O Osunkoya. Emory University School of Medicine, Atlanta, GA
Background: Intraductal carcinoma of the prostate (IDC-P) is an uncommon and controversial variant of prostatic adenocarcinoma. There have been only a few large studies on this entity. Herein, we reviewed cases of IDC-P at our institution, with emphasis on clinicopathologic parameters and follow-up.
Design: A search was made through the surgical pathology and consultation files at our institution between January 2008 and August 2012 for cases that were diagnostic of IDC-P (needle core biopsies, transurethral resections, and radical prostatectomy specimens). p63 was performed on all cases to confirm the presence of basal cells in a uniform distribution in the foci of IDC-P.
Results: Thirty one cases were identified (incidence at our institution: 1.5%). Mean patient age was 65 years (range: 48-79 years). 18/31 (54%) patients were Caucasian and 13/31 (46%) patients were African American. Mean serum PSA level was 19 ng/ml (range: 1.27-1500 ng/ml). Fifteen cases (48%) were from needle core biopsies, 6/31 (19%) cases from transurethral resections, 8/31 (26%) cases from radical prostatectomy specimens, and 2/31 (7%) cases from cystoprostatectomy specimens. All cases had adjacent acinar prostatic adenocarcinoma, bilateral involvement and demonstrated a desmoplastic stromal response. Gleason scores were as follows: 4+3=7 in 6/31 (19%) cases, 4+4=8 (10%) in 3/31 cases, 4+5=9 in 18/31 (58%) cases, 5+4=9 in 3/31 (10%) cases and 5+5=10 in 1/31 (3%) cases. Seven patients (23%) had previously received androgen deprivation therapy for prior acinar prostatic adenocarcinoma, however the areas with IDC-P and adjacent acinar prostatic adenocarcinoma did not show therapy related changes (therefore a Gleason score was assigned). Sixteen patients (52%) either presented with or progressed to AJCC 2010 Prognostic Group IV. Mean duration of follow up for all patients was 24 months (range: 1-52 months). At diagnosis or during follow up, 13/31 (42%) patients had lymph node metastasis, 7/31 (23%) patients had bone metastasis, 5/31 (16%) patients had urinary bladder involvement, and 8/31 (26%) patients died of disease within a mean duration of 14 months (range: 4-34 months).
Conclusions: IDC-P is a relatively uncommon, aggressive and distinct histological variant of prostatic adenocarcinoma characterized by an expansile proliferation of malignant prostatic acinar cells within preexisting prostatic ducts and acini. It is associated with a high tumor burden, adjacent conventional acinar prostatic adenocarcinoma, and desmoplastic stromal response. IDC-P may also develop in the post androgen deprivation therapy setting.
Category: Genitourinary (including renal tumors)
Monday, March 4, 2013 1:00 PM
Poster Session II # 144, Monday Afternoon