High-grade prostatic intraepithelial neoplasia (HGPIN) refers to a proliferation of glandular epithelial cells and is generally considered a nonobligatory precursor lesion of invasive prostate cancer.
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Epidemiology
High-grade prostatic intraepithelial neoplasia is diagnosed in core needle biopsies in up to 5% and is seen in almost all radical prostatectomy specimens 1. Incidence and extent increase with age, similar to prostate cancer 1.
Associations
High-grade prostatic intraepithelial neoplasia is associated with the finding of invasive prostate adenocarcinoma in up to 25% of subsequent biopsies.
Diagnosis
The diagnosis of prostatic high-grade intraepithelial neoplasia is histological 1.
Pathology
Microscopic appearance
Histological characteristics of high-grade prostatic intraepithelial neoplasia include the following 1-3:
- dark amphophilic cytoplasm
- nuclear crowding and stratification
- chromatin hyperchromasia
- prominent nucleoli
- different architectural patterns as tufted, micropapillary flat and cribriform
- basal cells might be discontinuous
Prostatic high-grade intraepithelial neoplasia is not assigned a Gleason grade 1.
Immunophenotype
Immunohistochemistry stains might show enhanced AMACR expression and are more commonly negative for ERG 1.
Radiographic features
Ultrasound
High-grade intraepithelial neoplasia might be hypoechoic on ultrasound and not distinguishable from prostate cancer 1.
MRI
Multiparametric MRI can aid in the detection of prostate cancer. Evaluation and reporting should be done using a likelihood score as, e.g. PI-RADS system explained in the respective article.
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