High-grade prostatic intraepithelial neoplasia

Last revised by Joachim Feger on 11 Feb 2022

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.

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.

High-grade prostatic intraepithelial neoplasia is associated with the finding of invasive prostate adenocarcinoma in up to 25% of subsequent biopsies.

The diagnosis of prostatic high-grade intraepithelial neoplasia is histological 1.

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.

Immunohistochemistry stains might show enhanced AMACR expression and are more commonly negative for ERG 1.

High-grade intraepithelial neoplasia might be hypoechoic on ultrasound and not distinguishable from prostate cancer 1.

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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