Intraductal carcinoma of prostate(IDC-P): from obscure to significant

The concept of intraductal carcinoma of prostate （IDC-P） has evolved over the years and its clinieopathologic significance has come to be more clearly appreciated. In contrast to morphologically malignant intraductal lesions that represent earlier stages of the malignant process in other anatomic sites such as the breast, IDC-P has now been generally recognized as a prognostically unfavorable manifestation of later stage spreading of its invasive counterpart. We here briefly review the evolution of the IDC-P concept, the histological diagnostic criteria and differential diagnosis, the clinical significance, as well as recent molecular data of IDC-P.

Intraductal Prostatic Carcinoma: Epidemiological and Anatomopathological Aspects in Dakar

Introduction: Intraductal carcinoma is often associated with high-grade, high-stage adenocarcinoma. Its frequency is variable and it is considered a poor prognostic factor. In our context, when prostatic carcinoma is diagnosed, pathologists do not always report the presence of this anatomopathological entity. We therefore conducted a study to determine the epidemiological and anatomopathological profile of patients with this lesion in Dakar. Materials and Methods: This is a retrospective descriptive study covering a 1-year period from January to December 2022. It focused on cases of intraductal carcinoma diagnosed among prostatic carcinomas collected in the anatomopathology laboratories of Hôpital Général Idrissa Pouye (HOGIP) and Hôpital Militaire de Ouakam (HMO). It was based on archives of anatomopathological reports, blocks and slides. A total of 200 cases of prostatic carcinoma were collated and reviewed to identify those presenting with intraductal carcinoma according to the diagnostic criteria of Guo and Epstein. Results: 87 cases of intraductal carcinoma were found, representing 43.5% of prostatic carcinomas. The mean age was 71 years. Patients in their seventh decade were the most represented, i.e. 42.5%. The majority of samples examined were biopsies (72.4%). The mean PSA level was 965.91 ng/ml, with extremes ranging from 0.03 to 10,000 ng/ml. Histologically, 96.5% of cases (N = 84) were invasive prostatic carcinoma. Gleason score 8 (4 + 4) was the most common, accounting for 42.53% (N = 37). On average, the study found four (04) foci of intraductal carcinoma per specimen, with extremes ranging from 1 to 30. Dense cribriform architecture accounted for 78.16%, loose cribriform for 11.5%, solid for 8.04% and micropapillary for 2.3%. Six cases (6.9%) showed foci of comedonecrosis. The vast majority of radical prostatectomies (87.5%) were classified as pT3. Node invasion and perineural sheathing were observed in 12.5% and 52.32% of cases respectively. Conclusion: Intraductal carcinoma is a poor prognostic factor that must be systematically reported in the anatomopathological report. In Senegal, it is often associated with advanced stage, high-grade carcinoma and high PSA levels.

Intraductal carcinoma of the prostate in prostate biopsy samples: correlation with aggressive pathological features after radical prostatectomy and prognostic value in high-risk prostate cancer

Intraductal carcinoma of the prostate(IDC-P)is an aggressive pathological pattern of prostate cancer(PCa).We investigated the association of IDC-P in prostate biopsy(PBx)with several pathological features after radical prostatectomy(RP)and its prognostic value in high-risk PCa.A total of 418 patients with high-risk PCa after RP were included in this study.IDC-P and its architectural patterns were identified according to the 2016 World Health Organization Classification.Chi-squared test and logistic regression were used to investigate the correlation between IDC-P and post-RP pathological features.Kaplan-Meier curves and Cox regression were applied to explore the prognostic value of IDC-P.IDC-P was identified in PBx in 36/418(8.6%)patients.Logistic regression indicated that IDC-P in PBx was independently associated with several pathological features of RP,including Gleason score 8-10(P<0.001),seminal vesicular invasion(P<0.001),and pathological T(pT)3a(P=0.043).Patients with IDC-P in PBx manifested poorer biochemical-free survival(BFS)than those without IDC-P(37.47 months vs not reached,P<0.001).The addition of IDC-P in several prognostic nomograms could improve the predictive accuracy of these tools.We conclude that IDC-P in PBx is positively associated with several aggressive pathological features after RP in high-risk PCa.In addition,IDC-P in PBx could effectively predict the BFS of high-risk PCa patients after RP.

The presence of intraductal carcinoma of the prostate is closely associated with poor prognosis:a systematic review and meta-analysis

We aimed to confirm the predictive ability of the presence of intraductal carcinoma of the prostate(IDC-P)for prognosis and the associations between IDC-P and clinicopathological parameters.Studies were identified in PubMed,Cochrane Library,EMBASE,Web of Science,and SCOPUS up to December 1,2019.Hazard ratios(HRs)for survival data and odds ratios for clinicopathological data with 95%confidence intervals(CIs)were extracted.Heterogeneity was evaluated by the I2 value,and quality was assessed by the Newcastle-Ottawa Scale criteria.A total of 4179 patients from 13 studies were included.The results showed that IDC-P presence was significantly associated with poor progression-free survival(PFS;HR=2.31;95%Cl:1.96-2.73),cancer-specific survival(HR=1.89;95%Cl:1.28-2.77),and overall survival(HR=2.14;95%Cl:1.53-3.01).In the subgroup analysis,IDC-P presence was significantly associated with poor PFS in prostate cancer treated by radical prostatectomy(HR=2.48;95%Cl:2.05-3.00)and treated by radiotherapy(HR=2.83;95%Cl:1.65-4.85).Regarding clinicopathological characteristics,patients with IDC-P presence had significantly higher tumor clinical stages,Gleason scores,probabilities of lymph node invasion,positive surgical margins,and positive extraprostatic extension.Our meta-analysis indicates that the presence of IDC-P is closely associated with poor prognosis and adverse clinicopathological characteristics.Our data support the value and clinical utility of the routine detection of IDC-P by pathological examination.These conclusions need further validation,and prospective studies are needed to find better treatment modalities other than traditional first-line therapy for patients with IDC-P.

Intraductal papillary mucinous carcinoma with atypical manifestations:Report of two cases

Intraductal papillary mucinous neoplasms （IPMNs） are a well-characterized group of rnucin-producing cystic neoplasms of the clear malignant potential type. We report here two cases of intraductal papillary mucinous carcinoma （IPMC） with atypical manifestations. In one case, we discussed a pseudomyxoma peritonei caused by a ruptured IPMC. In the other case we discussed the fistulization of IPMC into the stomach and duodenum. These two cases suggest that IPMN can either spontaneously rupture causing mucinous materials to spill into the free abdominal cavity or directly invade adjacent organs resulting in fistula development.

Intraductal papillary carcinoma of the breast: Analysis of mammography and MRI manifestations

Objective:To explore the diagnostic value of mammography and MRI in breast intraductal papillary carcinoma(IDPC)and compare the diagnostic value of the two methods.Methods:Collected 28 IDPC patients who underwent mammography and MRI from March 2011 to June 2019 and were confirmed by surgery and pathology.The imaging manifestations were analyzed and the accuracy of IDPC diagnosis was compared between the two methods.Results:Mammography of mammography:24 cases showed masses,3 cases showed asymmetric dense shadow with calcification,1 case showed large duct dilation in the areola area,and 6 cases showed short burrs on the edge of the tumor.MRI scan:28 cases of lesions had low signal intensity on T1WI and high signal on T2WI.19 cases showed cystic solid masses with small nodules on the cyst wall.25 cases showed obvious uneven enhancement lesions.The diagnostic accuracy of MRI was 89.3%.(25/28),the accuracy rate of mammography X-ray examination was 75.0%(21/28).There was no statistical difference in the diagnostic accuracy between the two methods,and it was not statistically significant(P=0.29).The combined use of the two inspection methods has a diagnostic accuracy rate of 96.4%.The combined two methods are more valuable than relying solely on mammography(P=0.03).Conclusion:IDPC is characterized by lobular or round masses.Large cysts with small nodules may be a special MRI manifestation of this cancer.Combining mammography and MRI can further improve the diagnosis of IDPC.

Expression and significance of CD44s, CD44v6, and nm23 mRNA in human cancer

AIM: To investigate the relationship between the expression levels of nm23 mRNA, CD44s, and CD44v6,and oncogenesis, development and metastasis of human gastric adenocarcinoma, colorectal adenocarcinoma,intraductal carcinoma of breast, and lung cancer.METHODS: Using tissue microarray by immuhistochemical (IHC) staining and in situ hybri-dization (ISH), we examined the expression levels of nm23mRNA, CD44s, and CD44v6 in 62 specimens of human gastric adenocarcinoma and 62 specimens of colorectal adenocarcinoma; the expression of CD44s and CD44v6in 120 specimens of intraductal carcinoma of breast and 20 specimens of normal breast tissue; the expression of nm23 mRNA in 72 specimens of human lung cancer and 23 specimens of normal tissue adjacent to cancer.RESULTS: The expression of nm23 mRNA in the tissues of gastric and colorectal adenocarcinoma was not significantly different from that in the normal tissues adjacent to cancer (P＞0.05), and was not associated with the invasion of tumor and the pathology grade of adenocarcinoma (P＞0.05). However, the expression of nm23 mRNA was correlated negatively to the lymph node metastasis of gastric and colorectal adenocarcinoma (r = -0.49, P＜0.01; r = -4.93, P＜0.01). The expression of CD44s in the tissues of gastric and colorectal adenocarcinoma was significantly different from that in the normal tissues adjacent to cancer (P＜0.05;P＜0.01). CD44v6 was expressed in the tissues of gastric and colorectal adenocarcinoma only, the expression of CD44v6 was significantly associated with the lymph node metastasis, invasion and pathological grade of the tumor (r = 0.47, P＜0.01; r = 5.04, P＜0.01). CD44sand CD44v6 were expressed in intraductal carcinoma of breast, the expression of CD44s and CD44v6 was significantly associated with lymph node metastases and invasion (P＜0.01). However, neither of them was expressed in the normal breast tissue. In addition, the expression of CD44v6 was closely related to the degree of cell differentiation of intraductal carcinoma of breast (x2= 5.68, P＜0.05). The expressional level of nm23mRNA was closely related to the degree of cell differentiation (P＜0.05) and lymph node metastasis (P＜0.01), but the expression of nm23 gene was not related to sex, age, and type of histological classification (P＞0.05).CONCLUSION: Patients with overexpression of CD44s and CD44v6 and low expression of nm23 mRNA have a higher lymph node metastatic rate and invasion. In addition, overexpression of CD44v6 is closely related to the degree of cell differentiation. Detection of the three genes is able to provide a reliable index to evaluate the invasion and metastasis of tumor cells.

Endoscopic trans-pterygoid resection of a low-grade cribriform cystadenocarcinoma of the infratemporal fossa

This article presents a case of low-grade cribriform cystadenocarcinomas(LGCCC),a rare salivary gland tumor manifesting in the infratemporal fossa(ITF).The lesion in this case is unique in its location,histopathology,and management in that the tumor resection was performed using an exclusively endoscopic,endonasal approach.This case highlights the expanding application of endoscopic skull base techniques to address an indolent,slow-growing malignancy of the ITF.