Prostatic intraepithelial neoplasia: recent advances.
BACKGROUND
There have been 2 putative prostatic cancer precursors, prostatic intraepithelial neoplasia (PIN) and atypical adenomatous hyperplasia (adenosis), but PIN remains as a well-known precancerous condition.


OBJECTIVE
To describe recent advances in knowledge of PIN and to better define the diagnostic criteria and differential diagnosis of PIN.


METHODS
Review of the pertinent literature and our experience.


CONCLUSIONS
The presence of ductal/acinar epithelial changes including nuclear enlargement, prominent nucleoli, chromatin alterations, and luminal complexity is an easy way to identify the disorder. Four main patterns of high-grade PIN (HGPIN) have been described: tufting, micropapillary, cribriform, and flat. In addition, variants of HGPIN have also been described. Both HGPIN and prostatic carcinoma share an increased incidence and severity with advancing age and with high rates of occurrence in the peripheral zone of the prostate. Furthermore, HGPIN and prostate cancer share genetic and molecular markers as well, with PIN representing an intermediate stage between benign epithelium and invasive carcinoma. The clinical significance of HGPIN is that it identifies patients at risk for prostatic carcinoma. With the increased use of extended biopsy protocols, clinicians are more likely to identify HGPIN and less likely to miss concurrent carcinoma.
Ayala
Alberto G
AG
Department of Pathology, The Methodist Hospital, Weill Cornell University School of Medicine, 6565 Fannin St, Room 227 (Main Building), Houston, TX 77030, USA. aayala@tmh.tmc.edu
Ro
Jae Y
JY
D002467:Cell Nucleus / Q000473:pathology; D006801:Humans; D008297:Male; D011230:Precancerous Conditions / Q000473:pathology*; D011467:Prostate / Q000473:pathology; D019048:Prostatic Intraepithelial Neoplasia / Q000145:classification / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*