Despite its first recognition even longer ago, in the past nearly 20 years, intraductal carcinoma of the prostate has become a standard histopathologic reporting parameter conveying a strong negative prognostic factor for prostatic adenocarcinoma. When seen at biopsy, intraductal carcinoma of the prostate is associated with risk for aggressive prostatectomy outcomes, including frequently high-grade, high-stage, high-volume disease, with increased risk for recurrence and progression. Multiple organizations, including the uropathology subspecialty societies to the World Health Organization, recognize and recommend reporting the presence of intraductal carcinoma, whether sampled in “pure” form or present with concomitant invasive adenocarcinoma. Moreover, emerging scholarship relates intraductal carcinoma to higher prevalence of homologous recombination repair deficiency mutations in prostatic adenocarcinoma, whether somatic or germline, which serve as indications for approved targeted therapies. Taken together, this is a diagnosis for the histopathologist not to miss. In view of these elevated stakes and the opportunity to further precision medicine, this review details neoplastic and non-neoplastic simulants in the differential diagnosis of intraductal carcinoma of the prostate.
尽管其首次被识别的时间更早，但在过去近20年间，前列腺导管内癌已成为标准组织病理学报告参数，提示前列腺腺癌具有强烈的负面预后意义。在活检中发现前列腺导管内癌时，其与侵袭性前列腺切除术不良结局风险相关，包括常见的高分级、高分期、大体积病灶，并增加复发和进展风险。包括泌尿病理亚专科协会及世界卫生组织在内的多个机构均认可并建议报告导管内癌的存在，无论是以“单纯”形式取样还是伴随浸润性腺癌出现。此外，新兴研究将导管内癌与前列腺腺癌中同源重组修复缺陷突变（无论是体细胞突变还是胚系突变）的高发生率联系起来，这些突变可作为已获批靶向治疗的适应症依据。综上所述，这是组织病理学家不容忽视的诊断要点。鉴于其日益重要的临床意义及推动精准医疗的机遇，本综述详细阐述了前列腺导管内癌鉴别诊断中的肿瘤性与非肿瘤性模拟病变。
肿瘤(癌症)患者之家