Preneoplasia in the prostate gland with emphasis on high grade prostatic intraepithelial neoplasia
Merrimen JL, Evans AJ, Srigley JR. Pathology. 2013 Mar 8. [Epub ahead of print]


*Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre and Department of Pathology, Dalhousie University, Halifax, Nova Scotia †University Health Network and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto ‡Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.


SUMMARY: There are a variety of morphological patterns and processes that have been implicated in the pathogenesis of prostate cancer. Prostatic intraepithelial neoplasia (PIN), inflammation with or without atrophy, and adenosis (atypical adenomatous hyperplasia) have all been given candidate status as precursor lesions of prostatic adenocarcinoma. Based on decades of research, high grade prostatic intraepithelial neoplasia (HPIN), a proliferative lesion of prostatic secretory cells, has emerged as the most likely morphological pre-invasive lesion involved in the evolution of many but not all prostatic adenocarcinomas. In this manuscript, we briefly discuss other proposed precursors of prostatic adenocarcinoma and then focus on the history, diagnostic criteria and morphology of HPIN. The incidence of HPIN and its relationship to prostate cancer is reviewed. The differential diagnosis of large glandular patterns in the prostate is discussed in depth. Finally, we summarise the recent clinicopathological studies evaluating the clinical significance of HPIN and discuss follow-up strategies in men diagnosed with HPI