High-grade prostatic adenocarcinoma involving duct/acinar structures is labeled intraductal carcinoma of the prostate (IDCP). As numerous studies have shown that IDCP is associated with high stage disease with a significant negative impact on cancer-specific survival, accurate diagnosis is crucial to ensure appropriate patient management. The definition of IDCP recommended by 2016 World Health Organization (WHO) classification suggests that cases of IDCP with micropapillary or loose cribriform architecture without comedonecrosis should have cells with ≥6× nuclear enlargement. It is unclear how this size criterion was derived and which of the parameters of nuclear size (nuclear diameter, nuclear surface area, or nuclear perimeter) it relates to. To evaluate the extent of nuclear enlargement in IDCP, we performed morphometric analyses relating to each of these parameters in 100 radical prostatectomy specimens. One hundred nuclei from foci of IDCP and 50 nuclei from foci of normal luminal epithelium were examined for each patient. Diagnosis of IDCP was based on cells with definite features of carcinoma present within duct/acinar structures. Comparing the means of each of the parameters between IDCP cells and benign luminal cells, there was a statistically significant enlargement in nuclear perimeter (P<0.0005), nuclear area (P<0.0005), and nuclear diameter (P<0.0005); however, the difference in mean nuclear size was limited to factors of 1.3×, 1.6×, and 1.3×, respectively. Three patients each had rare large nuclei (largest perimeter 45, 45, and 44 μm; maximum nuclear area 135, 136, and 136 μm2; and the largest diameter 18 µm in each). For these rare cells, the nuclear size difference, when compared with benign nuclei was; nuclear perimeter 2.0×, 2.1×, and 2.1×; nuclear area 3.6×, 3.8×, and 3.8×; and nuclear maximum diameter 3.0×, 2.5×, and 2.5×. The definition of nuclear enlargement of ≥6× was not reached in any of our cases, all of which clearly showed features of duct invasive carcinoma. In these cases, reliance on nuclear size criteria would have resulted in underdiagnosis of IDCP. This is of concern as failure to recognize IDCP, particularly in needle biopsies, could lead to delays in the timely treatment of aggressive high-grade prostate cancer, resulting in cancer progression and suboptimal patient oncological outcomes.

中文翻译：

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前列腺导管内癌：极端核大小不是诊断参数。

涉及导管/腺泡结构的高级前列腺腺癌被标记为前列腺导管内癌（IDCP）。大量研究表明，IDCP 与晚期疾病相关，对癌症特异性生存具有显着的负面影响，因此准确的诊断对于确保适当的患者管理至关重要。2016年世界卫生组织（WHO）分类推荐的IDCP定义表明，具有微乳头状或疏松筛状结构且无粉刺坏死的IDCP病例应具有≥6×核增大的细胞。目前还不清楚这个尺寸标准是如何得出的，以及它与核尺寸的哪些参数（核直径、核表面积或核周长）相关。为了评估 IDCP 中核增大的程度，我们对 100 个根治性前列腺切除术标本中的每个参数进行了形态测量分析。对每位患者检查来自 IDCP 病灶的 100 个细胞核和来自正常管腔上皮病灶的 50 个细胞核。IDCP 的诊断基于导管/腺泡结构内存在的具有明确癌特征的细胞。比较IDCP细胞与良性管腔细胞各参数均值，核周长（P<0.0005）、核面积（P<0.0005）和核直径（P<0.0005）均有统计学意义的增大；然而，平均核大小的差异分别限于 1.3×、1.6×和 1.3×。3 名患者均具有罕见的大细胞核（最大周长分别为 45、45 和 44 μm；最大核面积分别为 135、136 和 136 μm2；最大直径均为 18 μm）。对于这些罕见细胞，与良性细胞核相比，细胞核大小差异为；核周长2.0×、2.1×、2.1×；核面积3.6×、3.8×、3.8×；核最大直径3.0×、2.5×、2.5×。我们的所有病例均未达到核增大≥6×的定义，所有病例均明确显示导管浸润癌的特征。在这些情况下，依赖核大小标准会导致 IDCP 诊断不足。这是令人担忧的，因为未能识别 IDCP，特别是在针刺活检中，可能会导致侵袭性高级别前列腺癌的及时治疗延迟，从而导致癌症进展和患者肿瘤结果不理想。