TY - JOUR
T1 - Identification of intraductal-to-invasive spatial transitions in prostate cancer
T2 - proposal for a new unifying model on intraductal carcinogenesis
AU - Rijstenberg, Lucia L.
AU - Harikumar, Hridya
AU - Verhoef, Esther I.
AU - van den Bosch, Thierry P.P.
AU - Choiniere, Roselyne
AU - van Royen, Martin E.
AU - van Leenders, Geert J.L.H.
N1 - Publisher Copyright:
© 2025 The Author(s). Histopathology published by John Wiley & Sons Ltd.
PY - 2025/1/30
Y1 - 2025/1/30
N2 - Aims: Intraductal carcinoma (IDC) is an independent pathological parameter for adverse prostate cancer (PCa) outcome. Although most IDC are believed to originate from retrograde spread of established PCa, rare IDC cases may represent precursor lesions. The actual transition areas between intraductal and invasive cancer, however, have not yet been identified. Our objective was to identify intraductal-invasive PCa transitions using 2- and 3-dimensional microscopy. Methods and results: Seventy-five samples from 46 radical prostatectomies with PCa were immunohistochemically stained for basal cell keratins. In 35 samples, atypical glands that were indistinguishable from invasive adenocarcinoma (IAC) had focal 34BE12-positive basal cells. These IAC-like glands were present adjacent to IDC and prostatic intra-epithelial neoplasia (PIN) in 21 of 45 (46.7%) and 16 of 58 (27.6%) cases, respectively. Whole-mount confocal imaging of immunofluorescent Ker5/18 double-stained and cleared 1-mm-thick intact tissues revealed spatial continuity between IDC, IAC-like glands and IAC with a gradual loss of basal cells. In 24 of 35 (68.6%) samples more than one IAC-like focus (median 3.0) was present. Conclusions: We identified areas of spatial transition between PIN, IDC and IAC, characterised by remnant basal cells in IAC-like glands. Based on the coexistence of IDC and PIN, the gradual loss of basal cells in IAC-like glands and IAC-like glands’ multifocality, we propose a novel hypothesis on intraductal carcinogenesis, which we term ‘repetitive invasion, precursor progression’ (RIPP).
AB - Aims: Intraductal carcinoma (IDC) is an independent pathological parameter for adverse prostate cancer (PCa) outcome. Although most IDC are believed to originate from retrograde spread of established PCa, rare IDC cases may represent precursor lesions. The actual transition areas between intraductal and invasive cancer, however, have not yet been identified. Our objective was to identify intraductal-invasive PCa transitions using 2- and 3-dimensional microscopy. Methods and results: Seventy-five samples from 46 radical prostatectomies with PCa were immunohistochemically stained for basal cell keratins. In 35 samples, atypical glands that were indistinguishable from invasive adenocarcinoma (IAC) had focal 34BE12-positive basal cells. These IAC-like glands were present adjacent to IDC and prostatic intra-epithelial neoplasia (PIN) in 21 of 45 (46.7%) and 16 of 58 (27.6%) cases, respectively. Whole-mount confocal imaging of immunofluorescent Ker5/18 double-stained and cleared 1-mm-thick intact tissues revealed spatial continuity between IDC, IAC-like glands and IAC with a gradual loss of basal cells. In 24 of 35 (68.6%) samples more than one IAC-like focus (median 3.0) was present. Conclusions: We identified areas of spatial transition between PIN, IDC and IAC, characterised by remnant basal cells in IAC-like glands. Based on the coexistence of IDC and PIN, the gradual loss of basal cells in IAC-like glands and IAC-like glands’ multifocality, we propose a novel hypothesis on intraductal carcinogenesis, which we term ‘repetitive invasion, precursor progression’ (RIPP).
UR - http://www.scopus.com/inward/record.url?scp=85216588766&partnerID=8YFLogxK
U2 - 10.1111/his.15414
DO - 10.1111/his.15414
M3 - Article
C2 - 39888049
AN - SCOPUS:85216588766
SN - 0309-0167
VL - 86
SP - 1091
EP - 1100
JO - Histopathology
JF - Histopathology
IS - 7
ER -
