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Perils of hidden depths
  1. Anna E Mason,
  2. Murali Varma
  1. Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Dr Murali Varma, Cellular Pathology, University Hospital of Wales, Cardiff CF14 4XW, UK; wptmv{at}

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Clinical question

A man in his 60s presented with lower urinary tract symptoms. His serum prostate-specific antigen level was 6 ng/mL. A prostate biopsy was performed (figure 1).

Figure 1

Prostate biopsy at various magnifications (H&E).

What is your diagnosis?

  1. Acinar adenocarcinoma.

  2. Benign.

  3. High-grade prostatic intraepithelial neoplasia.

  4. Intraductal carcinoma of prostate.

  5. Prostatic intraepithelial neoplasia-like ductal carcinoma.

The correct answer is after the Discussion.


The prostate biopsy shows medium-sized prostate glands with papillary infoldings, tufting and prominent nucleoli (figure 2A–D). The low-power architecture with papillary infoldings is consistent with benign prostate glands. Tufting and nucleolar prominence would however suggest high-grade prostatic intraepithelial neoplasia (PIN).

Figure 2

Prostate biopsy containing medium-sized glands with papillary infoldings (A–C) and prominent nucleoli (B, D). Higher magnification of the larger gland shows stroma containing a single cell with amphophilic cytoplasm (C, D: arrows). Deeper levels revealed …

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  • Handling editor Iskander Chaudhry.

  • Contributors The case was identified by MV. The first draft of the manuscript was writtern by AEM. Both authors contributed to subsequent revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.