The impact of intracytoplasmic mucin in lung adenocarcinoma with pneumonic radiological presentation.
OBJECTIVE
This study investigated the clinical and prognostic impact of intracytoplasmic mucin in lung adenocarcinoma with "pneumonic" radiological presentation, formerly known as bronchioloalveolar carcinoma (BAC).


METHODS
Between 1986 and 2011, clinical and pathological data from 120 consecutive patients with lung adenocarcinoma with "pneumonic" radiological presentation were reviewed. Intracytoplasmic mucin was assessed using a diastase-resistant periodic acid-Schiff staining. The presence of EGFR or K-Ras mutations and ALK rearrangement were determined in surgical samples.


RESULTS
The two predominant histological patterns were invasive mucinous adenocarcinoma (40%) and lepidic predominant adenocarcinoma (32%). Intracytoplasmic mucin was detected in 71 patients (59.2%) who were more likely to be non-smokers (p=0.04) and have bronchorrhea (p=0.006), crepitant rales (p=0.02), or neutrophil alveolitis (p=0.0004). In mucin-producing tumors, EGFR mutation was not detected, K-Ras mutations and ALK rearrangement were present in 32% and 3% of cases, respectively. In non-mucin-producing tumors, EGFR and K-Ras mutations were detected in 17% and 10% of cases, respectively, no ALK rearrangement was detected. In univariate analysis, performance status>0, crepitant rales, bronchorrhea, neutrophil alveolitis, bilateral extension, intracytoplasmic mucin and no surgery were associated with worse survival. In multivariate analyses, intracytoplasmic mucin, neutrophil alveolitis, and no surgery were independent factors for worse survival.


CONCLUSIONS
Intracytoplasmic mucin is associated with specific clinical characteristics and is an independent factor for worse survival in lung adenocarcinoma formerly known as BAC.
ER2 UPMC/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Paris, France.
Michael
M
Duruisseaux
ER2 UPMC/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Paris, France; Service d'Anatomie pathologique, Hôpital Tenon, AP-HP, Paris, France.
Martine
M
Antoine
ER2 UPMC/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Paris, France; Service de Pneumologie, Hôpital Tenon, AP-HP, Paris, France.
Nathalie
N
Rabbe
ER2 UPMC/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Paris, France; Plateforme de Génomique des Tumeurs Solides, Hôpital Tenon, AP-HP, Paris, France.
Virginie
V
Poulot
Service d'Histologie et de Biologie Tumorale, Hôpital Tenon, AP-HP, Paris, France.
Jocelyne
J
Fleury-Feith
ER2 UPMC/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Paris, France.
Thibault
T
Vieira
Service de Pneumologie, Hôpital Tenon, AP-HP, Paris, France.
Armelle
A
Lavolé
ER2 UPMC/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Paris, France; Service de Pneumologie, Hôpital Tenon, AP-HP, Paris, France.
Jacques
J
Cadranel
ER2 UPMC/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Paris, France; Service de Pneumologie, Hôpital Tenon, AP-HP, Paris, France. Electronic address: marie.wislez@tnn.aphp.fr.
Marie
M
Wislez
D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000175:diagnosis* / Q000401:mortality; D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis*; D000077548:Anaplastic Lymphoma Kinase; D003593:Cytoplasm / Q000378:metabolism*; D066246:ErbB Receptors / Q000235:genetics; D005260:Female; D011905:Genes, ras / Q000235:genetics; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000378:metabolism*; D009361:Neoplasm Invasiveness; D009504:Neutrophils / Q000276:immunology*; D010503:Periodic Acid-Schiff Reaction; D011379:Prognosis; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics; D012307:Risk Factors; D016019:Survival Analysis
D009077:Mucins; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; C512478:EGFR protein, human; D066246:ErbB Receptors; D020794:Receptor Protein-Tyrosine Kinases
Bronchoalveolar carcinoma; Lepidic adenocarcinoma; Lung cancer; Mucinous variant; Mucosecretion; Prognosis