Gastric mucinous adenocarcinoma of lung has unique clinical and pathological characteristics
Objective To investigate the morphological characteristics,clinicopathological features,genetic alterations,and clinical outcomes of gastric mucinous adenocarcinoma(GMA),so as to supply personalized treatment for lung mu-cinous adenocarcinoma.Methods A total of 48 cases of invasive non-mucinous lung adenocarcinoma(INMA)and 40 cases of invasive mucinous adenocarcinoma(IMA)were retrospectively analyzed.The IMA cases included 30 cases of simple invasive mucinous adenocarcinoma(SIMA)and 10 cases of mucinous and non-mucinous mixed adenocarcinoma(MNMA).SIMA was further categorized into GMA,columnar cell mucinous adenocarcinoma(CMA),and mixed simple invasive mucinous adenocarcinoma(MSIMA).The clinicopathological data from the patients were collected.Im-munohistochemical analysis was performed on all paraffin-embedded samples to detect the expressions of mucin 5ac(MUC5ac),mucin 6(MUC6),thyroid transcription factor-1(TTF-1),cytokeratin 7(CK7),and cytokeratin 5/6(CK5/6).Additionally,polymerase chain reaction(PCR)or next-generation sequencing(NGS)was conducted to detect lung cancer-related genes.Results Compared with CMA,MSIMA,MNMA and INMA,the mean diameter of GMA was significantly smaller and the age of onset was slightly higher.Most of GMA occured in the lower lobes of the lungs.The positive rate of MUC6 in GMA was 92.93%,which was significantly higher than those in CMA(8.33%),MNMA(20.00%),and INMA(0%),with a statistically significant difference(P<0.001).The expression rates of TTF-1 and CK7 in GMA were significantly lower than those in MNMA and INMA(P<0.001).KRAS gene mutation rate in GMA was higher than that in CMA,MNMA,and INMA.Additionally,MUC6 expression was positively corre-lated with KRAS gene mutations(Pearson correlation coefficient＝ 0.590).Conclusion GMA is characterized by small tumor size,high occurrence rate in the lower lobe of the lung,high MUC6 expression,and high KRAS gene mu-tation rate.These unique pathological,clinical,and molecular features suggest that GMA should be considered a distinct subtype.
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