Prognostic Role of Microvascular Density and Mucin Production in 56 Cases of Adenocarcinoma of Lung- An Experience from a Center in Lahore, Pakistan

Introduction: The relative incidence of adenocarcinoma of the lung is increasing, and it is now the most common primary lung malignancy. This study examines certain clinical and pathological factors which may affect patient survival in lung adenocarcinoma in the developing country of Pakistan. Methods: This is a descriptive study involving 56 patients with biopsy-proven primary adenocarcinoma of lung. Biopsy tissues were reviewed along with medical record case histories. Formalin-fixed, paraffin-embedded tissue specimens were used for mucin histochemistry with mucicarmine, periodic acid Schiff (PAS) and alcian blue stains. Immunohistochemistry (IHC) with monoclonal antibodies against CD34 was used for assessment of microvascular density. Mast cell density was measured on Toluidine blue stained sections. Results: Mean age of patients was 55.96 ± 1.67 years. Male to female ratio was 3:2. 51.8% of patients were smokers, and weight-loss was seen in 46.4% of the patients. A majority (66.1%) had stage III/IV tumors with positive lymph nodes, and 26.8% tumors were mucinous. High mast cell density was found in 32.1% and high microvessel density in 44.6% tumor specimens. Weight-loss, stage, nodal status, mucin production and microvessel density showed significant deleterious effect on patient survival. Conclusions: The current study illustrates that for this population, weight loss, advanced stage of tumor, nodal status, mucin production by the tumor, and increased angiogenesis are predictors of poor survival in patients with primary pulmonary adenocarcinoma. Further prospective work will need to be performed to determine if these factors can assist in prognostication or formulation of treatment plan in newly diagnosed individuals in the general population.