The current WHO classification of lung cancer cannot appropriately characterize adenocarcinoma with mucin production. No suitable entity or typical adenocarcinoma with mucin has been established, and only two variants exist: invasive mucinous adenocarcinoma (IMA) and colloid adenocarcinoma. To obtain basic data toward appropriate classification, we sought to study the characterization of adenocarcinoma with mucin production based on criteria that account for both cytoplasmic and glandular mucin, as well as a mucin lake. EGFR and KRAS mutations and protein expression of TTF-1 and HNF4a were examined in 90 cases extracted from 748 consecutive adenocarcinomas. Among the 90 tumors, 14 were IMAs, and 76 were not. The non-IMA group had fewer mucin lakes (74%), more moderately/poorly differentiated tumors (57%), more EGFR (26%) mutations and fewer KRAS (34%) mutations than the IMA group. Interestingly, the tumors were divided into the three subtypes, TTF-1-positive, HNF4apositive and double-negative, almost exclusively. In conclusion, with the use of wider criteria for mucin production, as well as driver mutations and transcription factor expression, we may be able to establish criteria for adenocarcinomas with mucin, which may lead to the more appropriate classification of mucinous adenocarcinoma in the future.

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Objective: We aimed to examine long-term survival rate andthe risk factors of poor prognosis in patients whounderwent open surgery (OS) for abdominal aorticaneurysm (AAA). Materials and Methods: We performed a retrospective analysis of thepatients who underwent elective OS for AAAbetween 2005 and 2011 at Tokyo Medical andDental University Hospital. The relations betweenmortality rate and preoperative clinical factorswere examined. Results: For this study 195 patients were identified. Themortality was significantly related to size ofaneurysm, type of aneurysm, massive bleedingduring operation, age, anemia, uncontrolledhypertension, and comorbid chronic kidneydisease. No specific leading causes of death wereidentified for these increases in the mortalityrate. Cox proportional hazard model revealed thatanemia, hypertension, and chronic kidney disease(CKD) were independent predictive factors ofhigher mortality in the patients who underwent OSfor AAA. Discussion: In our previous study, high preoperative CRPlevel was correlated to long-term death rate afterendovascular aortic aneurysm repair (EVAR) forAAA. The difference might be attributed to the factthat OS relieves the aortic wall tension and reducesthe aortic inflammation, whereas EVAR does not,because of endoleak or endotension.

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