Distribution of Primary Lung Carcinomas in Relation to Time as Determined by Histochemical Techniques2

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Abstract
The 1,037 neoplasms with an original anatomic diagnosis of primary pulmonary carcinoma that were observed at necropsy at the Los Angeles County Hospital from 1927–57 were reviewed. Of these, 956 met the criteria for inclusion in this study. The neoplasms were reclassified according to two criteria: 1) a modification of Liebow's method in which hematoxylin-and-eosin-stained sections were used; 2) that of the World Health Organization in which, in addition, sections specially stained to demonstrate mucin and keratin were used. In our series approximately 30 percent was poorly differentiated or undifferentiated and close to 10 percent was the uncommon giant and/or spindle-cell variant. Most of these undifferentiated and poorly differentiated neoplasms contained acid mucopolysaccharide and were classified as adenocarcinoma. The percentage distribution of the various histologic types, especially the adenocarcinoma group, differed significantly according to the criteria used. Our data agree with other published reports which show that the frequency of lung carcinoma is increasing disproportionately to all necropsies. However, the roles played by various histologic types differ among studies. Independent of criteria used in our series, the proportion of epidermoid carcinomas in men is not increasing, while the proportion of adenocarcinomas apparently is increasing. Our ratios of epidermoid and undifferentiated carcinomas to adenocarcinomas are decreasing, while ratios reported by Kreyberg and others are increasing. Although this contrast is due partially to difference in interpretations by pathologists as well as to variations in methods and criteria, the Los Angeles County Hospital material is undeniably different from that reported elsewhere. The reasons for these differences need explanation, and further studies of both clinical and necropsy material from the Los Angeles area are indicated.