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Background: All aspects of mucoepidermoid carcinoma (MEC) of the lung including histologic grading, clinical behavior and its differentiation from adenosquamous cell carcinoma are still not fully understood. Methods: We reviewed the hematoxylin-eosin stained slides and medical re­cords of 31 cases of MEC of the lungs. The cases were classified as low and high grade accord­ing to the quantitative grading system formulated for MEC. High grade tumors were tested for an epidermal growth factor receptor (EGFR) mutation. Results: Twenty eight cases were classified as low grade and 3 cases as high grade. Histologically, lower glandular component, cellular atyp­ia, necrosis, mitoses >4/10 high power fields, and endolymphatic tumor emboli were typical char­acteristics of a high grade tumor. Although some tumors showed histologic features mimicking high grade tumors, they were classified as low grade tumors according to this quantitative grad­ing system. Low grade tumors showed no recurrence or metastasis. However, among three pa­tients with a high grade tumor, two had distant metastases and one died of disease. Additionally, an EGFR mutation was not detected. Conclusions: A high grade MEC was consistently different from a low grade tumor with regard to malignant histologic features and poor prognosis. There­fore, correct histologic grading is important in predicting the prognosis to avoid unnecessary treat­ment.

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