Assessing Mucin in Cervical Intraepithelial and Cancerous Lesions Using PAS and Alcian Blue Stain

Background: Cervical carcinoma is the fourth most common cancer in women worldwide and the second leading cause of cancer-related deaths. However, it is potentially treatable if precursor lesions and invasive carcinomas are identified early. Given the poor prognosis associated with adenocarcinoma and adenosquamous carcinoma, precise identification of these cancers during routine histopathological examinations can significantly benefit patients. Therefore, in developing countries like Bangladesh, using cost-effective mucin stains, such as Periodic Acid-Schiff and Alcian Blue, may be helpful in the early detection of carcinomatous processes, particularly aggressive mucin-secreting carcinomas.

Objective: This study explores mucin characteristics in cervical precancerous lesions and invasive cancers to enhance histological diagnosis and predict prognosis.

Materials and Methods: This cross-sectional descriptive study includes 100 paraffin blocks (70 from patients histopathologically diagnosed with cervical carcinoma and 30 from patients diagnosed with cervical intraepithelial lesions) at the Department of Pathology, Rajshahi Medical College.

Results: In a study involving 70 cases of invasive cervical carcinoma, mucin positivity was detected in 28 cases. Acidic mucin was the most prevalent type, found in 15 cases, followed by mixed mucin in 11 cases and neutral mucin in only 2 cases. Notably, mucin positivity was present in 15 cases of grade one cancers, which is significantly higher compared to grades two and three. Among 17 cases of poorly differentiated squamous cell carcinoma, 4 cases tested positive for mucin, leading to the reclassification of 3 cases as adenosquamous carcinoma and 1 case as adenocarcinoma. This result was statistically significant, with a P-value of less than 0.05. Furthermore, among 30 cases of cervical intraepithelial neoplasia, intraepithelial mucin was observed in 5 cases—of which 3 were identified as neutral mucin types and 2 as mixed. However, this finding was not statistically significant, indicated by a P-value greater than 0.05.

Conclusion: This study demonstrates that the prevalence of acid mucin rises in conjunction with an increase in tumor grade. Furthermore, some commonly diagnosed squamous cell carcinomas are actually mucin-secreting adenocarcinomas or adenosquamous carcinomas. Thus, mucin could serve as a valuable marker for accurate histological diagnosis, early detection of malignant transformation, and prediction of prognosis.