J Pathol Transl Med.  2022 Sep;56(5):270-280. 10.4132/jptm.2022.07.11.

Special AT-rich sequence-binding protein 2 (SATB2) in the differential diagnosis of osteogenic and non-osteogenic bone and soft tissue tumors

• Milton S
• Prabhu AJ
• Titus VTK
• John R
• Backianathan S
• Madhuri V

• KMID: 2533703
• DOI: http://doi.org/10.4132/jptm.2022.07.11

Abstract

Background
The diagnosis of osteosarcoma (OSA) depends on clinicopathological and radiological correlation. A biopsy is considered the gold standard for OSA diagnosis. However, since OSA is a great histological mimicker, diagnostic challenges exist. Immunohistochemistry (IHC) can serve as an adjunct for the histological diagnosis of OSA. Special AT-rich sequence-binding protein 2 (SATB2) was recently described as a reliable adjunct immunohistochemical marker for the diagnosis of OSA.
Methods
We investigated the IHC expression of SATB2 in 95 OSA and 100 non-osteogenic bone and soft tissue tumors using a monoclonal antibody (clone EPNCIR30A). The diagnostic utility of SATB2 and correlation with clinicopathological parameters were analyzed.
Results
SATB2 IHC was positive in 88 out of 95 cases (92.6%) of OSA and 50 out of 100 cases (50.0%) of primary non-osteogenic bone and soft tissue tumors. Of the 59 bone tumors, 37 cases (62.7%) were positive for SATB2, and of the 41 soft tissue tumors, 13 cases (31.7%) were positive for SATB2. The sensitivity of SATB2 as a diagnostic test was 92.6%, specificity 50%, positive predictive value 63.8%, and negative predictive value 87.7%.
Conclusions
Although SATB2 is a useful diagnostic marker for OSA, other clinical, histological and immunohistochemical features should be considered for the interpretation of SATB2.

Keyword

protein; Osteosarcoma; Immunohistochemistry; Osteoid; Non-osteogenic

Figure

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  Fig. 1 Special AT-rich sequence-binding protein 2 (SATB2) immunostaining in neoplastic cells in conventional osteosarcoma. (A) Fibroblastic osteosarcoma, 1+ strong SATB2 in spindle cells. (B) Chondroblastic osteosarcoma, 2+ weak SATB2 in malignant chondrocytes. (C) Osteoblastic osteosarcoma, 3+ moderate SATB2 in spindle cells. (D) Telangiectatic osteosarcoma, 4+ strong SATB2 in spindle cells. (E) Osteoblastic osteosarcoma, 5+ strong SATB2 in spindle cells. (F) Chondroblastic osteosarcoma, negative for SATB2 in chondrocytes and spindle cells.

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  Fig. 2 Histological subtypes of osteosarcoma: (A) osteoblastic osteosarcoma, (B) chondroblastic osteosarcoma, (C) fibroblastic osteosarcoma, (D) giant cell-rich osteosarcoma, and (E) telangiectatic osteosarcoma.

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  Fig. 3 Special AT-rich sequence-binding protein 2 (SATB2) immunostaining in non-osteogenic bone tumors. (A, B) Aneurysmal bone cyst, 3+ strong SATB2. (C, D) Giant cell tumor, 4+ strong SATB2. (E, F) Chondroblastoma 3+ strong SATB2. (G, H) Fibrous dysplasia, 5+ strong SATB2. (I, J) Chondrosarcoma, 1+ weak SATB2. (K, L) Adamantinoma, 4+ strong SATB2.

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  Fig. 4 Special AT-rich sequence-binding protein 2 (SATB2) immunostaining in non-osteogenic soft tissue tumors. (A, B) Undifferentiated pleomorphic sarcoma, 2+ weak SATB2. (C, D) Fibromatosis, 3+ weak SATB2. (E, F) Malignant peripheral nerve sheath tumor, 3+ moderate SATB2. (G, H) Intermediate grade leiomyosarcoma, 3+ moderate SATB2. (I, J) Synovial sarcoma, 4+ moderate SATB2.

Reference

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