Diagnostic utility of SATB2 in metastatic krukenberg tumors of the ovary: An immunohistochemical study of 70 cases with comparison to CDX2, CK7, CK20, Chromogranin, and synaptophysin

Chen Yang, Li Sun, Lingxin Zhang, Lixin Zhou, Ming Zhao, Yan Peng, Dongfeng Niu, Zhongwu Li, Xiaozheng Huang, Qiang Kang, Lin Jia, Jinping Lai, Dengfeng Cao

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

SATB2 is a sensitive marker for colorectal adenocarcinomas. No study has investigated its diagnostic utility in metastatic Krukenberg tumors (MKTs) of the ovary. Here we performed immunohistochemical staining SATB2 in 70 MKTs of various origins (stomach 27, colorectum 13, appendix 20 including 19 metastatic adenocarcinomas ex goblet cell carcinoids [AdexGCC] and 1 conventional poorly differentiated carcinoma with signet ring cells, breast 5, bladder 3, lung 2) to assess its diagnostic utility. We also compared SATB2 with CDX2, CK7, CK20, chromogranin, and synaptophysin in MKTs of gastric origin (MKTs-stomach), those of colorectal origin (MKTs-colorectum) and those due to appendiceal AdexGCCs (MKTAdexGCCs) for their sensitivity and specificity to distinguish these tumors. SATB2 staining was seen in 1/27 (4%) MKTsstomach (40% cells), 7/13 (54%) MKTs-colorectum (mean: 17% cells, median: 7%, range: 2% to 60%), and 19/19 (100%) of MKT-AdexGCCs (mean: 97% cells, median: 100%, range: 80% to 100%) (P < 0.01 between any two). SATB2 staining was seen in 1/1 metastatic appendiceal poorly differentiated carcinoma with signet ring cells (5% cells), 1/3 MKTs of bladder origin (60% cells), 0/2 MKTs of pulmonary origin, and 1/5 MKTs of breast origin (10% cells). SATB2 staining was diffuse strong in MKT-AdexGCCs whereas in other MKTs it was focal and weak in the signet ring and nonsignet ring nonglandular cells and from focal weak to diffuse strong in well-formed glands. MKTsstomach, MKTs-colorectum, and MKT-AdexGCCs showed no significant staining difference in CDX2 (100%, 100%, 100% cases, respectively; P=1.0), CK20 (96%, 100%, 100%, respectively; P=1.0), chromogranin (59%, 31%, 63%, respectively; P>0.05) or synaptophysin (59%, 63%, 84%, respectively; P>0.05) but they had significant difference in CK7 staining (93%, 8%, 42%, respectively; P < 0.05). Among these 6 markers, SATB2 is the best one to distinguish MKT-AdexGCCs from MKTs-stomach (100% sensitivity, 96% specificity) and MKTs-colorectum (100% sensitivity and 100% specificity if staining more than 75% tumor cells as the cutoff). In distinguishing MKTs-stomach from MKTs-colorectum, SATB2 is not as good as CK7 which is the best marker. Our results indicate that SATB2 is a highly sensitive marker (100% sensitivity) for metastatic MKT-AdexGCCs with high specificity (100% specificity when showing strong staining in at least 75% cells) among MKTs. SATB2 is a useful marker for determining the primary sites of MKTs of the ovary.

Original languageEnglish (US)
Pages (from-to)160-171
Number of pages12
JournalAmerican Journal of Surgical Pathology
Volume42
Issue number2
DOIs
StatePublished - Jan 1 2018

Fingerprint

Krukenberg Tumor
Chromogranins
Synaptophysin
Ovary
Stomach
Staining and Labeling
Sensitivity and Specificity
Adenocarcinoma
Signet Ring Cell Carcinoma

Keywords

  • Adenocarcinoma ex goblet cell carcinoid
  • Immunohistochemistry
  • Metastatic Krukenberg tumors
  • Ovary
  • SATB2

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

Diagnostic utility of SATB2 in metastatic krukenberg tumors of the ovary : An immunohistochemical study of 70 cases with comparison to CDX2, CK7, CK20, Chromogranin, and synaptophysin. / Yang, Chen; Sun, Li; Zhang, Lingxin; Zhou, Lixin; Zhao, Ming; Peng, Yan; Niu, Dongfeng; Li, Zhongwu; Huang, Xiaozheng; Kang, Qiang; Jia, Lin; Lai, Jinping; Cao, Dengfeng.

In: American Journal of Surgical Pathology, Vol. 42, No. 2, 01.01.2018, p. 160-171.

Research output: Contribution to journalArticle

Yang, Chen ; Sun, Li ; Zhang, Lingxin ; Zhou, Lixin ; Zhao, Ming ; Peng, Yan ; Niu, Dongfeng ; Li, Zhongwu ; Huang, Xiaozheng ; Kang, Qiang ; Jia, Lin ; Lai, Jinping ; Cao, Dengfeng. / Diagnostic utility of SATB2 in metastatic krukenberg tumors of the ovary : An immunohistochemical study of 70 cases with comparison to CDX2, CK7, CK20, Chromogranin, and synaptophysin. In: American Journal of Surgical Pathology. 2018 ; Vol. 42, No. 2. pp. 160-171.
@article{f1f4b3b756b54e4785e2ba36dcd857df,
title = "Diagnostic utility of SATB2 in metastatic krukenberg tumors of the ovary: An immunohistochemical study of 70 cases with comparison to CDX2, CK7, CK20, Chromogranin, and synaptophysin",
abstract = "SATB2 is a sensitive marker for colorectal adenocarcinomas. No study has investigated its diagnostic utility in metastatic Krukenberg tumors (MKTs) of the ovary. Here we performed immunohistochemical staining SATB2 in 70 MKTs of various origins (stomach 27, colorectum 13, appendix 20 including 19 metastatic adenocarcinomas ex goblet cell carcinoids [AdexGCC] and 1 conventional poorly differentiated carcinoma with signet ring cells, breast 5, bladder 3, lung 2) to assess its diagnostic utility. We also compared SATB2 with CDX2, CK7, CK20, chromogranin, and synaptophysin in MKTs of gastric origin (MKTs-stomach), those of colorectal origin (MKTs-colorectum) and those due to appendiceal AdexGCCs (MKTAdexGCCs) for their sensitivity and specificity to distinguish these tumors. SATB2 staining was seen in 1/27 (4{\%}) MKTsstomach (40{\%} cells), 7/13 (54{\%}) MKTs-colorectum (mean: 17{\%} cells, median: 7{\%}, range: 2{\%} to 60{\%}), and 19/19 (100{\%}) of MKT-AdexGCCs (mean: 97{\%} cells, median: 100{\%}, range: 80{\%} to 100{\%}) (P < 0.01 between any two). SATB2 staining was seen in 1/1 metastatic appendiceal poorly differentiated carcinoma with signet ring cells (5{\%} cells), 1/3 MKTs of bladder origin (60{\%} cells), 0/2 MKTs of pulmonary origin, and 1/5 MKTs of breast origin (10{\%} cells). SATB2 staining was diffuse strong in MKT-AdexGCCs whereas in other MKTs it was focal and weak in the signet ring and nonsignet ring nonglandular cells and from focal weak to diffuse strong in well-formed glands. MKTsstomach, MKTs-colorectum, and MKT-AdexGCCs showed no significant staining difference in CDX2 (100{\%}, 100{\%}, 100{\%} cases, respectively; P=1.0), CK20 (96{\%}, 100{\%}, 100{\%}, respectively; P=1.0), chromogranin (59{\%}, 31{\%}, 63{\%}, respectively; P>0.05) or synaptophysin (59{\%}, 63{\%}, 84{\%}, respectively; P>0.05) but they had significant difference in CK7 staining (93{\%}, 8{\%}, 42{\%}, respectively; P < 0.05). Among these 6 markers, SATB2 is the best one to distinguish MKT-AdexGCCs from MKTs-stomach (100{\%} sensitivity, 96{\%} specificity) and MKTs-colorectum (100{\%} sensitivity and 100{\%} specificity if staining more than 75{\%} tumor cells as the cutoff). In distinguishing MKTs-stomach from MKTs-colorectum, SATB2 is not as good as CK7 which is the best marker. Our results indicate that SATB2 is a highly sensitive marker (100{\%} sensitivity) for metastatic MKT-AdexGCCs with high specificity (100{\%} specificity when showing strong staining in at least 75{\%} cells) among MKTs. SATB2 is a useful marker for determining the primary sites of MKTs of the ovary.",
keywords = "Adenocarcinoma ex goblet cell carcinoid, Immunohistochemistry, Metastatic Krukenberg tumors, Ovary, SATB2",
author = "Chen Yang and Li Sun and Lingxin Zhang and Lixin Zhou and Ming Zhao and Yan Peng and Dongfeng Niu and Zhongwu Li and Xiaozheng Huang and Qiang Kang and Lin Jia and Jinping Lai and Dengfeng Cao",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/PAS.0000000000000951",
language = "English (US)",
volume = "42",
pages = "160--171",
journal = "American Journal of Surgical Pathology",
issn = "0147-5185",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Diagnostic utility of SATB2 in metastatic krukenberg tumors of the ovary

T2 - An immunohistochemical study of 70 cases with comparison to CDX2, CK7, CK20, Chromogranin, and synaptophysin

AU - Yang, Chen

AU - Sun, Li

AU - Zhang, Lingxin

AU - Zhou, Lixin

AU - Zhao, Ming

AU - Peng, Yan

AU - Niu, Dongfeng

AU - Li, Zhongwu

AU - Huang, Xiaozheng

AU - Kang, Qiang

AU - Jia, Lin

AU - Lai, Jinping

AU - Cao, Dengfeng

PY - 2018/1/1

Y1 - 2018/1/1

N2 - SATB2 is a sensitive marker for colorectal adenocarcinomas. No study has investigated its diagnostic utility in metastatic Krukenberg tumors (MKTs) of the ovary. Here we performed immunohistochemical staining SATB2 in 70 MKTs of various origins (stomach 27, colorectum 13, appendix 20 including 19 metastatic adenocarcinomas ex goblet cell carcinoids [AdexGCC] and 1 conventional poorly differentiated carcinoma with signet ring cells, breast 5, bladder 3, lung 2) to assess its diagnostic utility. We also compared SATB2 with CDX2, CK7, CK20, chromogranin, and synaptophysin in MKTs of gastric origin (MKTs-stomach), those of colorectal origin (MKTs-colorectum) and those due to appendiceal AdexGCCs (MKTAdexGCCs) for their sensitivity and specificity to distinguish these tumors. SATB2 staining was seen in 1/27 (4%) MKTsstomach (40% cells), 7/13 (54%) MKTs-colorectum (mean: 17% cells, median: 7%, range: 2% to 60%), and 19/19 (100%) of MKT-AdexGCCs (mean: 97% cells, median: 100%, range: 80% to 100%) (P < 0.01 between any two). SATB2 staining was seen in 1/1 metastatic appendiceal poorly differentiated carcinoma with signet ring cells (5% cells), 1/3 MKTs of bladder origin (60% cells), 0/2 MKTs of pulmonary origin, and 1/5 MKTs of breast origin (10% cells). SATB2 staining was diffuse strong in MKT-AdexGCCs whereas in other MKTs it was focal and weak in the signet ring and nonsignet ring nonglandular cells and from focal weak to diffuse strong in well-formed glands. MKTsstomach, MKTs-colorectum, and MKT-AdexGCCs showed no significant staining difference in CDX2 (100%, 100%, 100% cases, respectively; P=1.0), CK20 (96%, 100%, 100%, respectively; P=1.0), chromogranin (59%, 31%, 63%, respectively; P>0.05) or synaptophysin (59%, 63%, 84%, respectively; P>0.05) but they had significant difference in CK7 staining (93%, 8%, 42%, respectively; P < 0.05). Among these 6 markers, SATB2 is the best one to distinguish MKT-AdexGCCs from MKTs-stomach (100% sensitivity, 96% specificity) and MKTs-colorectum (100% sensitivity and 100% specificity if staining more than 75% tumor cells as the cutoff). In distinguishing MKTs-stomach from MKTs-colorectum, SATB2 is not as good as CK7 which is the best marker. Our results indicate that SATB2 is a highly sensitive marker (100% sensitivity) for metastatic MKT-AdexGCCs with high specificity (100% specificity when showing strong staining in at least 75% cells) among MKTs. SATB2 is a useful marker for determining the primary sites of MKTs of the ovary.

AB - SATB2 is a sensitive marker for colorectal adenocarcinomas. No study has investigated its diagnostic utility in metastatic Krukenberg tumors (MKTs) of the ovary. Here we performed immunohistochemical staining SATB2 in 70 MKTs of various origins (stomach 27, colorectum 13, appendix 20 including 19 metastatic adenocarcinomas ex goblet cell carcinoids [AdexGCC] and 1 conventional poorly differentiated carcinoma with signet ring cells, breast 5, bladder 3, lung 2) to assess its diagnostic utility. We also compared SATB2 with CDX2, CK7, CK20, chromogranin, and synaptophysin in MKTs of gastric origin (MKTs-stomach), those of colorectal origin (MKTs-colorectum) and those due to appendiceal AdexGCCs (MKTAdexGCCs) for their sensitivity and specificity to distinguish these tumors. SATB2 staining was seen in 1/27 (4%) MKTsstomach (40% cells), 7/13 (54%) MKTs-colorectum (mean: 17% cells, median: 7%, range: 2% to 60%), and 19/19 (100%) of MKT-AdexGCCs (mean: 97% cells, median: 100%, range: 80% to 100%) (P < 0.01 between any two). SATB2 staining was seen in 1/1 metastatic appendiceal poorly differentiated carcinoma with signet ring cells (5% cells), 1/3 MKTs of bladder origin (60% cells), 0/2 MKTs of pulmonary origin, and 1/5 MKTs of breast origin (10% cells). SATB2 staining was diffuse strong in MKT-AdexGCCs whereas in other MKTs it was focal and weak in the signet ring and nonsignet ring nonglandular cells and from focal weak to diffuse strong in well-formed glands. MKTsstomach, MKTs-colorectum, and MKT-AdexGCCs showed no significant staining difference in CDX2 (100%, 100%, 100% cases, respectively; P=1.0), CK20 (96%, 100%, 100%, respectively; P=1.0), chromogranin (59%, 31%, 63%, respectively; P>0.05) or synaptophysin (59%, 63%, 84%, respectively; P>0.05) but they had significant difference in CK7 staining (93%, 8%, 42%, respectively; P < 0.05). Among these 6 markers, SATB2 is the best one to distinguish MKT-AdexGCCs from MKTs-stomach (100% sensitivity, 96% specificity) and MKTs-colorectum (100% sensitivity and 100% specificity if staining more than 75% tumor cells as the cutoff). In distinguishing MKTs-stomach from MKTs-colorectum, SATB2 is not as good as CK7 which is the best marker. Our results indicate that SATB2 is a highly sensitive marker (100% sensitivity) for metastatic MKT-AdexGCCs with high specificity (100% specificity when showing strong staining in at least 75% cells) among MKTs. SATB2 is a useful marker for determining the primary sites of MKTs of the ovary.

KW - Adenocarcinoma ex goblet cell carcinoid

KW - Immunohistochemistry

KW - Metastatic Krukenberg tumors

KW - Ovary

KW - SATB2

UR - http://www.scopus.com/inward/record.url?scp=85043715310&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85043715310&partnerID=8YFLogxK

U2 - 10.1097/PAS.0000000000000951

DO - 10.1097/PAS.0000000000000951

M3 - Article

C2 - 28914716

AN - SCOPUS:85043715310

VL - 42

SP - 160

EP - 171

JO - American Journal of Surgical Pathology

JF - American Journal of Surgical Pathology

SN - 0147-5185

IS - 2

ER -