The Role of SATB2 as a Diagnostic Marker of Sinonasal Intestinal-type Adenocarcinoma.
Intestinal-type adenocarcinoma (ITAC) of the nasal cavity and paranasal sinuses is an uncommon tumor associated with exposure to wood and leather dust, nickel, and possibly smoking. ITAC shares phenotypical features with colorectal carcinoma. In contrast to most non-intestinal-type sinonasal adenocarcinomas, ITAC is an aggressive adenocarcinoma with poor clinical outcome; therefore, its reliable separation from non-ITAC is very important.



The use of a combination of immunohistochemical markers of intestinal differentiation was tested in a cohort of sinonasal carcinomas of different types. The aim of this study was to explore a new intestinal marker, SATB2, in conjunction with CDX2 and CK20 in differential diagnosis of sinonasal adenocarcinomas.



Seven ITACs, 66 non-ITACs, and 1 case of extensive intestinal metaplasia (IM) of the nasal mucosa were included in the study and stained with SATB2, CK20, CDX2, and CK7 antibodies. Detection of mismatch repair proteins was performed in all cases of ITAC. All 7 sinonasal ITACs have been tested for KRAS, NRAS, and BRAF gene mutations.



All ITACs showed positive expression for SATB2, whereas all non-ITAC cases were negative. The only 1 case of IM was found to be positive for SATB2, whereas the same case showed negative expression of CK20 and only focal immunostaining for CDX2. The genetic analysis showed that only 1 sinonasal ITAC (1/7) showed KRAS c.35G>C, p.(Gly12Ala) mutation, whereas BRAF and NRAS genes were wild type. Four ITACs revealed wild-type KRAS, NRAS, and BRAF, and 2 remaining cases were not analyzable. All ITACs showed preserved nuclear expression of mismatch repair proteins.



SATB2 in combination with CDX2 and CK20 differentiates sinonasal ITAC from non-ITAC with increased diagnostic sensitivity and specificity and detects IM in the sinonasal tract more easily.
Department of Pathology, Charles University in Prague, Faculty of Medicine in Plzen, Plzen, Czech Republic.|Biopticka Lab, Plzen, Czech Republic.
Alena
A
Skalova
Department of Pathology, University of Calgary, Calgary, AB, Canada.
Aylin
A
Sar
The Fingerland Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic.
Jan
J
Laco
Oncological Clinic, Charles University in Prague, Faculty of Medicine in Plzen, Plzen, Czech Republic.
Alena
A
Metelkova
Department of Pathology, Charles University in Prague, Faculty of Medicine in Plzen, Plzen, Czech Republic.
Marketa
M
Miesbauerova
Department of Pathology, Charles University in Prague, Faculty of Medicine in Plzen, Plzen, Czech Republic.|Molecular Pathology Laboratory, Bioptic Laboratory Ltd, Plzen, Czech Republic.
Petr
P
Steiner
Department of Pathology, Charles University in Prague, Faculty of Medicine in Plzen, Plzen, Czech Republic.|Biopticka Lab, Plzen, Czech Republic.
Marian
M
Švajdler
Department of Pathology, Charles University in Prague, Faculty of Medicine in Plzen, Plzen, Czech Republic.
Michal
M
Michal
D000230:Adenocarcinoma / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D000071616:CDX2 Transcription Factor / Q000378:metabolism; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology; D003937:Diagnosis, Differential; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007422:Intestines / Q000473:pathology*; D053554:Keratin-20 / Q000378:metabolism; D008297:Male; D036961:Matrix Attachment Region Binding Proteins / Q000378:metabolism*; D008679:Metaplasia; D008875:Middle Aged; D009296:Nasal Cavity / Q000473:pathology; D009669:Nose Neoplasms / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology; D010256:Paranasal Sinuses / Q000473:pathology; D011379:Prognosis; D014157:Transcription Factors / Q000378:metabolism*; D014934:Wood
D014408:Biomarkers, Tumor; D000071616:CDX2 Transcription Factor; C491270:CDX2 protein, human; C507499:KRT20 protein, human; D053554:Keratin-20; D036961:Matrix Attachment Region Binding Proteins; C521297:SATB2 protein, human; D014157:Transcription Factors