Summary
SATB2 can be used as an immunohistochemical marker for osteoblastic differentiation.
The differential diagnosis of a cutaneous sarcomatoid neoplasm sometimes includes
osteosarcoma when the tumour concomitantly involves the skin, soft tissue, and bone,
or when there is a past medical history of osteosarcoma. As the utility of SATB2 immunohistochemistry
in these scenarios was unclear, we aimed to determine the frequency and the pattern
of SATB2 expression in a variety of cutaneous sarcomatoid neoplasms. SATB2 expression
by immunohistochemistry was evaluated by intensity (0–3) and extent (0–100%) of staining
to generate an h-score for each case. Expression levels were classified into high-positive
(h-score ≥100), low-positive (20–99), and negative (<20) groups. Positive SATB2 expression
was observed in 18/23 (78%) atypical fibroxanthomas (AFX), 10/19 (53%) pleomorphic
dermal sarcomas, 9/20 (45%) cutaneous sarcomatoid squamous cell carcinomas, 14/39
(36%) sarcomatoid melanomas, 2/13 (15%) poorly differentiated cutaneous angiosarcomas,
10/17 (59%) high-grade cutaneous leiomyosarcomas, and 7/8 (88%) osteosarcoma controls.
With the exception of AFX, all cutaneous neoplasms showed significantly lower average
h-scores than osteosarcoma. AFX gave the highest average h-score (71) and percentage
of high-positive cases (48%) among all examined cutaneous neoplasms. Only two (1.5%)
of all cutaneous cases showed strong intensity of staining. Common SATB2 expression
in various cutaneous sarcomatoid neoplasms poses a potential diagnostic pitfall when
the differential diagnosis includes osteosarcoma. Requirement of strong staining and
a high-positive h-score improves the specificity of SATB2 in differentiating these
tumours from osteosarcoma.
Key words
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Article info
Publication history
Published online: January 31, 2023
Accepted:
October 21,
2022
Received in revised form:
October 13,
2022
Received:
August 8,
2022
Identification
Copyright
© 2023 Royal College of Pathologists of Australasia. Published by Elsevier B.V. All rights reserved.
