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abstract
Aims
The
distinction between primary ovarian mucinous tumors and appendiceal
mucinous neoplasms metastatic to the ovary can be challenging given the
overlap of morphologic features and immunohistochemical expression of
traditional markers. SATB2 has been recently described as a sensitive
and specific marker of colorectal epithelium. Its expression in
appendiceal mucinous tumors and its role in their distinction from
ovarian neoplasms have not been fully characterized.
Methods and results
Immunohistochemistry
was performed in tissue microarrays from 32 primary appendiceal
mucinous tumors (25 low grade appendiceal mucinous neoplasms and 7
adenocarcinomas) and 40 ovarian mucinous neoplasms (20 borderline tumors
and 20 adenocarcinomas).
Stains were interpreted as positive or negative by scoring intensity and distribution. SATB2 was positive in 93.8% of appendiceal and only one ovarian tumor; SATB2 was 97.5% specific for appendiceal origin. CK20, CDX2 and MUC2 were strongly and diffusely positive in appendiceal tumors; ovarian tumors were also positive, but with a patchy distribution and mild intensity. CK7 was expressed in 97.5% ovarian and 31.2% of appendiceal tumors. PAX8 was positive in 70% of ovarian tumors, and negative in all appendiceal lesions.
Stains were interpreted as positive or negative by scoring intensity and distribution. SATB2 was positive in 93.8% of appendiceal and only one ovarian tumor; SATB2 was 97.5% specific for appendiceal origin. CK20, CDX2 and MUC2 were strongly and diffusely positive in appendiceal tumors; ovarian tumors were also positive, but with a patchy distribution and mild intensity. CK7 was expressed in 97.5% ovarian and 31.2% of appendiceal tumors. PAX8 was positive in 70% of ovarian tumors, and negative in all appendiceal lesions.
Conclusions
SATB2
is frequently expressed in appendiceal mucinous neoplasms. In the
context of a mucinous neoplasm involving the ovary, any SATB2 positivity
should raise the possibility of appendiceal origin. Expression of CK20,
CDX2 and MUC2 supports appendiceal origin only when diffuse and strong.
These and other markers such as CK7 and PAX8 are recommended in the
work-up of ovarian mucinous tumors with any clinical or pathologic
features suspicious for secondary origin.
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