Stains & CD markers
Special AT-rich sequence-binding protein 2 (SATB2)

Editorial Board Member: Christian M. Schürch, M.D., Ph.D.
Deputy Editor-in-Chief: Raul S. Gonzalez, M.D.
Simona De Michele, M.D.
Helen E. Remotti, M.D.

Topic Completed: 21 June 2021

Minor changes: 21 June 2021

Copyright: 2017-2021, PathologyOutlines.com, Inc.

PubMed Search: SATB2 [TI] free full text [sb] pathology

Simona De Michele, M.D.
Helen E. Remotti, M.D.
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Cite this page: De Michele S, Remotti HE. Special AT-rich sequence-binding protein 2 (SATB2). PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stainssatb2.html. Accessed July 31st, 2021.
Definition / general
  • First identified in 2002 and characterized as a gene involved in cleft palate defects (Arch Pathol Lab Med 2017;141:1428)
  • Part of the matrix attachment region binding transcription factor family, which consists of transcription factors binding to adenine and thymine (AT) rich regions in the nuclear matrix, capable of altering the chromatin structure (Arch Pathol Lab Med 2017;141:1428)
Essential features
  • Nuclear marker normally expressed by epithelium of the lower gastrointestinal tract, brain, nongerminal center lymphoid cells, ductal epithelium of the testis and epididymis
  • High sensitivity and specificity for colorectal and appendiceal neoplasms; also can help diagnose osteosarcoma
  • Useful in an immunostaining panel of tumor of unknown primary to rule in colorectal metastasis (Am J Clin Pathol 2021;155:124)
  • Can be expressed in a subset of upper gastrointestinal adenocarcinomas; is rarely expressed in lung adenocarcinomas and pancreatobiliary neoplasms (Am J Clin Pathol 2021;155:124)
  • In contrast to CDX2, SATB2 positivity is rare in mucinous and enteric pulmonary adenocarcinomas
Pathophysiology
Diagrams / tables

Images hosted on other servers:
SATB2 immunohistochemistry in a large cohort of mucinous and nonmucinous adenocarcinomas

SATB2 IHC: mucinous and nonmucinous adenocarcinomas

Caption

SATB2 / CDX2 expression in mucinous tumors

Optimal SATB2 H score threshold to separate colonic and noncolonic adenocarcinomas

SATB2 H score: colonic and noncolonic adenocarcinomas

SATB2 literature review

SATB2 literature review

SATB2 expression in well differentiated neuroendocrine tumors and pheochromocytoma / paraganglioma

SATB2 expression
in WD NET /
pheochromocytoma
/ paraganglioma

Clinical features
  • Alterations of SATB2 gene (including intragenic duplication, deletions and point mutations in 2q32-q33) have been associated with SATB2 associated syndrome (SAS) (Am J Med Genet A 2014;164A:3083)
  • Phenotype is characterized by intellectual disability and craniofacial abnormalities, including cleft palate, dysmorphic features and dental abnormalities (Am J Med Genet A 2015;167A:1026)
Interpretation
  • Nuclear stain
Uses by pathologists
  • Differentiate colorectal carcinomas (SATB2+) from many other metastatic adenocarcinomas
  • Differentiate colorectal metastasis (SATB2+) from primary pulmonary adenocarcinoma of mucinous or enteric type (SATB2- but often CDX2+)
  • Differentiate metastatic colorectal adenocarcinomas (SATB2+) from pancreatobiliary neoplasms (SATB2-) (Am J Clin Pathol 2021;155:124)
  • Differentiate ovarian metastases of colorectal and appendiceal origin (SATB2+) from primary ovarian tumors of mucinous or endometrioid type (SATB2-) (Am J Surg Pathol 2016;40:419)
  • Differentiate osteosarcomas (SATB2+) from their malignant bone tumor mimickers, such as Ewing sarcomas (SATB2-) (Pathol Res Pract 2016;212:811)
  • As part of a panel in tumors of unknown origin (Pathol Res Pract 2016;212:811)
Prognostic factors
  • Higher SATB2 expression is associated with better prognosis and response to chemotherapy in metastatic colorectal carcinomas (Acta Oncol 2020;59:284)
  • Low SATB2 expression and mutated BRAF are associated with particularly poor prognosis (Acta Oncol 2020;59:284)
Microscopic (histologic) images

Contributed by Simona De Michele, M.D., Sepideh Besharati, M.D. and Anjali Saqi, M.D.
SATB2 control

SATB2 control

Mucinous adenocarcinoma of colon, moderately differentiated Mucinous adenocarcinoma of colon, moderately differentiated

Mucinous adenocarcinoma of colon, moderately differentiated

Colon adenocarcinoma, moderately differentiated Colon adenocarcinoma, moderately differentiated

Colon adenocarcinoma, moderately differentiated


Colon neuroendocrine tumor, well differentiated Colon neuroendocrine tumor, well differentiated

Colon neuroendocrine tumor, well differentiated

High grade osteosarcoma High grade osteosarcoma

High grade osteosarcoma

Rare case of SATB2+ mucinous lung adenocarcinoma Rare case of SATB2+ mucinous lung adenocarcinoma

Rare case of SATB2+ mucinous lung adenocarcinoma

Positive staining - normal
Positive staining - disease
Negative staining
Board review style question #1

When evaluating the pulmonary neoplasm shown in the image, which immunohistochemical stain is more specific than CDX2 in ruling in a colorectal metastasis?

  1. CK7
  2. CK20
  3. Napsin A
  4. SATB2
  5. TTF1
Board review style answer #1
D. SATB2

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