Diagnostic Utility of SATB2, CDX2, CD10, and β-Catenin Immunohistochemistry in WNT Pathway-Altered Odontogenic Tumors

Although WNT pathway-altered odontogenic tumors (WNT-OTs) are a genetically distinct group of odontogenic tumors (OTs), they may histologically resemble other OTs.

To investigate the utility of immunohistochemical markers in the diagnosis of WNT-OTs.

Immunohistochemistry for SATB2 (SATB homeobox 2), CDX2 (caudal type homeobox 2), CD10, and β-catenin was performed in 37 OTs consisting of 19 WNT-OTs (10 calcifying odontogenic cysts, 7 dentinogenic ghost cell tumors [DGCTs]/adenoid ameloblastomas [AAs], 2 ghost cell odontogenic carcinomas) and 18 non-WNT-OTs (7 unicystic ameloblastomas, 7 solid/multicystic ameloblastomas, 4 ameloblastic carcinomas).

All WNT-OTs were positive for SATB2, whereas all but 1 of the non-WNT-OTs were SATB2-negative, resulting in a sensitivity of 100% (19 of 19) and a specificity of 94.4% (17 of 18) for WNT-OTs. About two-thirds of WNT-OTs were positive for CDX2, whereas all non-WNT-OTs were CDX2-negative, resulting in a lower sensitivity of 63.2% (12 of 19) and a specificity of 100% (18 of 18). Although both CD10 and β-catenin showed 100% sensitivity (19 of 19), their specificities were low at 16.7% (3 of 18) and 44.4% (8 of 18), respectively; nevertheless, CD10 highlighted morular structures in most WNT-OTs. No differences in immunohistochemical profiles were observed between DGCT and AA.

This study presents novel findings on the immunoreactivity of intestinal markers SATB2 and CDX2 in WNT-OTs. SATB2 is a sensitive and specific marker for the diagnosis of WNT-OTs, and CDX2 and CD10 may serve as additional markers for WNT-OTs. Additionally, the immunohistochemical similarities between DGCT and AA further support the view that these 2 tumors represent the histologic spectrum of the same entity.