Application Of SATB2,CDX2,CK20 And Villin In The Diagnosis Of Ovarian And Appendicular Mucinous Tumors

Objective:Primary mucous tumors of the ovary(primary mucinous tumors,PMT)is a common epithelial ovarian tumor,but ovarian primary mucinous carcinoma is relatively rare,only accounts for only 3% of ovarian cancer.The most common part of the mucinous tumor involving the ovarian tissue,which mainly comes from gastrointestinal tumor.Especially metastatic mucinous ovarian tumors(MMN),which looks like benign,border line or malignant in morphology,are easily misdiagnosed and have serious consequences for these patients,so to identify ovarian primary and secondary mucinous tumors and to uncover the source of the ovarian mucinous tumor has important clinical significance.The identification of the primary site of peritoneal and pelvic mucinous neoplasms is challenging,including appendiceal mucinous neoplasms(AMN)and ovarian mucinous neoplasms(OMN).Due to the limitations of the pathological characteristics of tumors,immunohistochemical markers are often used as an auxiliary diagnostic tool for ovarian mucinous tumors,including the traditionally used markers CK7,CK20,CDX2,PAX8,MUC2,Villin and in the lower digestive tract(including the appendix The specific AT sequence binding protein 2(SATB2)that is highly selectively expressed.Methods:Immunohistochemical single and dual staining(DS)of specific AT sequence binding protein 2(SATB 2)and caudate homeobox 2(CDX2)and cytokeratin 20(CK 20)and Villin were studied in the identification of appendiceal mucinous neoplasms and ovarian mucinous neoplasms applications.The object of study selected 43 cases of ovarian mucinous neoplasms and 11 cases of appendiceal mucinous neoplasms(benign,borderline and malignant mucinous tumors)and 10 cases of normal ovarian tissue(uterus benign disease underwent hysterectomy plus bilateral adnexal)were SATB 2,CDX2,CK20,Villin immunohistochemical staining,and SATB 2 or CDX2 respectively with CK 20 or Villin with double staining.The sensitivity and specificity of SATB 2,CDX2,CK 20,Villin single staining and SATB 2 or CDX2 were combined with CK 20 or Villin in ovarian mucinous neoplasms and appendiceal mucinous neoplasms.Results:SATB 2,CDX2,CK 20,Villin single staining and SATB 2 or CDX2 respectively with CK 20 or Villin with double staining in the diagnosis of ovarian mucinous neoplasms and appendiceal mucinous neoplasms,the highest specificity of SATB2 was 79% in immunohistochemistry single staining,and the sensitivity was 82%;the sensitivity of SATB 2 and Villin with double staining was 73%,the specificity increased to 93%;the sensitivity of SATB 2 and CK 20 with double staining was 73%,and specificity was100%;in contrast,CDX2 and CK 20/Villin with double staining although slightly higher sensitivity(91%/82%),but the specificity is low(56%).Conclusion:1.This experiment proved that the expression of SATB2,CK20,CDX2,Villin immuno histochemical mono staining and SATB2 or CDX2 in combination with CK20 or Villin in both ovarian mucinous neoplasms and appendiceal mucinous neoplasms were significantly different.Combination of SATB2,CK20,CDX2 and Villin double staining is helpful for differential diagnosis of ovarian mucinous neoplasms and appendiceal mucinous neoplasms.2.SATB 2/CK 20 compatible double staining has the greatest clinical value in differential diagnosis of ovarian mucinous neoplasms and appendiceal mucinous neoplasms,SATB2/CK20 double staining is better than any single staining or any other dual staining in distinguishing AMNS and OMNs.3.more importantly,the double staining of immunohistochemistry can help the limited tissue specimen to complete the identification work.