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.
Author notes
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. RS-2023-00212868).
Competing Interests
The authors have no relevant financial interest in the products or companies described in this article.
This work was presented orally at the 36th European Congress of Pathology; September 7–11, 2024; Florence, Italy.
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