SATB2 is not a reliable diagnostic marker for distinguishing between oral osteosarcoma and fibro-osseous lesions of the jaws

Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 May;131(5):572-581. doi: 10.1016/j.oooo.2020.10.025. Epub 2020 Nov 4.


Objective: Special AT-rich binding protein 2 (SATB2) is an immunohistochemical marker for osteoblast differentiation. Our aim was to investigate SATB2 expression in oral osteosarcoma and other bone-producing oral tumors/reactive lesions to evaluate its usefulness as a diagnostic marker.

Study design: A total of 74 intraosseous and soft tissue bone-producing surgical samples and 10 samples of reactive bone tissue were stained with SATB2, including osteosarcoma/chondrosarcoma (n = 16), fibro-osseous lesions (n = 42), central giant cell granuloma (n = 6), osteoblastoma (n = 1), and gingival lesions (n = 9). Nuclear labeling of the stromal spindle cells and intensity of staining was scored and analyzed.

Results: The intraosseous (n = 65/65) and soft tissue samples (n = 9/9) diffusely expressed SATB2. The strongest expression was observed in juvenile aggressive ossifying fibroma (n = 2/2). Weak SATB2 expression was observed in the stromal spindle cells adjacent to reactive bone tissue (periosteal bone reaction).

Conclusions: Our results indicate that SATB2 is not a reliable diagnostic marker for oral osteosarcoma but has practical use in detecting cells with osteoblast differentiation in histologic samples with scant bone production or in differentiating between a periosteal bone reaction and neoplastic bone induced by the tumor mesenchymal cells. Targeting SATB2 as an alternative therapy in oral osteosarcoma, fibro-osseous lesions, and central giant cell granuloma should be further investigated.

MeSH terms

  • Biomarkers, Tumor
  • Bone Neoplasms* / diagnosis
  • Humans
  • Jaw
  • Matrix Attachment Region Binding Proteins*
  • Mouth Neoplasms* / diagnosis
  • Osteosarcoma* / diagnosis
  • Transcription Factors


  • Biomarkers, Tumor
  • Matrix Attachment Region Binding Proteins
  • SATB2 protein, human
  • Transcription Factors