High-grade transformation (HGT) or dedifferentiation has been described in a variety of salivary gland carcinomas, including acinic cell carcinoma, secretory carcinoma, adenoid cystic carcinoma, epithelial-myoepithelial carcinoma, polymorphous adenocarcinoma, low-grade mucoepidermoid carcinoma, and hyalinizing clear cell carcinoma. High-grade (HG) transformed tumors are composed of a conventional low-grade component characterized by specific microscopic and immunohistochemical features for the given entity, intermingled with or juxtaposed to areas of HG morphology. This is usually either poorly differentiated adenocarcinoma, carcinoma not otherwise specified, or undifferentiated carcinoma, in which the original line of differentiation is lost. The HG component is composed of solid nests of anaplastic cells with large vesicular pleomorphic nuclei, prominent nucleoli, and abundant cytoplasm. Frequent mitoses and extensive necrosis may be present. The Ki-67 labeling index is consistently higher in the HG component. The molecular genetic mechanisms responsible for HGT of salivary gland carcinomas are largely unknown, though p53 inactivation and human epidermal growth factor receptor 2 overexpression and/or gene amplification have been demonstrated in the HG component in a few examples, the frequency varies for each histologic type. Salivary gland carcinomas with HGT are more aggressive than conventional carcinomas, with a higher local recurrence rate and a poorer prognosis. They have a high propensity for cervical lymph node metastasis suggesting a need for a wider resection and neck dissection. HGT of salivary gland carcinoma can occur either at initial presentation or less commonly at the time of recurrence, sometimes following postoperative radiotherapy. The potential for HGT in almost any type of salivary gland carcinoma warrants a thorough sampling of all salivary gland malignancies to prevent oversight of a HG component.

Department of Anatomical Pathology University of Calgary Calgary AB Canada

Department of Biomedical Sciences and Medicine Epigenetics and Human Disease University of Algarve Faro Portugal

Department of Oncology Section Head and Neck Oncology KU Leuven Leuven Belgium

Department of Otorhinolaryngology Mayo Clinic Rochester MN

Department of Pathology and Medical Biology University Medical Center Groningen Groningen The Netherlands

Department of Pathology Moffitt Cancer Center Tampa FL

Department of Pathology Sahlgrenska Center for Cancer Research Sahlgrenska University Hospital University of Gothenburg Gothenburg Sweden

Department of Pathology Turku University Hospital Turku Finland

Department of Pathology University of Texas Southwestern Medical Center Dallas TX

Department of Translational Research and of New Technologies in Medicine and Surgery University of Pisa Pisa

Departments of Pathology

Institute of Biomedicine Pathology University of Turku

Institute of Pathology Friedrich Alexander University Erlangen Nürnberg University Hospital Erlangen Germany

International Head and Neck Scientific Group Padua Italy

Otorhinolaryngology Charles University Faculty of Medicine in Plzen Plzen Czech Republic

Otorhinolaryngology Head and Neck Surgery University Hospitals Leuven

See more in PubMed

Dahlin DC, Beabout JW. Dedifferentiation of low-grade chondrosarcomas. Cancer. 1971;28:461–466.

Meis JM. “Dedifferentiation” in bone and soft tissue tumors: a histological indicator of tumor progression. Pathol Annu. 1991;26:37–62.

Stanley RJ, Weiland LH, Olsen KD, et al. Dedifferentiated acinic cell (acinous) carcinoma of the parotid gland. Otolaryngol Head Neck Surg. 1988;98:155–161.

Henley JD, Geary WA, Jackson CL, et al. Dedifferentiated acinic cell carcinoma of the parotid gland: a distinct rarely described entity. Hum Pathol. 1997;28:869–873.

Di Palma S, Corletto V, Lavarino C, et al. Unilateral aneuploid dedifferentiated acinic cell carcinoma associated with bilateral low grade diploid acinic cell carcinoma of the parotid gland. Virchows Arch. 1999;434:361–365.

Skálová A, Sima R, Vanecek T, et al. Acinic cell carcinoma with high-grade transformation: a report of 9 cases with immunohistochemical study and analysis of TP53 and HER-2/neu genes. Am J Surg Pathol. 2009;33:1137–1145.

Thompson LD, Aslam MN, Stall JN, et al. Clinicopathologic and immunophenotypic characterization of 25 cases of acinic cell carcinoma with high-grade transformation. Head Neck Pathol. 2016;10:152–160.

Skalova A, Vanecek T, Majewska H, et al. Mammary analogue secretory carcinoma of salivary glands with high grade transformation: report of three cases with the ETV6-NTRK3 gene fusion and analysis of TP53, β-catenin, EGFR and CCND1 genes. Am J Surg Pathol. 2014;38:23–33.

Xu B, Aryeequaye R, Wang L, et al. Sinonasal secretory carcinoma of salivary gland with high grade transformation: a case report of this under-recognized diagnostic entity with prognostic and therapeutic implications. Head Neck Pathol. 2018;12:274–278.

Cheuk W, Chan JKC, Ngan RKC. Dedifferentiation in adenoid cystic carcinoma of salivary gland. An uncommon complication associated with an accelerated clinical course. Am J Surg Pathol. 1999;23:465–472.

Nagao T, Gaffey TA, Serizawa H, et al. Dedifferentiated adenoid cystic carcinoma: a clinicopathologic study of 6 cases. Mod Pathol. 2003;16:1265–1272.

Seethala RR, Hunt JL, Baloch ZW, et al. Adenoid cystic carcinoma with high-grade transformation: a report of 11 cases and a review of the literature. Am J Surg Pathol. 2007;31:1683–1694.

Simpson RHW, Clarke TJ, Sarsfield PT, et al. Epithelial-myoepithelial carcinoma of salivary glands. J Clin Pathol. 1991;44:419–423.

Seethala RR, Barnes EL, Hunt JL. Epithelial-myoepithelial carcinoma: a review of the clinicopathologic spectrum and immunophenotypic characteristics in 61 tumors of the salivary glands and upper aerodigestive tract. Am J Surg Pathol. 2007;31:44–57.

Simpson RH, Pereira EM, Ribeiro AC, et al. Polymorphous low-grade adenocarcinoma of the salivary glands with transformation to high-grade carcinoma. Histopathology. 2002;41:250–259.

Nagao T, Gaffey TA, Kay PA, et al. Dedifferentiation in low-grade mucoepidermoid carcinoma of the parotid gland. Hum Pathol. 2003;34:1068–1072.

Jin R, Craddock KJ, Irish JC, et al. Recurrent hyalinizing clear cell carcinoma of the base of tongue with high-grade transformation and EWSR1 gene rearrangement by FISH. Head Neck Pathol. 2012;6:389–394.

Nagao T. “Dedifferentiation” and high-grade transformation in salivary gland carcinomas. Head Neck Pathol. 2013;7(suppl 1):S37–S47.

Kanai Y. Alterations of DNA methylation and clinicopathological diversity of human cancers. Pathol Int. 2008;58:544–558.

Wang Z, Ling S, Rettig E, et al. Epigenetic screening of salivary gland mucoepidermoid carcinoma identifies hypomethylation of CLIC3 as a common alteration. Oral Oncol. 2015;51:1120–1125.

Costa AF, Altemani A, Hermsen M. Current concepts on dedifferentiation/high-grade transformation in salivary gland tumors. Pathol Res Int. 2011;2011:325965.

Petersson F. High-grade transformation (“dedifferentiation”)—malignant progression of salivary gland neoplasms, including carcinoma ex pleomorphic adenoma: a review. Pathol Case Rev. 2015;20:27–37.

Vander Poorten V, Triantafyllou A, Thompson LDR, et al. Salivary acinic cell carcinoma: reappraisal and update. Eur Arch Otorhinolaryngol. 2016;273:3511–3531.

Ilayaraja V, Prasad H, Anuthama K, et al. Acinic cell carcinoma of minor salivary gland showing features of high-grade transformation. J Oral Maxillofac Pathol. 2014;18:97–101.

Chintakuntlawar AV, Shon W, Erickson-Johnson M, et al. High-grade transformation of acinic cell carcinoma: an inadequately treated entity? Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;121:542–549.

Burry D, Dafalla M, Ahmed S, et al. High grade transformatiom of salivary gland acinic cell carcinoma with emphasis on histological diagnosis and clinical implications. Pathol Res Pract. 2016;212:1059–1063.

Yue LE, Samankan S, Liu X, et al. Ten patients with high-grade transformation of acinic cell carcinomas. Expression profiling of beta-catenin and cyclin D1 is useful. Path Res Pract. 2020;216:152767.

Cheˆnevert J, Duvvuri U, Chiosea S, et al. DOG1: a novel marker of salivary acinar and intercalated duct differentiation. Mod Pathol. 2012;25:919–929.

Haller F, Skálová A, Ihrler S, et al. Nuclear NR4A3 immunostaining is a specific and sensitive novel marker for acinic cell carcinoma of the salivary glands. Am J Surg Pathol. 2019;43:1264–1272.

Skalova A, Vanecek T, Sima R, et al. Mammary analogue secretory carcinoma of salivary glands, containing the ETV6-NTRK3 fusion gene: a hitherto undescribed salivary gland tumor entity. Am J Surg Pathol. 2010;34:599–608.

Jung MJ, Song JS, Kim SY, et al. Finding and characterizing mammary analogue secretory carcinoma of the salivary gland. Korean J Pathol. 2013;47:36–43.

Cipriani NA, Blair EA, Finkle J, et al. Salivary gland secretory carcinoma with high-grade transformation, CDKN2A/B loss, distant metastasis, and lack of sustained response to crizotinib. Int J Surg Pathol. 2017;25:613–618.

Majewska H, Skalova A, Stodulski D, et al. Mammary analogue secretory carcinoma of salivary glands: a new entity associated with ETV6 gene rearrangement. Virchows Arch. 2015;466:245–254.

Luo W, Lindley SW, Lindley PH, et al. Mammary analog secretory carcinoma of salivary gland with high-grade histology arising in hard palate, report of a case and review of literature. Int J Clin Exp Pathol. 2014;7:9008–9022.

Skalova A, Banečkova M, Thompson LDR, et al. Expanding the molecular spectrum of secretory carcinoma of salivary glands with novel VIM-RET fusion. Am J Surg Pathol. 2020;44:1295–1307.

Taverna C, Baněčková M, Lorenzon M, et al. MUC4 is a valuable marker for distinguishing secretory carcinoma of the salivary glands from its mimics. Histopathology. 2020. [Epub ahead of print].

Ito Y, Ishibashi K, Masaki A, et al. Mammary analogue secretory carcinoma of salivary glands: a clinicopathological and molecular study including 2 cases harboring ETV6-X fusion. Am J Surg Pathol. 2015;39:602–610.

Skalova A, Vanecek T, Simpson RHW, et al. Mammary analogue secretory carcinoma of salivary glands. Molecular analysis of 25 ETV6 gene rearranged tumors with lack of detection of classical ETV6-NTRK3 fusion transcript by standard RT-PCR: report of 4 cases harboring ETV6-X gene fusion. Am J Surg Pathol. 2016;40:3–13.

Skalova A, Vanecek T, Martinek P, et al. Molecular profiling of mammary analogue secretory carcinoma revealed a subset of tumors harboring a novel ETV6-RET translocation: report of 10 cases. Am J Surg Pathol. 2018;42:234–246.

Rooper LM, Karantanos T, Ning Y, et al. Salivary secretory carcinoma with a novel ETV6-MET fusion: expanding the molecular spectrum of a recently described entity. Am J Surg Pathol. 2018;42:1121–1126.

Guilmette J, Dias-Santagata D, Nose V, et al. Novel gene fusions in secretory carcinoma of the salivary glands: enlarging the ETV6 family. Hum Pathol. 2019;83:50–58.

Kummar S, Lassen UN. TRK inhibition: a new tumor agnostic treatment strategy. Target Oncol. 2018;13:545–556.

Drilon A. TRK inhibitors in TRK fusion-positive cancers. Ann Oncol. 2019;30(suppl 8):viii23–viii30.

Li AY, McCusker MG, Russo A, et al. RET fusions in solid tumors. Cancer Treat Rev. 2019;81:101911.

Batsakis JG, Luna MA, El-Naggar A. Histopathologic grading of salivary gland neoplasms: III. Adenoid cystic carcinomas. Ann Otol Rhinol Laryngol. 1990;99:1007–1009.

Szanto PA, Luna MA, Tortoledo ME, et al. Histologic grading of adenoid cystic carcinoma of the salivary glands. Cancer. 1984;54:1062–1069.

Moles MA, Avila IR, Archilla AR. Dedifferentiation occurring in adenoid cystic carcinoma of the tongue. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88:177–180.

Chau Y, Hongyo T, Aozasa K, et al. Dedifferentiation of adenoid cystic carcinoma: report of a case implicating p53 gene mutation. Hum Pathol. 2001;32:1403–1407.

Sato K, Ueda Y, Sakurai A, et al. Adenoid cystic carcinoma of the maxillary sinus with gradual histologic transformation to high-grade adenocarcinoma: a comparative report with dedifferentiated carcinoma. Virchows Arch. 2006;448:204–208.

Handra-Luca A, Planchard D, Fouret P. Docetaxel-cisplatin radiotherapy in adenoid cystic carcinoma with high-grade transformation. Oral Oncol. 2009;45:e208–e209.

Malhotra KP, Agrawal V, Pandey R. High grade transformation in adenoid cystic carcinoma of the parotid: report of a case with cytologic, histologic and immunohistochemical study. Head Neck Pathol. 2009;3:310–314.

Bonfitto VL, Demasi AP, Costa AF, et al. High-grade transformation of adenoid cystic carcinomas: a study of the expression of GLUT1 glucose transporter and of mitochondrial antigen. J Clin Pathol. 2010;63:615–619.

Panarelli JF, Zoumalan CI, Mukkamala K, et al. Dedifferentiated adenoid cystic carcinoma of the lacrimal gland. Ophthal Plast Reconstr Surg. 2011;27:e119–e121.

Boland JM, McPhail ED, García JJ, et al. Detection of human papilloma virus and p16 expression in high-grade adenoid cystic carcinoma of the head and neck. Mod Pathol. 2012;25:529–536.

Argyris PP, Pambuccian SE, Cayci Z, et al. Lacrimal gland adenoid cystic carcinoma with high-grade transformation to myoepithelial carcinoma: report of a case and review of literature. Head Neck Pathol. 2013;7:85–92.

Costa AF, Tasso MG, Mariano FV, et al. Levels and patterns of expression of hypoxia-inducible factor-1alpha, vascular endothelial growth factor, glucose transporter-1 and CD105 in adenoid cystic carcinomas with high-grade transformation. Histopathology. 2012;60:816–825.

Persson M, Andrén Y, Mark J, et al. Recurrent fusion of MYB and NFIB transcription factor genes in carcinomas of the breast and head and neck. Proc Natl Acad Sci USA. 2009;106:18740–18744.

Costa AF, Altemani A, Vékony H, et al. Genetic profile of adenoid cystic carcinomas (ACC) with high-grade transformation versus solid type. Cell Oncol (Dordr). 2011;34:369–379.

Seethala RR, Cieply K, Barnes EL, et al. Progressive genetic alterations of adenoid cystic carcinoma with high-grade transformation. Arch Pathol Lab Med. 2011;135:123–130.

Hellquist H, Skálová A, Barnes L, et al. Cervical lymph node metastasis in high-grade transformation of head and neck adenoid cystic carcinoma: a collective international review. Adv Ther. 2016;33:357–368.

Hellquist H, Skalova A, Azadeh B. Salivary hybrid tumour revisited: could they represent high-grade transformation in a low grade neoplasm? Virchows Arch. 2016;469:643–650.

Donath K, Seifert G, Schmitz R. Diagnosis and ultrastructure of the tubular carcinoma of salivary gland ducts. Epithelial-myoepithelial carcinoma of the intercalated ducts. Virchows Arch A Pathol Pathol Anat. 1972;356:16–31.

Alos L, Carrillo R, Ramos J, et al. High-grade carcinoma component in epithelial-myoepithelial carcinoma of salivary glands clinicopathological, immunohistochemical and flow-cytometric study of three cases. Virchows Arch. 1999;434:291–299.

Fonseca I, Félix A, Soares J. Dedifferentiation in salivary gland carcinomas. Am J Surg Pathol. 2000;24:469–471.

Kusafuka K, Takizawa Y, Ueno T, et al. Dedifferentiated epithelial-myoepithelial carcinoma of the parotid gland: a rare case report of immunohistochemical analysis and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:85–91.

Sarode VR, Truelson J, Zaidie M. Dedifferentiated epithelialmyoepithelial carcinoma of the parotid gland with aberrant expression of prostate specific antigen: a case report. Int J Surg Pathol. 2010;18:401–405.

Baker AR, Ohanessian SE, Adil E, et al. Dedifferentiated epithelial-myoepithelial carcinoma: analysis of a rare entity based on a case report and literature review. Int J Surg Pathol. 2013;21:514–519.

Niederhagen M, Zengel P, Ihrler S. Secondary high-malignant transformation of a low-malignant epithelial-myoepithelial carcinoma. Pathologe. 2009;30:461–465.

Roy P, Bullock MJ, Perez-Ordon˜ez B, et al. Epithelial-myoepithelial carcinoma with high grade transformation. Am J Surg Pathol. 2010;34:1258–1265.

Lima FJ, Porto DE, Cavalcante JR, et al. Epithelial-myoepithelial carcinoma of high grade transformation: the case report in the buccal mucosa. Open Dent J. 2012;6:111–117.

Yang S, Chen X. Epithelial-myoepithelial carcinoma with high grade transformation. Int J Oral Maxillofac Surg. 2012;41:810–813.

Park JO, Jung CK, Sun DI, et al. Anunusual presentation of aggressive epithelial-myoepithelial carcinoma of the nasal cavity with high grade histology. J Laryngol Otol. 2011;125:1286–1289.

Suzuki T, Murata S, Yamaguchi H, et al. Epithelial-myoepithelial carcinoma with myoepithelial anaplasia: report of a case with cytologic findings of a rare variant. Acta Cytol. 2010;54:605–610.

Nagao T, Sugano I, Ishida Y, et al. Hybrid carcinomas of the salivary glands: report of nine cases with a clinicopathologic, immunohistochemical, and p53 gene alteration analysis. Mod Pathol. 2002;15:724–733.

Bell D, Di Palma S, Katabi N, et al. El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ. Myoepithelial carcinoma. World Health Organization (WHO) Classification of Head and Neck Tumours, 4th edition. IARC Press, Lyon, France. 2017:174–175.

Xu B, Mneimneh W, Torrence DE, et al. Misinterpreted myoepithelial carcinoma of salivary gland a challenging and potentially significant pitfall. Am J Surg Pathol. 2019;43:601–609.

Dalin MG, Katabi N, Persson M, et al. Multi-dimensional genomic analysis of myoepithelial carcinoma identifies prevalent oncogenic gene fusions. Nat Commun. 2017;8:1197.

Skálová A, Agaimy A, Vanecek T, et al. Molecular profiling of clear cell myoepithelial carcinoma of salivary glands with EWSR1 rearrangement identifies frequent plag1 gene fusions but no EWSR1 fusion transcripts. Am J Surg Pathol. 2021;45:1–13.

Kong M, Drill EN, Morris L, et al. Prognostic factors in myoepithelial carcinoma of salivary glands: a clinicopathologic study of 48 cases. Am J Surg Pathol. 2015;39:931–938.

Skalova A, Weinreb I, Hyrcza M, et al. Clear cell myoepithelial carcinoma of salivary glands showing EWSR1 rearrangement: molecular analysis of 94 salivary gland carcinomas with prominent clear cell component. Am J Surg Pathol. 2015;39:338–348.

Ogawa I, Nishida T, Miyauchi M, et al. Dedifferentiated malignant myoepithelioma of the parotid gland. Pathol Int. 2003;53:704–709.

Nagao T, Gaffey TA, Kay PA, et al. Dedifferentiation in low-grade mucoepidermoid carcinoma of the parotid gland. Hum Pathol. 2003;34:1068–1072.

Subramaniam MM, Ng SB, Seah SB, et al. Molecular characterization of dedifferentiated mucoepidermoid carcinoma of the trachea using laser microdissection-based TP53 mutation analysis. Histopathology. 2009;55:472–475.

Lee H, Roh J-L, Choi Y-J, et al. High grade transformation in mucoepidermoid carcinoma of the minor salivary gland with polyploidy of the rearranged MAML2 gene. Head Neck Pathol. 2020;14:822–827.

Tonon G, Modi S, Wu L, et al. t(11;19)(q21;p13) translocation in mucoepidermoid carcinoma creates a novel fusion product that disrupts a Notch signaling pathway. Nat Genet. 2003;33:208–213.

Jee KJ, Persson M, Heikinheimo K, et al. Genomic profiles and CRTC1-MAML2 fusion distinguish different subtypes of mucoepidermoid carcinoma. Mod Pathol. 2013;26:213–222.

Seethala RR, Dacic S, Cieply K, et al. A reappraisal of the MECT1/MAML2 translocation in salivary mucoepidermoid carcinomas. Am J Surg Pathol. 2010;34:1106–1121.

Behboudi A, Enlund F, Winnes M, et al. Molecular classification of mucoepidermoid carcinomas—prognostic significance of the MECT1-MAML2 fusion oncogene. Genes Chromosomes Cancer. 2006;45:470–481.

El-Naggar AK, Chan JKC, Grandis JR, et al. World Health Organization Classification of Tumours: Pathology and Genetics of Head and Neck Tumours, 4th ed. In: Takata T, Slootweg PJ, eds. Lyon, France: International Agency for Research on Cancer (IARC); 2017:167–168.

Barnes EL, Eveson JW, Reichart P, Sidransky D, eds. World Health Organization Classification of Tumours: Pathology and Genetics of Head and Neck Tumours, 3rd ed. Lyon, France: IARC Press; 2005:223–224.

Vander Poorten V, Triantafyllou A, Skálová A, et al. Polymorphous adenocarcinoma of the salivary glands: reappraisal and update. Eur Arch Otorhinolaryngol. 2018;275:1681–1695.

Bradley PJ, McGurk M. Incidence of salivary gland neoplasms in a defined UK population. Br J Oral Maxillofac Surg. 2013;51:399–403.

Seethala RR, Johnson JT, Barnes EL, et al. Polymorphous low-grade adenocarcinoma: the University of Pittsburgh experience. Arch Otolaryngol Head Neck Surg. 2010;136:385–392.

Xu B, Aneja A, Ghossein R, et al. Predictors of outcome in the phenotypic spectrum of polymorphous low-grade adenocarcinoma (PLGA) and cribriform adenocarcinoma of salivary gland (CASG): a retrospective study of 69 patients. Am J Surg Pathol. 2016;40:1526–1537.

Michal M, Skalova A, Simpson RH, et al. Cribriform adenocarcinoma of the tongue: a hitherto unrecognized type of adenocarcinoma characteristically occurring in the tongue. Histopathology. 1999;35:495–501.

Skalova A, Sima R, Kaspirkova-Nemcova J, et al. Cribriform adenocarcinoma of minor salivary gland origin principally affecting the tongue: characterization of new entity. Am J Surg Pathol. 2011;35:1168–1176.

Laco J, Kamaradova K, Vitkova P, et al. Cribriform adenocarcinoma of minor salivary glands may express galectin-3, cytokeratin 19, and HBME-1 and contains polymorphisms of RET and H-RAS proto-oncogenes. Virchows Arch. 2012;461:531–540.

Evans HL, Luna MA. Polymorphous low-grade adenocarcinoma: a study of 40 cases with long-term follow up and an evaluation of the importance of papillary areas. Am J Surg Pathol. 2000;24:1319–1328.

Xu B, Barbieri AL, Bishop JA, et al. Histologic classification and molecular signature of polymorphous adenocarcinoma (PAC) and cribriform adenocarcinoma of salivary glands (CASG). An international interobserver study. Am J Surg Pathol. 2020;44:545–552.

Mills SE, Garland TA, Allen MS Jr. Low-grade papillary adenocarcinoma of palatal salivary gland origin. Am J Surg Pathol. 1984;8:367–374.

Lloreta J, Serrano S, Corominas JM, et al. Polymorphous low-grade adenocarcinoma arising in the nasal cavities with an associated undifferentiated carcinoma. Ultrastruct Pathol. 1995;19:365–370.

Pelkey TJ, Mills SE. Histologic transformation of polymorphous low-grade adenocarcinoma of salivary gland. Am J Clin Pathol. 1999;111:785–791.

Milchgrub S, Gnepp DR, Vuitch F, et al. Hyalinizing clear cell carcinoma of salivary gland. Am J Surg Pathol. 1994;18:74–82.

Antonescu CR, Katabi N, Zhang L, et al. EWSR1-ATF1 fusion is a novel and consistent finding in hyalinizing clear-cell carcinoma of salivary gland. Genes Chromosomes Cancer. 2011;50:559–570.

O’Regan E, Shandilya M, Gnepp DR, et al. Hyalinizing clear cell carcinoma of salivary gland: an aggressive variant. Oral Oncol. 2004;40:348–352.

High-grade non-intestinal type sinonasal adenocarcinoma with ETV6::NTRK3 fusion, distinct from secretory carcinoma by immunoprofile and morphology

Development of head and neck pathology in Europe

Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Salivary Glands