Salivary gland tumors are a rare, heterogeneous group of neoplasms that pose significant diagnostic challenges for the histopathologist. Histopathological diagnosis relies primarily on morphological assessment, with ancillary special stains and immunohistochemistry. In recent years, new defining genomic alterations have been characterized in these tumors. In particular, they include gene fusions which have shown to be tightly tumor-type specific, and thus valuable for use in diagnostically challenging cases. These discoveries also help in refining tumor classification. Furthermore, such genetic alterations may have prognostic as well as potentially therapeutic implications in the era of personalized medicine. This review aims at providing a summary of the most recent updates in this field.

Bioptic Laboratory Ltd Plzen Czech Republic

Department of Pathology and Laboratory Medicine University of Calgary Arnie Charboneau Cancer Institute Calgary Alberta Canada

Department of Pathology Charles University Faculty of Medicine in Plzen Plzen Czech Republic

Institute of Biomedicine Pathology University of Turku and Turku University Hospital Turku Finland

Molecular and Genetic Laboratory Bioptic Laboratory Ltd Plzen Czech Republic

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El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg P, eds. Tumours of salivary glands. World Health Organisation Classification of Head and Neck Tumours. 4th ed. IARC Press; 2017:159-202 [Chapter 7].

Skalova A, Stenman G, Simpson RHW, et al. The role of molecular testing in the differential diagnosis of salivary gland carcinomas. Am J Surg Pathol. 2018;42:11-27.

Stenman G. Fusion oncogenes in salivary gland tumors: molecular and clinical consequences. Head Neck Pathol. 2013;7:S12-S19.

Moutasim KA, Thomas GJ. Salivary gland tumours: update on molecular diagnostics. Diagn Histopathol. 2021;26(4):159-164.

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.

Skalova A, Vanecek T, Martinek P, et al. Molecular profiling of mammary analog secretory carcinoma revealed a subset of tumors harboring a novel ETV6-RET translocation: report of 10 cases. Am J Surg Pathol. 2018;42(2):234-246.

Majewska H, Skálová A, Stodulski D, et al. Mammary analogue secretory carcinoma of salivary glands: first retrospective study of a new entity in Poland with special reference to ETV6 gene rearrangement. Virchows Arch. 2015;466:245-254.

Fujii K, Murase T, Beppu S, et al. MYB, MYBL1, MYBL2 and NFIB gene alterations and MYC overexpression in salivary gland adenoid cystic carcinoma. Histopathology. 2017;71(5):823-834.

Jee KJ, Persson M, Heikinheimo K, et al. Genomic profiles and CRTC1-MAML2 fusion distinguish different subtypes of mucoepidermoid carcinoma. Mod Pathol. 2013;26(2):213-222.

Okumura Y, Miyabe S, Nakayama T, et al. Impact of CRTC1/3-MAML2 fusions on histological classification and prognosis of mucoepidermoid carcinoma. Histopathology. 2011;59(1):90-97.

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(7):559-570.

Cocco E, Scaltriti M, Drilon A. NTRK fusion-positive cancers and TRK inhibitor therapy. Nat Rev Clin Oncol. 2018;15(12):731-747.

Lassen U. How I treat NTRK gene fusion-positive cancers. ESMO Open. 2019;4(Suppl 2):e000612.

Drilon A. TRK inhibitors in TRK fusion-positive cancers. Ann Oncol. 2019;30(Suppl_8):viii23-viii30. doi:10.1093/annonc/mdz282

Drilon A, Hu ZI, Lai GGY, Tan DSW. Targeting RET-driven cancers: lessons from evolving preclinical and clinical landscapes. Nat Rev Clin Oncol. 2018;15(3):151-167. doi:10.1038/nrclinonc.2017.175

Pulciani S, Santos E, Lauver AV, Long LK, Aaronson SA, Barbacid M. Oncogenes in solid human tumours. Nature. 1982;300(5892):539-542.

Martin-Zanca D, Hughes SH, Barbacid M. A human oncogene formed by the fusion of truncated tropomyosin and protein tyrosine kinase sequences. Nature. 1986;319(6056):743-748.

Nakagawara A. Trk receptor tyrosine kinases: a bridge between cancer and neural development. Cancer Lett. 2001;169(2):107-114.

Tognon C, Knezevich SR, Huntsman D, et al. Expression of the ETV6-NTRK3 gene fusion as a primary event in human secretory breast carcinoma. Cancer Cell. 2002;2(5):367-376.

Knezevich SR, McFadden DE, Tao W, Lim JF, Sorensen PH. A novel ETV6-NTRK3 gene fusion in congenital fibrosarcoma. Nat Genet. 1998;18(2):184-187.

Rubin BP, Chen CJ, Morgan TW, et al. Congenital mesoblastic nephroma t(12;15) is associated with ETV6-NTRK3 gene fusion: cytogenetic and molecular relationship to congenital (infantile) fibrosarcoma. Am J Pathol. 1998;153(5):1451-1458.

Amatu A, Sartore-Bianchi A, Siena S. NTRK gene fusions as novel targets of cancer therapy across multiple tumour types. ESMO Open. 2016;1(2):e000023. doi:10.1136/esmoopen-2015-000023

Drilon A, Laetsch T, Kummar S, et al. Efficacy of larotrectinib in TRK fusion-positive cancers in adults and children. N Engl J Med. 2018;378:731-739.

Brandhuber BJ et al. Identification and characterization of highly potent and selective RET kinase inhibitors for the treatment of RET-driven cancers. Mol Cancer Ther. 2015;14(Suppl 2):B192.

Subbiah V, Gainor JF, Rahal R, et al. Precision targeted therapy with BLU-667 for RET-driven cancers. Cancer Discov. 2018;8(7):836-849.

Skalova A. Mammary analogue secretory carcinoma of salivary gland origin: an update and expanded morphologic and immunohistochemical spectrum of recently described entity. Head Neck Pathol. 2013;7(Suppl 1):S30-S36.

Skálová A, Gnepp DR, Lewis JS Jr, et al. Newly described entities in salivary gland pathology. Am J Surg Pathol. 2017;41(8):e33-e47.

Skalova A, Michal M, Simpson RH. Newly described salivary gland tumors. Mod Pathol. 2017;30(s1):S27-S43. doi:10.1038/modpathol.2016.167

Rooper L, Karantanos T, Ning Y, et al. Salivary secretory carcinoma with a novel ETV6-MET fusion. Am J Surg Pathol. 2018;42(8):1121-1126.

Skálová A, Banečkova M, Thompson LDR, et al. Expanding the molecular spectrum of secretory carcinoma of salivary glands with a novel VIM-RET fusion. Am J Surg Pathol. 2020;44(10):1295-1307.

Skálová A, Vanecek T, Majewska H, et al. Mammary analogue secretory carcinoma of salivary glands with high-grade transformation: report of 3 cases with the ETV6-NTRK3 gene fusion and analysis of TP53, β-catenin, EGFR, and CCND1 genes. Am J Surg Pathol. 2014;38(1):23-33.

Doebele R, Drilon A, Paz-Ares L, et al. Entrectinib in patients with advanced or metastatic NTRK fusion-positive solid tumours: integrated analysis of three phase 1-2 trials. Lancet. 2020;21:271-282.

Hemming M, Nathenson M, Lin J, et al. Response and mechanisms of resistance to larotrectinib and selitrectinib in metastatic undifferentiated sarcoma harboring oncogenic fusion of NTRK. JCO Precis Oncol. 2020;4:79-90.

Florou V, Nevala-Plagemann C, Whisenant J, Maeda P, Gilcrease GW, Garrido-Laguna I. Clinical activity of selitrectinib in a patient with mammary analogue secretory carcinoma of the parotid gland with secondary resistance to eentrectinib. J Natl Compr Canc Netw. 2021;19(5):478-482.

Weinreb I. Hyalinizing clear cell carcinoma of salivary gland: a review and update. Head Neck Pathol. 2013;7(Suppl 1):S20-S29.

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.

Fisher C. The diversity of soft tissue tumours with EWSR1 gene rearrangements: a review. Histopathology. 2014;64:134-150.

Chapman E, Skalova A, Ptakova N, et al. Molecular profiling of hyalinizing clear cell carcinomas revealed a subset of tumors harboring a novel EWSR1-CREM fusion: report of 3 cases. Am J Surg Pathol. 2018;42:1182-1189.

Shah AA, LeGallo RD, van Zante A, et al. EWSR1 genetic rearrangements in salivary gland tumors: a specific and very common feature of hyalinizing clear cell carcinoma. Am J Surg Pathol. 2013;37:571-578.

Skálová 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.

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):1-13.

Tanguay J, Weinreb I. What the EWSR1-ATF1 fusion has taught us about hyalinizing clear cell carcinoma. Head Neck Pathol. 2013;7:28-34.

Thway K, Fisher C. Tumors with EWSR1-CREB1 and EWSR1-ATF1 fusions: the current status. Am J Surg Pathol. 2012;36:e1-e11.

Bilodeau EA, Weinreb I, Antonescu CR, et al. Clear cell odontogenic carcinomas show EWSR1 rearrangements: a novel finding and a biological link to salivary clear cell carcinomas. Am J Surg Pathol. 2013;37:1001-1005.

Santana T, de Andrade FL, de Sousa Melo MC, da Rocha GBL, Trierveiler M. Clear cell odontogenic carcinoma harboring the EWSR1-ATF1 fusion gene: report of a rare case. Head Neck Pathol. 2019;14:847-851.

Loening T, Leivo I, Simpson RHW, et al. Intraductal carcinoma. In: El-Naggar A, Chan JKC, Grandis JR, Takata T, Slootweg PJ, eds. World Health Organization (WHO) Classification of Head and Neck Tumours. 4th ed. IARC Press; 2017:170-171.

Delgado R, Klimstra D, Albores-Saavedra J. Low grade salivary duct carcinoma. A distinctive variant with a low grade histology and a predominant intraductal growth pattern. Cancer. 1996;78:958-967.

Brandwein-Gensler MS, Gnepp DR. WHO classification of tumours. In: Barnes L, Eveson JW, Reichart P, Sidransky D, eds. Pathology and Genetics of Head and Neck Tumours. IARC Press; 2005:233.

Weinreb I, Tabanda-Lichauco R, Van der Kwast T, et al. Low-grade intraductal carcinoma of salivary gland: report of 3 cases with marked apocrine differentiation. Am J Surg Pathol. 2006;30:1014-1021.

Weinreb I, Bishop JA, Chiosea SI, et al. Recurrent RET gene rearrangements in intraductal carcinomas of salivary gland. Am J Surg Pathol. 2018;42(4):442-452.

Skálová A, Vanecek T, Uro-Coste E, et al. Molecular profiling of salivary gland Intraductal carcinoma revealed a subset of tumors harboring NCOA4-RET and novel TRIM27-RET fusions: a report of 17 cases. Am J Surg Pathol. 2018;42(11):1445-1455.

Skálová A, Ptáková N, Santana T, et al. NCOA4-RET and TRIM27-RET are characteristic gene fusions in salivary intraductal carcinoma, including invasive and metastatic tumors: is "intraductal" correct? Am J Surg Pathol. 2019;43(10):1303-1313.

Rooper LM, Thompson LDR, Gagan J, Oliai BR, Weinreb I, Bishop JA. Salivary intraductal carcinoma arising within intraparotid lymph node: a report of 4 cases with identification of a novel STRN-ALK fusion. Head Neck Pathol. 2021;15(1):179-185.

Bishop JA, Nakaguro M, Whaley RD, et al. Oncocytic intraductal carcinoma of salivary glands: a distinct variant with TRIM33-RET fusions and BRAF V600E mutations. Histopathology. 2021;79(3):338-346.

Auclair PL, Goode RK, Ellis GL. Mucoepidermoid carcinoma of intraoral salivary glands. Evaluation and application of grading criteria in 143 cases. Cancer. 1992;69:2021-2030.

Brandwein MS, Ivanov K, Wallace DI, et al. Mucoepidermoid carcinoma: a clinicopathologic study of 80 patients with special reference to histologial grading. Am J Surg Pathol. 2001;25:835-845.

Katabi N, Ghossein R, Ali S, Dogan S, Klimstra D, Ganly I. Prognostic features in mucoepidermoid carcinoma of major salivary glands with emphasis on tumor histologic grading. Histopathology. 2014;65:793-804.

Sams RN, Gnepp DR. P63 expression can be used in differential diagnosis of salivary gland acinic cell and mucoepidermoid carcinomas. Head Neck Pathol. 2013;7:64-68.

Seethala RR, Dacic S, Cieply K, Kelly LM, Nikiforova MN. A reappraisal of the MECT1-MAML2 translocation in mucoepidermoid carcinomas. Am J Surg Pathol. 2010;34:213-222.

Okamura Y, Nakano S, Murase T, et al. Prognostic impact of CRTC1-MAML2 fusions in salivary gland mucoepidermoid carcinoma. A multi-institutional retrospective study. Cancer Sci. 2020;111:4195-4204.

Nordkvist A, Gustafsson H, Juberg-Ode M, Stenman G. Recurrent rearrangements of 11q14-22 in mucoepidermoid carcinoma. Cancer Genet Cytogenet. 1994;74:77-83.

Nakayama T, Miyabe S, Okabe M, et al. Clinicopathological significance of the CRTC3-MAML2 fusion transcript in mucoepidermoid carcinoma. Mod Pathol. 2009;2009(22):1575-1581.

Möller E, Stenman G, Mandahl N, et al. POU5F1, encoding a key regulator of stem cell pluripotency is fused to EWSR1 in hidradenoma of the skin and mucoepidermoid carcinoma of the salivary glands. J Pathol. 2008;215:78-86.

Cipriani NA, Lusardi JJ, McElherne J, et al. Mucoepidermoid carcinoma: a comparison of histologic grading systems and relationship to MAML2 rearrangement and prognosis. Am J Surg Pathol. 2019;43:885-897.

Fehr A, Werenicz S, Trocchi P, et al. Mucoepidermoid carcinoma of the salivary glands revisited with special reference to histologic grading and CRTC1/3-MAML2 genotyping. Virchows Arch. 2021;479:975-985. doi:10.1007/s00428-021-03146-x

Kang H, Tan M, Bishop JA, et al. Whole-exome sequencing of salivary gland mucoepidermoid carcinoma. Clin Cancer Res. 2017;23:283-288.

Bishop JA, Cowan ML, Shum CH, Westra WH. MAML2 rearrangements in variant forms of mucoepidermoid carcinoma: ancillary diagnostic testing for the ciliated and Warthin-like variants. Am J Surg Pathol. 2018;42:130-136.

Skálová A, Agaimy A, Stanowska O, et al. Molecular profiling of salivary oncocytic mucoepidermoid carcinomas helps to resolve differential diagnostic dilemma with low-grade oncocytic lesions. Am J Surg Pathol. 2020;44(12):1612-1622.

Jaso J, Malhotra R. Adenoid cystic carcinoma. Arch Pathol Lab Med. 2011;135(4):511-515.

Seethala RR, Hunt JL, Baloch ZW, LiVolsi VA, Barnes EL. Adenoid cystic carcinoma with high-grade transformation: a report of 11 cases and review of the literature. Am J Surg Pathol. 2007;31(11):1683-1694.

Nordkvist A, Mark J, Gustafsson H, Bang G, Stenman G. Non-random chromosome rearrangements in adenoid cystic carcinoma of the salivary glands. Genes Chromosomes Cancer. 1994;10(2):115-121.

Stenman G, Sandros J, Dahlenfors R, Juberg-Ode M, Mark J. 6q- and loss of the Y chromosome-two common deviations in malignant human salivary gland tumors. Cancer Genet Cytogenet. 1986;22:283-293.

Higashi K, Jin Y, Johansson M, et al. Rearrangement of 9p13 as the primary chromosomal aberration in adenoid cystic carcinoma of the respiratory tract. Genes Chromosomes Cancer. 1991;3:21-23.

Persson M, Andrén Y, Mark J, Horlings HM, Persson F, Stenman G. 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(44):18740-18744.

De Almeida-Pinto YD, Costa SFDS, de Andrade BAB, et al. t(6;9)(MYB-NFIB) in head and neck adenoid cystic carcinoma: a systematic review with meta-analysis. Oral Dis. 2019;25(5):1277-1282.

Zhang J, Wu G, Miller P, Tatevossian R, Dalton J, Tang B. Whole genome sequencing identifies genetic alterations in pediatric low-grade gliomas. Nat Genet. 2013;45:602-612.

Yusenko MV, Trentmann A, Andersson MK, et al. Monensin, a novel potent MYB inhibitor, suppresses proliferation of acute myeloid leukemia and adenoid cystic carcinoma cells. Cancer Lett. 2020;479:61-70.

Fujii K, Murase T, Beppu S, et al. MYB, MYBL1, MYBL2 and NFIB gene alterations and MYC overexpression in salivary gland adenoid cystic carcinoma. Histopathology. 2017;71(5):823-834.

Shibata E, Morita KI, Kayamori K, et al. Detection of novel fusion genes by next-generation sequencing-based targeted RNA sequencing analysis in adenoid cystic carcinoma of head and neck. Oral Surg Oral Med Oral Pathol Oral Radiol. 2021;132(4):426-433.

Ferrarotto R, Mitani Y, Diao L, et al. Activating NOTCH1 mutations define a distinct subgroup of patients with adenoid cystic carcinoma who have poor prognosis, propensity to bone and liver metastasis, and potential responsiveness to Notch1 inhibitors. J Clin Oncol. 2017;35(3):352-360.

Even C, Lassen U, Merchan J, et al. Safety and clinical activity of the Notch inhibitor, crenigacestat (LY3039478), in an open-label phase I trial expansion cohort of advanced or metastatic adenoid cystic carcinoma. Invest New Drugs. 2020;38(2):402-409.

Bishop JA, Weinreb I, Swanson D, et al. Microsecretory adenocarcinoma: a novel salivary gland tumor characterized by a recurrent MEF2C-SS18 fusion. Am J Surg Pathol. 2019;43(8):1023-1032.

Bishop JA, Sajed DP, Weinreb I, et al. Microsecretory adenocarcinoma of salivary glands: an expanded series of 24 cases. Head Neck Pathol. 2021;15(4):1192-1201.

Kawakami F, Nagao T, Honda Y, et al. Microsecretory adenocarcinoma of the hard palate: a case report of a recently described entity. Pathol Int. 2020;70(10):781-785.

McDermott JC, Cardoso MC, Yu YT, et al. HMEF2C gene encodes skeletal muscle- and brain-specific transcription factors. Mol Cell Biol. 1993;13(4):2564-2577.

Cooley Coleman JA, Sarasua SM, Boccuto L, Moore HW, Skinner SA, DeLuca JM. Comprehensive investigation of the phenotype of MEF2C-related disorders in human patients: a systematic review. Am J Med Genet A. 2021;185(12):3884-3984. doi:10.1002/ajmg.a.62412

Homminga I, Pieters R, Langerak AW, et al. Integrated transcript and genome analyses reveal NKX2-1 and MEF2C as potential oncogenes in T cell acute lymphoblastic leukemia. Cancer Cell. 2011;19:484-497.

Antonescu CR, Agaram NP, Sung YS, Zhang L, Dickson BC. Undifferentiated round cell sarcomas with novel SS18-POU5F1 fusions. Genes Chromosomes Cancer. 2020;59(11):620-626.

Pan R, Wang Z, Wang X, Fang R, Xia Q, Rao Q. CRTC1-SS18 fusion sarcoma with aberrant anaplastic lymphoma kinase expression. Int J Surg Pathol. 2022;30(1):99-105.

Gu Z, Churchman M, Roberts K, et al. Genomic analyses identify recurrent MEF2D fusions in acute lymphoblastic leukaemia. Nat Commun. 2016;7:13331.

Michal M, Skálová A, Simpson R, 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(8):1168-1176.

Xu B, Barbieri A, Bishop J, et al. Histologic classification and molecular signature of polymorphous adenocarcinoma (PAC) and cribriform adenocarcinoma of salivary gland (CASG): an international interobserver study. Am J Surg Pathol. 2020;44:545-552.

Weinreb I, Piscuoglio S, Martelotto LG, et al. Hotspot activating PRKD1 somatic mutations in polymorphous low-grade adenocarcinomas of the salivary glands. Nat Genet. 2014;46:1166-1169.

Weinreb I, Zhang L, Tirunagari LM, et al. Novel PRKD gene rearrangements and variant fusions in cribriform adenocarcinoma of salivary gland origin. Genes Chromosomes Cancer. 2014;53:845-856.

Andreasen S, Melchior LC, Kiss K, et al. The PRKD1 E710D hotspot mutation is highly specific in separating polymorphous adenocarcinoma of the palate from adenoid cystic carcinoma and pleomorphic adenoma on FNA. Cancer Cytopathol. 2018;126:275-281.

Sebastiao APM, Xu B, Lozada JR, et al. Histologic spectrum of polymorphous adenocarcinoma of the salivary gland harbor genetic alterations affecting PRKD genes. Mod Pathol. 2020;33(1):65-73.

Griffith CC, Thompson LD, Assaad A, et al. Salivary duct carcinoma and the concept of early carcinoma ex pleomorphic adenoma. Histopathology. 2014;65(6):854-860.

Katabi N, Ghossein R, Ho A, et al. Consistent PLAG1 and HMGA2 abnormalities distinguish carcinoma ex-pleomorphic adenoma from its de novo counterparts. Hum Pathol. 2015;46(1):26-33. doi:10.1016/j.humpath.2014.08.017

Rotellini M, Palomba A, Baroni G, Franchi A. Diagnostic utility of PLAG1 immunohistochemical determination in salivary gland tumors. Appl Immunohistochem Mol Morphol. 2014;22(5):390-394. doi:10.1097/PAI.0b013e3182936ea7

Bahrami A, Dalton JD, Shivakumar B, Krane JF. PLAG1 alteration in carcinoma ex pleomorphic adenoma: immunohistochemical and fluorescence in situ hybridization studies of 22 cases. Head Neck Pathol. 2012;6(3):328-335. doi:10.1007/s12105-012-0353-8

Bubola J, MacMillan CM, Demicco EG, et al. Targeted RNA sequencing in the routine clinical detection of fusion genes in salivary gland tumors. Genes Chromosomes Cancer. 2021;60(10):695-708. doi:10.1002/gcc.22979

Dalin MG, Katabi N, Persson M, et al. Multi-dimensional genomic analysis of myoepithelial carcinoma identifies prevalent oncogenic gene fusions. Nat Commun. 2017;8(1):1197. doi:10.1038/s41467-017-01178-z

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):1-13. doi:10.1097/PAS.0000000000001591

Seethala RR. Oncocytic and apocrine epithelial myoepithelial carcinoma: novel variants of a challenging tumor. Head Neck Pathol. 2013;7(Suppl 1):S77-S84.

Haller F, Bieg M, Will R, et al. Enhancer hijacking activates oncogenic transcription factor NR4A3 in acinic cell carcinomas of the salivary glands. Nat Commun. 2019;10(1):368.

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(9):1264-1272.

Barasch N, Gong X, Kwei KA, et al. Recurrent rearrangements of the Myb/SANT-like DNA-binding domain containing 3 gene (MSANTD3) in salivary gland acinic cell carcinoma. PLoS One. 2017;12(2):e0171265.

Andreasen S, Varma S, Barasch N, et al. The HTN3-MSANTD3 fusion gene defines a subset of Acinic cell carcinoma of the salivary gland. Am J Surg Pathol. 2019;43(4):489-496.

Agaimy A, Baněčková M, Ihrler S, et al. ALK rearrangements characterize 2 distinct types of salivary gland carcinomas: clinicopathologic and molecular analysis of 4 cases and literature review. Am J Surg Pathol. 2021;45(9):1166-1178.

Dogan S, Ng CKY, Xu B, et al. The repertoire of genetic alterations in salivary duct carcinoma including a novel HNRNPH3-ALK rearrangement. Hum Pathol. 2019;88:66-77.

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