1
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Affiliation(s)
- Alan L Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY.,Department of Medicine Weill Cornell Medical College, New York City, NY
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2
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Fushimi C, Tada Y, Takahashi H, Nagao T, Ojiri H, Masubuchi T, Matsuki T, Miura K, Kawakita D, Hirai H, Hoshino E, Kamata S, Saotome T. A prospective phase II study of combined androgen blockade in patients with androgen receptor-positive metastatic or locally advanced unresectable salivary gland carcinoma. Ann Oncol 2018; 29:979-984. [PMID: 29211833 PMCID: PMC5913639 DOI: 10.1093/annonc/mdx771] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background There is no standard first-line chemotherapy for recurrent/metastatic (RM) or unresectable locally advanced (LA) salivary gland carcinoma (SGC). Patients and methods We conducted a single institution, open-label, single arm, phase II trial of combined androgen blockade (CAB) for androgen receptor (AR)-positive SGC. Leuprorelin acetate was administered subcutaneously at a dose of 3.75 mg every 4 weeks. Bicalutamide was administered orally at a daily dose of 80 mg. Patients were treated until progressive disease or unacceptable toxicities. Results Thirty-six eligible patients were enrolled. Thirty-three patients had RM disease and three patients had LA disease. The pathological diagnoses were salivary duct carcinoma (34 patients, 94%) and adenocarcinoma, NOS (two patients, 6%). The best overall response rate was 41.7% [n = 15, 95% confidence interval (CI), 25.5%-59.2%], the clinical benefit rate was 75.0% (n = 27, 95% CI, 57.8%-87.9%). The median progression-free survival was 8.8 months (95% CI, 6.3-12.3 months) and the median overall survival was 30.5 months (95% CI, 16.8 months to not reached). Additional analyses between treatment outcomes and clinicopathological factors or biomarkers including AR positivity, human epidermal growth factor receptor 2 status, and its complex downstream signaling pathway gene mutations showed no statistically significant differences. Elevated grade 3 liver transaminases and increased serum creatinine were reported in two patients, respectively. Discontinuation of leuprorelin acetate or bicalutamide due to adverse event occurred in one patient. Conclusion This study suggests that CAB has equivalent efficacy and less toxicity for patients with AR-positive RM or unresectable LA SGC compared with conventional chemotherapy, which warrants further study. Clinical Trial Registration UMIN-CTR (http://www.umin.ac.jp/ctr/index-j.htm), identification number: UMIN000005703.
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Affiliation(s)
- C Fushimi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Y Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
| | - H Takahashi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - T Nagao
- Department of Anatomic Pathology, Tokyo Medical University School of Medicine, Tokyo, Japan
| | - H Ojiri
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - T Masubuchi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - T Matsuki
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - K Miura
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - D Kawakita
- Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - H Hirai
- Department of Anatomic Pathology, Tokyo Medical University School of Medicine, Tokyo, Japan
| | - E Hoshino
- Support Unit for Conducting Clinically Essential Studies, Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - S Kamata
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - T Saotome
- Division of Medical Oncology, Matsudo City Hospital, Chiba, Japan
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3
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Can NT, Lingen MW, Mashek H, McElherne J, Briese R, Fitzpatrick C, van Zante A, Cipriani NA. Expression of Hormone Receptors and HER-2 in Benign and Malignant Salivary Gland Tumors. Head Neck Pathol 2017; 12:95-104. [PMID: 28681314 PMCID: PMC5873488 DOI: 10.1007/s12105-017-0833-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 06/19/2017] [Indexed: 11/24/2022]
Abstract
With the advent of targeted therapies, expression of sex hormone receptors and HER-2 in salivary gland tumors (SGTs) is of clinical interest. Previous reports of estrogen (ER) and progesterone (PR) receptor expression have varied. Androgen receptor (AR) and HER-2 overexpression are frequently reported in salivary duct carcinoma (SDC), but have not been studied systematically in other SGTs. This study examines ER, PR, AR, and HER-2 expression in SGTs. Immunohistochemistry for ER, PR, AR, and HER-2 was performed on 254 SGTs (134 malignant). ER, PR, and AR expression was scored using Allred system. HER-2 expression was scored using Dako HercepTest guidelines. FISH for HER-2 amplification was performed on select cases with HER-2 overexpression (2-3+). No SGT demonstrated strong expression of ER or PR. Combined strong AR and HER-2 expression was seen in 22 carcinomas: 14/25 SDC, 3/16 poorly differentiated, two oncocytic, and one each carcinoma ex pleomorphic adenoma, squamous cell, and intraductal carcinoma. Eighteen additional high grade carcinomas had HER-2 overexpression with absent, weak, or moderate AR expression; eight high grade carcinomas had isolated strong AR expression with 0-1+ HER-2 staining. Of 15 tested cases, six demonstrated HER-2 amplification by FISH, all of which had 3+ immunoreactivity. Neither benign nor malignant SGTs had strong expression of ER or PR. None of the benign SGTs overexpressed AR or HER-2. Coexpression of AR and HER-2 should not define SDC, but immunostaining should be considered in high grade salivary carcinomas, as some show overexpression and may benefit from targeted therapy.
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Affiliation(s)
- Nhu Thuy Can
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, MC 6101, Chicago, IL 60637 USA ,Department of Pathology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Mark W. Lingen
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, MC 6101, Chicago, IL 60637 USA
| | - Heather Mashek
- Constitutional Cytogenetics and Cytogenomics, Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - James McElherne
- Constitutional Cytogenetics and Cytogenomics, Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - Renee Briese
- Constitutional Cytogenetics and Cytogenomics, Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - Carrie Fitzpatrick
- Constitutional Cytogenetics and Cytogenomics, Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - Annemieke van Zante
- Department of Pathology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Nicole A. Cipriani
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, MC 6101, Chicago, IL 60637 USA
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4
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Rahimi S, Bradley KL, Akaev I, Marani C, Yeoh CC, Brennan PA. Androgen Receptor Expression in Primary Nonsquamous Cell Rare-Variant Carcinomas of the Head and Neck. OTO Open 2017; 1:2473974X17715633. [PMID: 30480186 PMCID: PMC6239020 DOI: 10.1177/2473974x17715633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 04/26/2017] [Accepted: 05/26/2017] [Indexed: 11/16/2022] Open
Abstract
Objective Androgen receptor (AR) is a diagnostic immunohistochemical marker for
salivary gland duct carcinoma (SDC), but other nonsquamous cell head and
neck carcinomas (NSCCs) may also express it. The aim of this preliminary
study was to investigate the immunohistochemical expression of AR in rare
head and neck NSCCs. Study Design Retrospective analysis of histologic records. Setting A large community hospital. Subjects and Methods Twenty-seven patients with NSCC were selected (21 men, 6 women; average age,
69 years). Exclusion criteria were histologically confirmed primary and
metastatic head and neck squamous cell carcinomas and thyroid carcinomas. AR
immunohistochemistry was done on formalin-fixed, paraffin-embedded tissue
blocks. Results Variable AR expression was found in 5 of 27 (25%) cases of NSCC. All 7
patients with SDC showed intense and extensive positive immunoreactivity. Of
27 NSCC tumors, 15 (56%) had negative staining. Conclusion In the head and neck, expression of AR is not limited to SDCs; other NSCCs
also express it. When surgery or radiotherapy is not appropriate for
recurrent or metastatic head and neck NSCC, palliative chemotherapy offers
poor results. Antiandrogen therapy is well tolerated and is much less toxic
than chemotherapy. Since androgen deprivation therapy has been used against
SDCs, this therapy may theoretically be used in a small subset of head and
neck NSCCs.
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Affiliation(s)
- Siavash Rahimi
- Pathology Centre-Histopathology, Queen Alexandra Hospital, Portsmouth, UK.,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | | | - Iolia Akaev
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Carla Marani
- Division of Histopathology, San Carlo Hospital, Rome, Italy
| | - Chit Cheng Yeoh
- Department of Oncology, Queen Alexandra Hospital, Portsmouth, UK
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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5
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Udager AM, Chiosea SI. Salivary Duct Carcinoma: An Update on Morphologic Mimics and Diagnostic Use of Androgen Receptor Immunohistochemistry. Head Neck Pathol 2017; 11:288-294. [PMID: 28321773 PMCID: PMC5550399 DOI: 10.1007/s12105-017-0798-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/06/2017] [Indexed: 12/29/2022]
Abstract
More than 15 years ago, seminal studies by Dr. E. Leon Barnes and colleagues transformed our understanding of salivary duct carcinoma (SDC) and, in doing so, paved the way for contemporary diagnostic and therapeutic approaches to this aggressive salivary adenocarcinoma. In particular, attention to the apocrine phenotype of SDC and expression of androgen receptor (AR) by immunohistochemistry has improved the diagnostic accuracy and showed how SDC can be reliably distinguished from its morphologic mimics (i.e., other salivary gland carcinomas with high grade transformation, low grade cribriform cystadenocarcinoma, and squamous cell carcinomas involving parotid). Furthermore, the observation that SDC shares AR expression with prostate cancer and apocrine breast cancer foresaw the discovery of common molecular alterations between SDC and these tumor types and draw attention to androgen deprivation therapy for SDC patients.
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Affiliation(s)
- Aaron M Udager
- Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Simion I Chiosea
- Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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6
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Androgen Receptor Signaling in Salivary Gland Cancer. Cancers (Basel) 2017; 9:cancers9020017. [PMID: 28208703 PMCID: PMC5332940 DOI: 10.3390/cancers9020017] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/28/2017] [Accepted: 02/03/2017] [Indexed: 11/17/2022] Open
Abstract
Salivary gland cancers comprise a small subset of human malignancies, and are classified into multiple subtypes that exhibit diverse histology, molecular biology and clinical presentation. Local disease is potentially curable with surgery, which may be combined with adjuvant radiotherapy. However, metastatic or unresectable tumors rarely respond to chemotherapy and carry a poorer prognosis. Recent molecular studies have shown evidence of androgen receptor signaling in several types of salivary gland cancer, mainly salivary duct carcinoma. Successful treatment with anti-androgen therapy in other androgen receptor-positive malignancies such as prostate and breast cancer has inspired researchers to investigate this treatment in salivary gland cancer as well. In this review, we describe the prevalence, biology, and therapeutic implications of androgen receptor signaling in salivary gland cancer.
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7
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Locati LD, Perrone F, Cortelazzi B, Lo Vullo S, Bossi P, Dagrada G, Quattrone P, Bergamini C, Potepan P, Civelli E, Fallai C, Pilotti S, Licitra L. Clinical activity of androgen deprivation therapy in patients with metastatic/relapsed androgen receptor-positive salivary gland cancers. Head Neck 2015; 38:724-31. [PMID: 25522335 DOI: 10.1002/hed.23940] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Androgen deprivation therapy has some clinical activity in selected salivary gland cancer histotypes, with androgen receptor expression. METHODS We retrospectively analyzed patients with androgen receptor-expressing recurrent/metastatic salivary gland cancer, treated with androgen deprivation therapy. Protein expression of androgen receptor and ErbB family members was investigated. Progression-free survival (PFS) and overall survival (OS) were the main endpoints. RESULTS Seventeen patients were identified. No significant toxicities were reported. Overall response rate was 64.7%; 3-year PFS and 5-year OS were 11.8% and 19.3%, respectively. Androgen receptor overexpression may be sustained by gain of chromosome X (58%) and TP53 mutation (44%). No association between response to androgen deprivation therapy and epidermal growth factor receptor (EGFR), human epidermal growth factor receptor (HER)2, HER3 expression, PIK3CA mutations, or phosphatase and tensin homolog (PTEN) deletion was identified. CONCLUSION We confirm the activity of androgen deprivation therapy in androgen receptor-expressing recurrent/metastatic salivary gland cancers. The hypothesis that an androgen receptor increased gene copy number may represent a possible mechanism of primary resistance should be further investigated.
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Affiliation(s)
- Laura D Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Perrone
- Laboratory of Experimental Molecular Pathology, Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Barbara Cortelazzi
- Laboratory of Experimental Molecular Pathology, Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Lo Vullo
- Clinical Epidemiology and Trial Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Bossi
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gianpaolo Dagrada
- Laboratory of Experimental Molecular Pathology, Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pasquale Quattrone
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristiana Bergamini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Potepan
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Civelli
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Fallai
- Department of Radiotherapy 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvana Pilotti
- Laboratory of Experimental Molecular Pathology, Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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8
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Bogaerts J, Sydes MR, Keat N, McConnell A, Benson A, Ho A, Roth A, Fortpied C, Eng C, Peckitt C, Coens C, Pettaway C, Arnold D, Hall E, Marshall E, Sclafani F, Hatcher H, Earl H, Ray-Coquard I, Paul J, Blay JY, Whelan J, Panageas K, Wheatley K, Harrington K, Licitra L, Billingham L, Hensley M, McCabe M, Patel PM, Carvajal R, Wilson R, Glynne-Jones R, McWilliams R, Leyvraz S, Rao S, Nicholson S, Filiaci V, Negrouk A, Lacombe D, Dupont E, Pauporté I, Welch JJ, Law K, Trimble T, Seymour M. Clinical trial designs for rare diseases: studies developed and discussed by the International Rare Cancers Initiative. Eur J Cancer 2015; 51:271-81. [PMID: 25542058 PMCID: PMC4639696 DOI: 10.1016/j.ejca.2014.10.027] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/28/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The past three decades have seen rapid improvements in the diagnosis and treatment of most cancers and the most important contributor has been research. Progress in rare cancers has been slower, not least because of the challenges of undertaking research. SETTINGS The International Rare Cancers Initiative (IRCI) is a partnership which aims to stimulate and facilitate the development of international clinical trials for patients with rare cancers. It is focused on interventional--usually randomized--clinical trials with the clear goal of improving outcomes for patients. The key challenges are organisational and methodological. A multi-disciplinary workshop to review the methods used in ICRI portfolio trials was held in Amsterdam in September 2013. Other as-yet unrealised methods were also discussed. RESULTS The IRCI trials are each presented to exemplify possible approaches to designing credible trials in rare cancers. Researchers may consider these for use in future trials and understand the choices made for each design. INTERPRETATION Trials can be designed using a wide array of possibilities. There is no 'one size fits all' solution. In order to make progress in the rare diseases, decisions to change practice will have to be based on less direct evidence from clinical trials than in more common diseases.
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Affiliation(s)
- Jan Bogaerts
- European Organisation for Research and Treatment of Cancer, Belgium
| | - Matthew R Sydes
- Medical Research Council Clinical Trial Unit at University College London, United Kingdom
| | | | | | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
| | - Alan Ho
- Memorial Sloan Kettering Cancer Center, United States
| | - Arnaud Roth
- Geneva University Hospital, Medical Oncology, Switzerland
| | | | - Cathy Eng
- The University of Texas M.D. Anderson Cancer Center, United States
| | | | - Corneel Coens
- European Organisation for Research and Treatment of Cancer, Belgium
| | - Curtis Pettaway
- The University of Texas M.D. Anderson Cancer Center, United States
| | - Dirk Arnold
- Hubertus Wald Tumorzentrum - University Cancer Centre Hamburg, Germany
| | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Helen Hatcher
- The University of Cambridge Department of Oncology and NIHR Cambridge Biomedical Research Centre, United Kingdom
| | - Helena Earl
- The University of Cambridge Department of Oncology and NIHR Cambridge Biomedical Research Centre, United Kingdom
| | | | - James Paul
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | | | - Jeremy Whelan
- NIHR University College London Hospitals Biomedical Research Centre, United Kingdom
| | | | | | | | | | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit and MRC Midland Hub for Trials Methodology Research, University of Birmingham, United Kingdom
| | | | | | | | | | | | | | | | - Serge Leyvraz
- Centre hospitalier universitaire vaudois, Switzerland
| | | | | | | | | | - Denis Lacombe
- European Organisation for Research and Treatment of Cancer, Belgium
| | - Elisabeth Dupont
- Center for Global Health, US National Cancer Institute, United States
| | | | - John J Welch
- Center for Global Health, US National Cancer Institute, United States
| | - Kate Law
- Cancer Research UK, United Kingdom
| | - Ted Trimble
- Center for Global Health, US National Cancer Institute, United States
| | - Matthew Seymour
- National Institute for Health Research Clinical Research Network/Cancer, United Kingdom
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9
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Campos-Gómez S, Flores-Arredondo JH, Dorantes-Heredia R, Chapa-Ibargüengoitia M, de la Peña-Lopez R. Case report: anti-hormonal therapy in the treatment of ductal carcinoma of the parotid gland. BMC Cancer 2014; 14:701. [PMID: 25249211 PMCID: PMC4190344 DOI: 10.1186/1471-2407-14-701] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 08/26/2014] [Indexed: 11/18/2022] Open
Abstract
Background Ductal carcinomas of the parotid gland are rare, highly aggressive, have a poor prognosis and are histologically similar to Ductal Breast Cancer. We report what we believe to be the first case in literature of metastatic salivary duct carcinoma (SDC) of the parotid gland with objective response to tamoxifen and aromatase inhibitors, achieving a long-term stability of disease with no associated toxicity. Case presentation A 70-year-old female was referred to our institution for treatment of a painless nodular lesion in the scalp, localized in the frontal region of the cranium. A biopsy was taken and tested positive for metastatic ductal carcinoma. On PET CT hypermetabolic nodules were localized in the left parotid gland (11 mm), right parotid gland (10 and 12 mm), submandibular node (11 mm) and left cervical node (10 mm). A salivary ductal carcinoma was considered to be the primary tumor. The patient was subsequently started on tamoxifen, with a complete response from the scalp nodule and left parotid nodule, while the right parotid nodule demonstrated a partial response that maintained stable for 2 years until progression. Anastrazol was chosen as the next line of treatment, achieving 6 more months of stable disease. As a pseudo-adjuvant treatment, surgical resection of the right parotid lesion was performed and helped achieve two years of disease stability. Conclusions Estrogen receptor antagonists such as tamoxifen or aromatase inhibitors may represent a target for the establishment of a safe alternative and novel therapy for SDC, however more accurate data obtained from larger studies are required.
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Affiliation(s)
- Saúl Campos-Gómez
- Departamento de Oncología Médica, Centro Oncológico Estatal, ISSEMYM, Toluca, México.
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10
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Masubuchi T, Tada Y, Maruya SI, Osamura Y, Kamata SE, Miura K, Fushimi C, Takahashi H, Kawakita D, Kishimoto S, Nagao T. Clinicopathological significance of androgen receptor, HER2, Ki-67 and EGFR expressions in salivary duct carcinoma. Int J Clin Oncol 2014; 20:35-44. [PMID: 24553861 DOI: 10.1007/s10147-014-0674-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 01/28/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Salivary duct carcinoma (SDC) is a highly aggressive disease which often metastasizes to distant sites, and there is no established standard therapy for this systemic disease. Given that SDC is biologically similar to breast and prostate cancer, anti-androgenic receptor (AR) and anti-human epidermal growth factor receptor 2 (HER2) therapies have the potential to exert effects, not only on patients with breast and prostate cancer but also on those with SDC. METHODS The expression levels of HER2, epidermal growth factor receptor (EGFR), Ki-67, and AR were assessed in 32 patients with SDC, and their correlations with overall survival (OS) and disease-free survival (DFS) were analyzed retrospectively. SDC was classified into five subtypes using a method similar to that used for breast cancer. RESULTS Anti-AR, HER2, and EGFR were positive in 23 (71.9 %), 14 (43.8 %), and 26 (81.3 %) cases, respectively. One or more of these 3 factors were positive in 30 (93.8 %) cases. The Ki-67 labeling index was greater than 15 % in all cases. While molecular status did not correlate with OS, EGFR and AR positivity were significantly associated with DFS in univariate analysis. Multivariate analysis revealed that EGFR was the only independent predictor of DFS. CONCLUSIONS The statuses of some molecules are useful to predict DFS in patients with SDC. Ki-67 overexpression suggests that cytotoxic agents are effective for SDC. Since the majority of SDCs express AR, HER2, and/or EGFR, assessing and targeting these molecules are promising strategies to improve the prognosis of unresectable, metastatic or recurrent SDC, and a classification system according to the molecular expression status may be useful to select appropriate therapy.
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Affiliation(s)
- Tatsuo Masubuchi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8239, Japan
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11
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Bossi P, Locati LD, Licitra L. Biological agents in head and neck cancer. Expert Rev Anticancer Ther 2014; 7:1643-50. [DOI: 10.1586/14737140.7.11.1643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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12
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Vattemi E, Graiff C, Sava T, Pedersini R, Caldara A, Mandarà M. Systemic therapies for recurrent and/or metastatic salivary gland cancers. Expert Rev Anticancer Ther 2014; 8:393-402. [DOI: 10.1586/14737140.8.3.393] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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13
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Lagha A, Chraiet N, Ayadi M, Krimi S, Allani B, Rifi H, Raies H, Mezlini A. Systemic therapy in the management of metastatic or advanced salivary gland cancers. Oral Oncol 2012; 48:948-957. [PMID: 22698431 DOI: 10.1016/j.oraloncology.2012.05.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 05/02/2012] [Indexed: 11/17/2022]
Abstract
Salivary gland cancers are very rare tumors. They are characterized by a histologic heterogeneity and a poor outcome. According to this rarity, few prospective data are available to date. No standard recommendations could be held for the use of systemic therapy in these tumors. Several case reports and small studies have investigated the contribution of different agents of chemotherapy. With the extension of molecular biology approach in oncology several signaling pathways have been discovered in different cancers including salivary gland cancers; thus a number of targeted therapies have been investigated. This paper reviewed exhaustively the studies investigating the role of systemic therapies (chemotherapy, targeted therapy, hormone therapy) in salivary gland cancers.
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Affiliation(s)
- Aymen Lagha
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia.
| | - Nesrine Chraiet
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Mouna Ayadi
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Sarra Krimi
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Bassem Allani
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Hela Rifi
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Henda Raies
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Amel Mezlini
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
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14
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Abstract
Salivary gland carcinomas are a heterogeneous group of tumors with different biologic behavior. Given the lack of large randomized studies, there is no standard treatment for advanced and/or metastatic salivary gland tumors, and systemic therapy is empirically based. Tumor-specific recurrent chromosomal translocations and fusion oncogenes in aggressive head and neck malignancies have diagnostic, therapeutic, and prognostic implications. Pathognomonic fusion transcripts have been identified in subsets of mucoepidermoid carcinoma and adenoid cystic carcinoma. These translocations target 1) transcription factors involved in growth factor signaling and cell cycle regulation, 2) transcriptional co-activators, and 3) tyrosine kinase receptors. Prioritizing studies with a translational component to advance the molecular understanding of these cancers and molecular-targeted therapy clinical trials is critical.
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Affiliation(s)
- Diana Bell
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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15
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Systemic therapy in the management of metastatic or advanced salivary gland cancers. HEAD & NECK ONCOLOGY 2012; 4:19. [PMID: 22558945 PMCID: PMC3414773 DOI: 10.1186/1758-3284-4-19] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 05/04/2012] [Indexed: 11/10/2022]
Abstract
Salivary gland cancers are very rare tumors. They are characterized by a histologic heterogeneity and a poor outcome. According to this rarity, few prospective data are available to date. No standard recommendations could be held for the use of systemic therapy in these tumors. Several case reports and small studies have investigated the contribution of different agents of chemotherapy. With the extension of molecular biology approach in oncology several signaling pathways have been discovered in different cancers including salivary gland cancers; thus a number of targeted therapies have been investigated. This paper reviewed exhaustively the studies investigating the role of systemic therapies (chemotherapy, targeted therapy, hormone therapy) in salivary gland cancers.
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Konttinen YT, Stegaev V, Mackiewicz Z, Porola P, Hänninen A, Szodoray P. Salivary glands - "an unisex organ'? Oral Dis 2010; 16:577-85. [PMID: 20412448 DOI: 10.1111/j.1601-0825.2010.01669.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Usually no distinction is made between female and male salivary glands although cyclic changes of and ⁄ or differences in serum and salivary sex steroid concentrations characterize women and men. Moreover, sexual dimorphism is well recognized in salivary glands of rodents.Salivary glands contain estrogen and androgen receptors and are, according to modern high throughput technologies,subjected to gender differences not explainable by gene dose effects by the X chromosome alone. Because sex steroids are lipophilic, it is often thought that approximately 10% of them passively diffuse from plasma to saliva. Indeed, saliva can find use as sample material in sports medicine, pediatrics, veterinary medicine and behavioral sciences. Last but not least, humans and other primates are unique in that they have a reticular zone in their adrenal cortex, which produces dehydroepiandrosterone and androstendione pro-hormones. These are processed in peripheral tissues, not only in female breast and uterus and male prostate, but also in salivary glands by an intracrine enzymatic machinery to active 17b-estradiol,dihydrotestosterone and others, to satisfy and buffer against a constantly changing needs caused by circadian,menstrual, pregnancy and chronobiological hormonal changes in the systemic circulation. Female dominance of Sjögren's syndrome and certain forms of salivary gland cancer probably reflect these gender-based differences.
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Affiliation(s)
- Y T Konttinen
- Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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17
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Treatment relevant target immunophenotyping of 139 salivary gland carcinomas (SGCs). Oral Oncol 2009; 45:986-90. [DOI: 10.1016/j.oraloncology.2009.05.635] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 05/11/2009] [Accepted: 05/12/2009] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW Salivary gland neoplasms are composed of histopathologically and clinically diverse entities. The reported response rates of salivary gland tumors to chemotherapy are generally poor. Molecular studies have provided some information on their biology and have identified new targets with therapeutic potential. RECENT FINDINGS Several agents are currently being tested that target molecular signaling and cancer cell biology. The pathways involved include but are not limited to vascular endothelial growth factor and epidermal growth factor receptors. Novel treatments under evaluation include tyrosine kinase inhibitors, antibodies, angiogenesis inhibitors, demethylating agents, and proteasome inhibitors. SUMMARY Some of these new targeted approaches hold promise for our future ability to treat patients with salivary gland cancer unresponsive to traditional therapy, but others were disappointing. The presence of the molecular target alone is not sufficient to guarantee an antitumor effect with targeted therapy. The success of these molecular-targeted agents depends on the molecular abnormalities involved in carcinogenesis.
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Chandana SR, Conley BA. Salivary gland cancers: current treatments, molecular characteristics and new therapies. Expert Rev Anticancer Ther 2008; 8:645-52. [PMID: 18402531 DOI: 10.1586/14737140.8.4.645] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Salivary gland cancers are relatively rare and quite diverse. Current therapy relies on local ablation. There are few large clinical trials or randomized trials to guide treatment, especially for metastatic disease. This article reviews the epidemiology, staging, molecular characteristics, and treatment evidence for the most common types of salivary cancers and suggests potential future diagnostic and treatment directions. Progress in understanding the molecular and cell biology of salivary gland cancers may lead to the development of targeted therapies in these rare tumors. Multidisciplinary and multi-institutional collaborative studies are needed to help improve survival in salivary gland cancers.
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Affiliation(s)
- Sreenivasa R Chandana
- Division of Hematology/Oncology, Michigan State University, Breslin Cancer Center 401, W. Greenlawn Avenue, Lansing, MI, USA.
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20
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Laurie SA, Licitra L. Systemic therapy in the palliative management of advanced salivary gland cancers. J Clin Oncol 2006; 24:2673-8. [PMID: 16763282 DOI: 10.1200/jco.2005.05.3025] [Citation(s) in RCA: 202] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cancers of the salivary glands are unusual lesions that vary widely in their histologic appearance and molecular characteristics. Likewise, there is a wide spectrum of biologic behavior, ranging from low-grade, minimally invasive tumors, to highly lethal malignancies. There are few data on the role of systemic therapies in the management of these cancers, and chemotherapy is generally reserved for the palliative management of advanced disease that is not amenable to local therapies such as surgery and/or radiation. The majority of patients for whom systemic therapy is considered will have either adenoid cystic carcinoma, mucoepidermoid carcinoma, or high-grade adenocarcinoma. This article will review the available literature regarding the use of palliative chemotherapy for patients with advanced salivary gland cancer of these histologies, with an emphasis on the potential role of targeted agents. There is a need for a determined, coordinated effort to conduct high-quality clinical trials in patients with these rare cancers.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/pathology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/therapeutic use
- Boronic Acids/therapeutic use
- Bortezomib
- Carcinoma, Adenoid Cystic/drug therapy
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Mucoepidermoid/drug therapy
- Carcinoma, Mucoepidermoid/pathology
- Clinical Trials as Topic
- Deoxycytidine/analogs & derivatives
- Deoxycytidine/therapeutic use
- Humans
- Lapatinib
- Neoplasm Metastasis
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/pathology
- Palliative Care
- Pyrazines/therapeutic use
- Quinazolines/therapeutic use
- Receptor, ErbB-2/metabolism
- Receptors, Androgen/metabolism
- Salivary Ducts
- Salivary Gland Neoplasms/drug therapy
- Salivary Gland Neoplasms/pathology
- Trastuzumab
- Gemcitabine
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Affiliation(s)
- Scott A Laurie
- Ottawa Hospital Regional Cancer Centre, the University of Ottawa, Ottawa, Canada
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21
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Affiliation(s)
- L Licitra
- Head and Neck Cancer Medical Oncology Unit, Cancer Medicine Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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22
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Abstract
PURPOSE OF REVIEW This review deals with classification and treatment of some rare nonsquamous cell carcinomas of the head and neck. RECENT FINDINGS Paranasal sinus tumor classification is under evaluation. Contrary to the past, the recent tendency is to build stage classifications on prognostic factors that mainly reflect limitations for adequate surgery, and not simply on dimensional criteria, which are more frequently used in TNM. Among sinonasal tract tumors new pathologic entities have been described. So far, little is known about their natural history and about the need to use pathologic classification to differentiate treatment. Recent advances in radiotherapeutic techniques, such as intensity-modulated radiotherapy, will probably have an impact on future treatment of paranasal sinus tumors. Several molecular targets (c-kit, HER-2/neu, androgen receptors) have been identified in salivary gland cancer. It is interesting to note that among different histotypes there is a trend toward a consistent expression of specific markers in specific cancers, suggesting a possible implication of them in the disease histogenesis. Not surprisingly these findings prompted clinical research with molecular targeted drugs. SUMMARY Nonsquamous cell carcinomas of the head and neck are rare neoplasms. A multidisciplinary team treatment plan is needed, in particular for skull base-located tumors. Salivary gland cancer displays several molecular targets that need to be investigated further.
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Affiliation(s)
- Lisa Licitra
- Head and Neck Department, Medical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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Locati LD, Quattrone P, Bossi P, Marchianò AV, Cantù G, Licitra L. A complete remission with androgen-deprivation therapy in a recurrent androgen receptor-expressing adenocarcinoma of the parotid gland. Ann Oncol 2003; 14:1327-8. [PMID: 12881399 DOI: 10.1093/annonc/mdg331] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Fan CY, Wang J, Barnes EL. Expression of androgen receptor and prostatic specific markers in salivary duct carcinoma: an immunohistochemical analysis of 13 cases and review of the literature. Am J Surg Pathol 2000; 24:579-86. [PMID: 10757407 DOI: 10.1097/00000478-200004000-00014] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Salivary duct carcinoma (SDC) is an uncommon, pathologically distinct entity characterized by its morphologic resemblance to ductal carcinoma of the breast and highly aggressive behavior. Approximately two thirds of patients die within 4 years of initial diagnosis despite aggressive, combined surgical resection and radiotherapy. Review of the literature indicates that androgen receptor (AR), a marker frequently detected in prostatic carcinoma, is expressed in over 90% of SDCs, whereas two common breast carcinoma markers, estrogen and progesterone receptors (ER and PR), are expressed in only 1.3% and 6% of the tumors, respectively, by immunohistochemistry. This hormonal profile suggests that SDC, in contrast to its histiologic similarity to ductal carcinoma of the breast, is immunophenotypically more related to prostatic carcinoma. To substantiate this hypothesis, we performed immunohistochemical staining of 13 cases of SDC for the presence of AR and two prostatic markers, prostate specific antigen (PSA) and prostatic acid phosphatase (PAP). Our results showed multifocal, scattered, moderate immunostaining for PAP and diffuse, moderate immunostaining for PSA in seven (58.3%) and two (16.7%) cases, respectively. These results create a potential diagnostic challenge to surgical pathologists who are dealing with a metastatic adenocarcinoma of AR+/PSA+/-/PAP+/- phenotype, particularly in male patients of unknown primary. Metastatic salivary duct carcinoma should be given serious thought if clinical investigation fails to reveal a prostatic primary. The immunophenotypic homology that exists between SDC and prostatic carcinoma also suggests that antiandrogen therapy as used in the treatment of prostatic carcinoma might be beneficial in patients with metastatic SDC when all other conventional modalities fail.
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MESH Headings
- Acid Phosphatase/analysis
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Ductal, Breast/chemistry
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/chemistry
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Female
- Humans
- Immunoenzyme Techniques
- Male
- Middle Aged
- Prostate-Specific Antigen/analysis
- Receptors, Androgen/analysis
- Salivary Ducts/chemistry
- Salivary Ducts/pathology
- Salivary Gland Neoplasms/chemistry
- Salivary Gland Neoplasms/pathology
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Affiliation(s)
- C Y Fan
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, USA
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