Case Report: Case report: a rare salivary gland tumor

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We report a 40 year old male with parotid swelling diagnosed as pleomorphic adenoma, who underwent parotidectomy with modified radical neck dissection and later, on routine histopathology, the swelling was reported as a salivary duct carcinoma, confirmed via immunohistochemistery. Given the relative low occurrence and known difficulty in making an accurate diagnosis using fine needle aspiration cytology, the possibility of salivary duct carcinoma in the appropriate clinical setting of elderly patients with parotid mass and facial palsy should be seriously considered." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/1-41", "name": "Case Report: Case report: a rare salivary gland tumor" } } ] } Home Browse Case Report: Case report: a rare salivary gland tumor ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Sareen R and Pandey CL. Case Report: Case report: a rare salivary gland tumor [version 1; peer review: 2 approved with reservations] . F1000Research 2012, 1 :41 ( https://doi.org/10.12688/f1000research.1-41.v1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Case report: a rare salivary gland tumor [version 1; peer review: 2 approved with reservations] Rateesh Sareen 1 , Chandra L Pandey 2 Rateesh Sareen 1 , Chandra L Pandey 2 PUBLISHED 31 Oct 2012 Author details Author details 1 DNB Pathology, SDM Hospital Jaipur, Jaipur, 302004, India 2 Department of Pathology, Bhagwan Mahaveer Cancer Hospital and Research Center, Jaipur, 302017, India OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Salivary duct carcinoma is a distinctive primary neoplasm of the major salivary gland characterized by aggressive behavior with early metastasis, local recurrence and significant mortality. We report a 40 year old male with parotid swelling diagnosed as pleomorphic adenoma, who underwent parotidectomy with modified radical neck dissection and later, on routine histopathology, the swelling was reported as a salivary duct carcinoma, confirmed via immunohistochemistery. Given the relative low occurrence and known difficulty in making an accurate diagnosis using fine needle aspiration cytology, the possibility of salivary duct carcinoma in the appropriate clinical setting of elderly patients with parotid mass and facial palsy should be seriously considered. READ ALL READ LESS Corresponding Author(s) Rateesh Sareen ( [email protected] ) Close Corresponding author: Rateesh Sareen Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2012 Sareen R and Pandey CL. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data associated with the article are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication). How to cite: Sareen R and Pandey CL. Case Report: Case report: a rare salivary gland tumor [version 1; peer review: 2 approved with reservations] . F1000Research 2012, 1 :41 ( https://doi.org/10.12688/f1000research.1-41.v1 ) First published: 31 Oct 2012, 1 :41 ( https://doi.org/10.12688/f1000research.1-41.v1 ) Latest published: 31 Oct 2012, 1 :41 ( https://doi.org/10.12688/f1000research.1-41.v1 ) Editorial note: Please note that the refereeing status of this article was changed from “indexed” to “[v1; ref status: approved with reservations 2]”. When this article was first published, F1000Research was still in its beta phase; during this period articles that received any two of “Approved” or “Approved with Reservations” statuses from the reviewers were labelled as “indexed”. When the journal was formally launched in January 2013, the requirements for indexing were tightened, and only articles that are given either two “Approved” or one “Approved” plus two “Approved with Reservations” statuses by the reviewers are labelled “indexed”. The new criteria for “indexing” can still be met in the future if a new revised version receives the necessary approval status from the reviewers. Introduction Salivary duct carcinoma is a distinctive primary neoplasm of the major salivary gland first described by Kleinsasser et al in 1968 1 . The term was selected because of its resemblance to ductal carcinoma of the breast. It is characterized by aggressive behavior with early metastasis, local recurrence and significant mortality. Nearly 85% of cases occur in the parotid gland followed by submandibular gland 2 . The tumor has predilection for older men in the 6th to 7th decades of life 3 . A number of patients experience facial nerve palsy or paralysis and/or pain, and have cervical lymphadenopathy on presentation 1 . Familiarity with this entity is necessary to avoid false interpretation. Case report A 40 year old Hindu male who had a 15 year history of smoking presented with a gradually increasing painless swelling on the left parotid region. On examination an 8 × 6 cm swelling was observed the A single Level II mobile lymph node of size < 1 cm was palpable. There was no facial palsy. An ultrasonograph of the parotid region performed previously revealed a well defined hypoechoic mass (4.7 × 3.9 cm) with lobulation occupying the left temporomandibular joint with adjacent hypoechoic areas of varying sizes: 1.9 × 1.6 cm, 1.4 × 1.5 cm, and 1.1 × 1.2 cm. It was interpreted as a parotid mass. Fine needle aspiration cytology (FNAC) from the left parotid gland was done and reported as a pleomorphic adenoma. However, FNAC from the submandibular lymph node comprised of blood only. A repeat FNAC at our institute ( Figure 1 ) showed moderately cellular aspirates with few clusters of normal salivary gland tissue along with epithelial cells showing overcrowding, with a mild-to-moderate pleomorphic population of medium sized cells with the vesicular nuclei having evenly distributed chromatin without conspicuous nucleoi. Cytoplasm was eosinophilic with ill defined borders. It was interpreted as an epithelial neoplasm. Figure 1. A hematoxylin and eosin stain of fine needle aspiration cytology of the parotid gland (40x). A CT scan of the face and neck showed that the left parotid gland had enlarged in size (9 × 6 × 4 cm), involving deep and superficial lobes, with replacement of normal glandular architecture by homogenous soft tissue. The adjacent musculo-fascial planes were preserved. Multiple enlarged discrete lymph nodes in the left parotid were noted. The left internal jugular vein was compressed and no intraluminal thrombosis was seen. In order to reach a diagnosis, a frozen Level II lymph node was performed. ( Figure 2 ) On frozen section, the lymph node architecture was not seen. Cells were singly scattered having scanty cytoplasm, enlarged hyperchromatic nuclei and condensed chromatin. It was not possible to identify the type of malignancy and was therefore reported as a high grade malignant neoplasm. Figure 2. A hematoxylin and eosin stain of a frozen level III lymph node (40x). On routine histopathology, neck nodes were resected. Six out of seven lymph nodes showed a metastatic neoplasm comprising of sheets and lobules of pleomorphic cells with coarse clumped chromatin separated by fibrous septa. Mitotic activity increased, rosette formation was noted, and it was reported as a poorly differentiated carcinoma with basaloid phenotype. The presence of a high mitotic rate and of focal large, polypoid nuclei suggested an origin from the sebaceous gland. Finally, a total parotidectomy with modified neck dissection was performed. On gross examination the specimen comprised of: – Single gray soft tissue piece with skin tag (15 × 14 × 4 cm). – Skin (4.5 × 2 cm). – Salivary glands (4 × 2 × 2 cm) were grossly unremarkable. – Multiple lymph nodes at level II & III – (1.5 to 5.5 cm). – A deep lobe parotid gland. – Several gray soft tissue pieces (7 × 7 × 3 cm) with a level I lymph node. – A single gray soft tissue piece (4 × 4 × 1 cm) ( Figure 3 ). Figure 3. A gross photo of the parotidectomy. Microscopic analysis ( Figure 4 , Figure 5 ) showed that the tumor comprised of slightly pleomorhic ovoid cells with vesicular nuclei arranged in sheets and a trabecular pattern separated by fibrous septa. Mitotic activity was not increased. Focal area showed an acinar and comedo pattern. Perineural and lymphovascular invasion were seen. Infiltration into the salivary gland tissue was noted. Eight out of ten lymph nodes showed metastatic carcinoma. In view of metastasis to a lymph node, a diagnosis of high grade malignant epithelial neoplasm was suggested, which was later confirmed via immunohistochemistry as salivary duct carcinoma. Figure 4. A hematoxylin and eosin stain of the parotid gland tumor (10x). Figure 5. A hematoxylin and eosin stain of the parotid gland tumor (40x). Discussion Salivary duct carcinoma (SDC) is an aggressive adenocarcinoma which resembles high-grade breast ductal carcinoma. It is also known as cribriform salivary carcinoma of excretory ducts, or high-grade salivary duct carcinoma. SDC represents 9% of salivary malignancies. The male: female ratio is at least 4:1 and most patients present after age 50 4 . The parotid is most commonly involved, but submandibular, sublingual, minor salivary gland, maxillary and laryngeal tumours have been reported 2 . SDCs are usually firm, solid, tan, white or grey, with a cystic component. Infiltration of the adjacent parenchyma is usually obvious, but occasional tumours may appear to be circumscribed. SDC may also arise as the malignant component of a carcinoma ex-pleomorphic adenoma, so that the macroscopic features of pleomorphic adenoma may also be present. For SDC, perineural spread (60%) and intravascular tumour emboli (31%) are common 4 . SDC resembles intraductal and infiltrating mammary duct carcinoma, both architecturally and cytologically. The diagnostic “ductal lesion” comprises pleomorphic, epithelioid tumour cells with a cribriform growth pattern, “Roman bridge” formation, and intraductal comedonecrosis. Cytologically, these cells have abundant, pink cytoplasm and large pleomorphic nuclei with prominent nucleoli and coarse chromatin. The cytoplasm may also be densely eosinophilic, granular, or oncocytic. Mitotic figures are usually abundant. Goblet cells are not seen 5 , 6 . Immunohistochemistry SDC is immunoreactive for low- and high-molecular-weight cytokeratin, and markers such as carcinoembryonic antigen (CEA), LeuM1, and epithelial membrane antigen (EMA) 7 . Strong nuclear reactivity for androgen receptors (AR) is reported in all SDC. As well as being positive for GCDFP-15, they are negative for S-100 protein, myoepithelial markers as well as estrogen and progesterone receptors 8 . The MIB1 proliferative index is high. Most SDCs show positive distinct membrane staining for HER-2/neu protein. Metastatic breast and squamous carcinomas, oncocytic carcinoma and mucoepidermoid carcinoma come in differential diagnosis because they also show similar immunohistochemistry profiles 9 – 11 . SDC is one of the most aggressive salivary malignancies. Sites for distant metastasis include lungs, bones, liver, brain and skin 4 . Sixty-five percent of patients die from the disease, usually within 4 years of diagnosis (ranging from 5 months to 10 years) 11 . The clinical course is characterized by early distant metastases. Tumour size, distant metastasis, and HER-2/neu overexpression are putative prognostic parameters for SDC, while expression of p53 protein, DNA aneuploidy, and proliferative activity do not correlate with outcome 9 , 10 . The clinical outcome for the mucin-rich variant of SDC is similar to that of conventional SDC 12 . Conclusion Given the known difficulty in making an accurate diagnosis of salivary duct carcinoma 13 , the identification of a tumor exhibiting variable nuclear grade with cribriform, papillary and comedo patterns in the appropriate clinical setting of elderly patients with parotid mass and facial palsy should suggest the diagnosis of this uncommon tumor after excluding a metastatic carcinoma. Consent Written Informed consent for publication was obtained from the patient. Author contributions RS and CLP contributed to the conception and design of the study. RS collected and analyzed the data and wrote up the manuscript. RS and CLP both approved the manuscript. Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Acknowledgements Mr Mudit Sharma Senior Technician, Department of Pathology and Bhagwan Mahaveer Cancer Hospital and Research Center, Jaipur, India for assisting in performing section cutting, staining and special stains. Faculty Opinions recommended References 1. Lewis JE, McKinney BC, Weiland LH, et al. : Salivary Duct carcinoma. Clinicopathologic and Immunohistochemical Review of 26 Cases. Cancer. 1996; 77 (2): 223–30. PubMed Abstract | <a target="xrefwindow" id="d1175177e524" href="https://doi.org/10.1002/(SICI)1097-0142(19960115)77:2 Publisher Full Text 2. Epivatianos A, Dimitrakopoulos J, Trigonidis G: Intraoral salivary duct carcinoma: a clinicopathological study of four cases and review of the literature. Ann Dent. 1995; 54 (1–2): 36–40. PubMed Abstract 3. Boson WL, Gomez RS, Araujo L, et al. : Odontogenic myxomas are not associated with activating mutations of the Gs alpha gene. Anticancer Res. 1998; 18 (6A): 4415–4417. PubMed Abstract 4. 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PubMed Abstract | <a target="xrefwindow" id="d1175177e741" href="https://doi.org/10.1002/1097-0142(19900515)65:10 Publisher Full Text 12. Simpsonn RHW, Prasad AR, Lewis JE, et al. : Mucin-rich variant of salivary duct carcinoma: a clinicopathologic and immunohistochemical study of four cases. Am J Surg Pathol. 2003; 27 (8): 1070–1079. PubMed Abstract | Publisher Full Text 13. Kinnera V, Nandyala R, Yootla M, et al. : Salivary duct carcinoma of parotid gland. Internet J Pathol. 2009; 10 (1). Reference Source Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 31 Oct 2012 ADD YOUR COMMENT Comment Author details Author details 1 DNB Pathology, SDM Hospital Jaipur, Jaipur, 302004, India 2 Department of Pathology, Bhagwan Mahaveer Cancer Hospital and Research Center, Jaipur, 302017, India Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 31 Oct 2012, 1:41 https://doi.org/10.12688/f1000research.1-41.v1 Copyright © 2012 Sareen R and Pandey CL. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data associated with the article are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication). Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Sareen R and Pandey CL. Case Report: Case report: a rare salivary gland tumor [version 1; peer review: 2 approved with reservations] . F1000Research 2012, 1 :41 ( https://doi.org/10.12688/f1000research.1-41.v1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 31 Oct 2012 Views 0 Cite How to cite this report: Cantu G. Reviewer Report For: Case Report: Case report: a rare salivary gland tumor [version 1; peer review: 2 approved with reservations] . F1000Research 2012, 1 :41 ( https://doi.org/10.5256/f1000research.218.r354 ) The direct URL for this report is: https://f1000research.com/articles/1-41/v1#referee-response-354 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 04 Nov 2012 Giulio Cantu , Cranio-Maxillo-Facial Surgery Department, Istituto Nazionale Tumori, Milan, Italy Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.218.r354 Every report of rare cases must be appreciated, even if salivary duct carcinoma is not so rare (9% of salivary glands malignancies), and dozens of cases have been reported in the past. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Competing Interests: No competing interests were disclosed. Every report of rare cases must be appreciated, even if salivary duct carcinoma is not so rare (9% of salivary glands malignancies), and dozens of cases have been reported in the past. Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Cantu G. Reviewer Report For: Case Report: Case report: a rare salivary gland tumor [version 1; peer review: 2 approved with reservations] . F1000Research 2012, 1 :41 ( https://doi.org/10.5256/f1000research.218.r354 ) The direct URL for this report is: https://f1000research.com/articles/1-41/v1#referee-response-354 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Dulguerov P. Reviewer Report For: Case Report: Case report: a rare salivary gland tumor [version 1; peer review: 2 approved with reservations] . F1000Research 2012, 1 :41 ( https://doi.org/10.5256/f1000research.218.r353 ) The direct URL for this report is: https://f1000research.com/articles/1-41/v1#referee-response-353 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 01 Nov 2012 Pavel Dulguerov , Department of Otorhinolaryngology – Head & Neck Surgery, Geneva University Hospital, Geneva, Switzerland Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.218.r353 In general, This is a well written case report of salivary duct carcinoma. In this case, like most rare and poorly differentiated salivary neoplasms, the correct diagnosis was only possible on the final specimen despite FNA, frozen, and permanent section histopathology ... Continue reading READ ALL In general, This is a well written case report of salivary duct carcinoma. In this case, like most rare and poorly differentiated salivary neoplasms, the correct diagnosis was only possible on the final specimen despite FNA, frozen, and permanent section histopathology of the metastatic lymph nodes. While the immunohistochemistry is reviewed in the discussion, it is not specified how it was used in this particular case. This report will not alter the clinical management of this disease but it highlights the most salient points in the clinical diagnosis of salivary ductal carcinoma. Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Dulguerov P. Reviewer Report For: Case Report: Case report: a rare salivary gland tumor [version 1; peer review: 2 approved with reservations] . F1000Research 2012, 1 :41 ( https://doi.org/10.5256/f1000research.218.r353 ) The direct URL for this report is: https://f1000research.com/articles/1-41/v1#referee-response-353 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 31 Oct 2012 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 31 Oct 12 read read Pavel Dulguerov , Geneva University Hospital, Geneva, Switzerland Giulio Cantu , Istituto Nazionale Tumori, Milan, Italy Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2012 Cantu G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 04 Nov 2012 | for Version 1 Giulio Cantu , Cranio-Maxillo-Facial Surgery Department, Istituto Nazionale Tumori, Milan, Italy 0 Views copyright © 2012 Cantu G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Every report of rare cases must be appreciated, even if salivary duct carcinoma is not so rare (9% of salivary glands malignancies), and dozens of cases have been reported in the past. Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Cantu G. Peer Review Report For: Case Report: Case report: a rare salivary gland tumor [version 1; peer review: 2 approved with reservations] . F1000Research 2012, 1 :41 ( https://doi.org/10.5256/f1000research.218.r354) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/1-41/v1#referee-response-354 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2012 Dulguerov P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 01 Nov 2012 | for Version 1 Pavel Dulguerov , Department of Otorhinolaryngology – Head & Neck Surgery, Geneva University Hospital, Geneva, Switzerland 0 Views copyright © 2012 Dulguerov P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions In general, This is a well written case report of salivary duct carcinoma. In this case, like most rare and poorly differentiated salivary neoplasms, the correct diagnosis was only possible on the final specimen despite FNA, frozen, and permanent section histopathology of the metastatic lymph nodes. While the immunohistochemistry is reviewed in the discussion, it is not specified how it was used in this particular case. This report will not alter the clinical management of this disease but it highlights the most salient points in the clinical diagnosis of salivary ductal carcinoma. Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Dulguerov P. Peer Review Report For: Case Report: Case report: a rare salivary gland tumor [version 1; peer review: 2 approved with reservations] . F1000Research 2012, 1 :41 ( https://doi.org/10.5256/f1000research.218.r353) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/1-41/v1#referee-response-353 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); });