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Surgical Pathology 304 Id: SA61 High-Level Expression of Standard Form CD44 in Distant Metastasis of Estrogen Receptor-Negative Breast Cancer Wei Zheng, Lichao Zhao, Shin-Ae Kang, Takemi Tanaka, University of Oklahoma Health Science Center Breast cancer is the most common malignancy in women in the United States, and hematogenous metastasis accounts for the majority of cancer-related morbidity and mortality, yet the mechanism remains unclear. CD44 (a cell surface receptor) has been implicated to regulate the adhesion of circulating cancer cells to the endothelium by interaction with vascular adhesion molecules selectins. However, to date, no comparison of CD44s expression and breast cancer subtype in distant metastases of human patient has been reported. This study, for the first time, to our knowledge, reveals that high-level expression of standard form CD44 (CD44s) is uniquely associated with estrogen receptor (ER)-negative breast cancers but not other subtypes of breast cancer in distant metastases, indicating CD44s as a potential marker in predicting breast cancer aggressiveness. CD44s and E-selectin expression levels were analyzed by immunohistochemistry using 31 brain and pulmonary metastases of breast cancer from female patients. Semiquantitative scoring of CD44s and E-selectin expression was performed blindly. Association/correlation of CD44s and ER or progesterone receptor (PR) status was analyzed using Mann-Whitney test. Results indicate highlevel expression of CD44s in ER-negative brain and pulmonary metastases of breast cancer in comparison to ER+ metastases. The expression of CD44s was inversely correlated with ER statuses. However, no correlation was found between CD44s and PR status. E-selectin expression was also highly upregulated in metastatic carcinomas. These findings suggest a distinct role for CD44s in ER-negative breast cancers, and propose CD44 as a potential marker in predicting a metastatic phenotype of ER-negative breast cancer. © American Society for Clinical Pathology Am J Clin Pathol 2015;144:A304