Background Prognosis and treatment options differ for each molecular subtype of breast cancer, but risk of regional lymph node (LN) metastasis for each subtype has not been well-studied. Since LN status is the most important predictor for prognosis, the aim of this study is to investigate the propensity for LN metastasis in each of the five breast cancer molecular subtypes. Methods Under an IRB-approved protocol, we retrospectively reviewed the charts of all pathologically confirmed breast cancer cases from 1/2004 to 6/2012. Five subtypes were defined as luminal A (hormone receptor +, Ki67 low), luminal B (hormone receptor+, Ki67 high), luminal-human epidermal growth factor receptor 2 (HER-2), HER-2-enriched (hormone receptor negative), and triple negative (TN). Results A total of 375 patients with complete data were classified by subtype: 95 (25.3%) luminal A, 120 (32%) luminal B, 69 (18.4%) luminal-HER-2, 26 (6.9%) HER-2-enriched, and 65 (17.3%) TN. On univariate analysis, age (<50), higher tumor grade, HER-2 + status, tumor size, and molecular subtype were significant for LN positivity. Molecular subtype correlated strongly with tumors size (X2; p=0.0004); therefore, multivariable logistic regression did not identify molecular subtype as an independent variable to predict LN positivity. Conclusions Luminal A tumors have the lowest risk of LN metastasis, while luminal HER-2 subtype has the highest risk of LN metastasis. Immunohistochemical-based molecular classification can be readily performed and knowledge of the factors that affect LN status may help with treatment decisions.

Low-grade fibromyxoid sarcoma (LGFMS) represents a rare soft tissue tumor that was first characterized in 1987. LGFMS usually presents as a large, deeply situated mass in adults and is characterized by deceptively bland histopathologic features. LFGMS is less common in superficial soft tissue and in children. It is distinctly uncommon for LGFMS to exhibit nuclear pleomorphism. Herein, we present a case of a 10-year-old male who presented with a subcutaneous back mass that displayed features typical for LGFMS as well as scattered large, hyperchromatic and pleomorphic nuclei. The constellation of clinicopathologic features, including the young age of the patient, the small size and superficial location of the tumor and the presence of scattered nuclear pleomorphism are all unusual features for LGFMS. Fluorescent in situ hybridization (FISH) with a break-apart probe for FUS revealed the presence of a FUS gene rearrangement confirming the diagnosis of LGFMS. This case highlights the importance of maintaining a high index of suspicion for LGFMS even in the context of small, superficially-located tumors, pediatric patients or tumors with scattered nuclear pleomorphism.

Human endogenous retroviral elements (HERVs) are thought to be germline-integrated genetic remnants of exogenous retroviral infections. HERVs comprise approximately 5%-8% of the human genome. Although all HERV genomes are highly defective, some, especially the K type (HERV-K), have the potential to be expressed and have biological activities. HERV-K expression has been detected in human melanomas. There are also reports on the regulation and potential activities of HERV-K in melanoma cells. Although a causal link between the activation of HERV-K and melanoma development has yet to be determined, existing data support the further research efforts in this area. In this review, we summarize the published studies on the expression, regulation, and activity of HERV-K in human melanoma.

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