Nucleophosmin (NPM) is a multifunctional protein involved in a complex network of interactions. The role of NPM in oncogenesis is controversial. The NPM gene (NPM1) is mutated or rearranged in a number of hematological disorders, but such changes have not been detected in solid cancers. However, experiments with cultured NPM-null cells and with mice carrying a single inactivated NPM allele indicate a tumor suppressor function for NPM. To resolve the role of NPM in solid cancers, we examined its expression and localization in histologically normal breast tissue and a large array of human breast carcinoma samples (n ؍ 1160), and also evaluated its association with clinicopathological variables and patient survival. The intensity and localization (nucleolar, nuclear, cytoplasmic) of NPM varied across clinical samples. No mutations explaining the differences were found, but the present findings indicate that expression levels of NPM affected its localization. Our study also revealed a novel granular staining pattern for NPM, which was an independent prognostic factor of poor prognosis. In addition, reduced levels of NPM protein were associated with poor prognosis. Nucleophosmin (NPM) is a ubiquitously expressed multifunctional nucleolar phosphoprotein. It localizes mainly to the nucleoli, but also shuttles in and out of the nucleolus, and between the nucleus and the cytoplasm. 1,2 NPM belongs to the nucleoplasmin family of nuclear chaperone proteins. It is involved in a complex network of interactions and has multiple functions. In addition to its chaperone activity, 3,4 NPM is involved in centrosome duplication, 5 ribosome biogenesis, 6,7 and environmental stress responses. 8,9 NPM also regulates the tumor suppressor proteins p53 10 -12 and p14 ARF . [13][14][15] Moreover, NPM protein is post-translationally modified by acetylation, 16 sumoylation, 17,18 ubiquitinylation, 19 and phosphorylation. 20 -23 NPM has been heavily implicated in cancer pathogenesis, but its actual role in oncogenesis is controversial. 24 NPM1 is mutated or rearranged in a number of hematological disorders, 25 and it is the most frequently mutated gene in acute myeloid leukemia. In addition, NPM protein is reported to be overexpressed in cancer cells, and it was originally proposed as a proto-oncogene. However, rapidly proliferating tumor cells could show elevated NPM levels, simply because NPM expression increases rapidly in early G1 phase during mitosis. 26 On the other hand, inactivation of NPM1 in the germline leads to embryonic lethality. 27,28 Moreover, experiments with cultured NPM-null cells 27,28 and mice carrying a single inactivated NPM allele indicate a tumor suppressor function for NPM. 27 NPM1