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Background: Primary non-Hodgkin's lymphoma of the breast is an aggressive and rare disease with DLBCL (Diffuse Large B Cell Lymphoma) being the most common variant followed by Marginal zone lymphoma (MZL), follicular lymphoma (FL) and Burkitt's lymphoma. Out of these, MZL and FL are less aggressive variants unless they undergo transformation. Primary breast lymphoma can mimic inflammatory breast cancer clinically due to peau d'orange appearance of the overlying skin. Association of primary breast lymphoma with TNF alpha inhibitors is rare but has been reported in the literature. Case presentation: We present one such case where a 56-year-old lady presented with a breast lump and nipple retraction in her right breast for 6 weeks. The patient had a history of psoriatic arthritis and had been on Disease modifying anti-rheumatic drugs (DMARDS) for six years. TNF alpha inhibitor was started 3.5 years ago. Clinically, the case was highly suspicious for inflammatory breast cancer. Bilateral mammogram revealed 80mm irregular density in the right retro areolar region of breast; however, no discrete mass was identified on ultrasound examination. Core biopsy showed extranodal marginal zone lymphoma with features of impending transformation. The neoplastic cells were positive for CD45, CD20, PAX5 and BCL6. These cells were negative for AE1/AE3, CD5, CD10, MUM1 and cyclin D1. The patient was then started on R-CHOP (rituximab-cyclophosphamide-hydroxydaunorubicin-oncovin-prednisone) chemotherapy regime for six cycles. TNF alpha inhibitor was stopped. The patient tolerated the chemotherapy regime well and no flare ups of psoriasis were noted. Conclusion: There was rapid progression of breast tumour within a span of 6 weeks in a patient with no family history, no systemic lymphadenopathy and in a background of TNF alpha inhibitors. Based on these findings and the published literature, a probable association of primary breast lymphomas with TNF alpha inhibitors is likely. Although this causal association may be minimal, more research should be done to consolidate the findings. [ABSTRACT FROM AUTHOR]

Background: B3 category mainly consists of lesions that provide benign histology on core biopsy, but either are known to show heterogeneity or have increased risk of associated malignancy. However, the level of risk is very different for different entities. All the cases should be looked for atypia. The objective of this study is to compare various B3 lesions in two audits, to calculate the median rate and upgrade rates (the rate at which they turn into malignancy on subsequent excision) for different B3 lesions and to compare them with the national standards and published literature. The study aims to see whether vacuum assisted excision or surgical excision has been done in such lesions. Methods: This is a retrospective study and encompasses two audits done in 2017- 18 and 2020-21 at Queen's hospital, Barking, Havering and Redbridge NHS trust. A total of 4478 cases were reviewed and 206 cases were graded as B3 on core biopsy. Results: Overall, 113 cases were graded as B3 in 2020-21 and 93 cases in 2017- 18 giving the median rate of 5% and the overall upgrade rate of 12%. Intraductal papilloma was the most commonly seen lesion in both audits. Also, 31 cases underwent vacuum assisted excision and 62 cases underwent surgical excision, with 38 cases not undergoing further excision. Conclusion: The median rate was within the 'preferred median rate'- 4.5-8.5% and the upgrade rate was comparable (16.57%) with those of National Breast Cancer screening audit, 2016-2019. The type of excision for various lesions was in line with the criteria stated by the Royal College of Pathologists. The lesions which were not excised did not turn into malignancy on follow-up. [ABSTRACT FROM AUTHOR]