case_images: PMC11250244_01
case_images: 3D-diagnostic mammogram showing multiple masses in the L breast.
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case_images: F1
case_images: A 54-year-old woman presented with a 2-week history of rapidly growing left breast mass with 3D left diagnostic mammogram showing multiple masses (Fig. 1).
case_images: US of the L breast showing a 6.1 cm heterogeneous mass at 12:00, approximately 3.0 cm from the nipple, with additional smaller masses including a 4.5 cm lesion at 9:00 and a 2.6 cm lesion at 9:00 with a solitary 1.4 cm axillary node with borderline cortical thickening.
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case_images: F2
case_images: Ultrasound confirmed a 6.1 cm heterogeneous mass at 12:00 approximately, 3.0 cm from the nipple, with additional smaller masses including a 4.5 cm lesion at 9:00 and a 2.6 cm lesion at 9:00 with a solitary 1.4 cm axillary node with borderline cortical thickening (Fig. 2).
case_images: Hematoxylin and eosin x400 showing infiltrate of medium-sized neoplastic lymphocytes with round nuclear borders, inconspicuous nucleoli, and scant cytoplasm.
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case_images: F3
case_images: Ultrasound-guided core biopsy of the breast mass showed infiltrate of medium-sized neoplastic lymphocytes with round nuclear borders, inconspicuous nucleoli, and scant cytoplasm (Fig. 3) which stained as CD79a-positive B cells co-expressing CD10, BCL2, tdt, and MYC.
case_images: a Immunohistochemistry (IHC) terminal deoxynucleotidyl transferase (tdt) positivity x20 (a), CD10 positivity at IHC x20 (b), and MYC expressivity at IHC x20 (c).
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case_images: F4
case_images: CD10 positivity, and Figure 4c represents MYC expressivity. CD20 is weakly expressed on a subset of cells which is presented in Figure 5.
case_images: CD20 weakly expressed at IHC.
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case_images: F5
case_images: CD10 positivity, and Figure 4c represents MYC expressivity. CD20 is weakly expressed on a subset of cells which is presented in Figure 5.
case_images: Interspersed reactive CD3-positive T cells at IHC.
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case_images: F6
case_images: T cells were interspersed (Fig. 6) and FISH analysis for BLYM performed at Mayo Clinic in Rochester, MN, revealed that 75% of nuclei have IGH:MYC fusion and a BCL2 rearrangement with no rearrangement of BCL6. This finding is consistent with "high-grade B-cell lymphoma with MYC and BCL2 rearrangements" and tdt expression.