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case_images: Timeline of this case report.
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case_images: Her past medical history was notable for a low-grade FL under watchful waiting (Figure 1).
case_images: Whole-body PET-CT before (A) and after (B) neoadjuvant therapy. After treatment, the right breast mass (red arrows) significantly decreased in size. Bilateral cervical (Orange arrows), bilateral axillary (green arrows), mediastinal (purple arrows), cardiophrenic (yellow arrows), intraabdominal, intrapelvic and bilateral inguinal (black arrows) LNs decreased in both size and 18F-FDG uptake. A significant decrease in size and 18F-FDG uptake was also detected in spleen (blue arrows).
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case_images: Increased 18F-FDG activity was also detected in enlarged spleen and bone marrow (Figure 2A). A significant decrease in size and 18F-FDG uptake was also detected in spleen (Figure 2B). 
case_images: Histopathological and immunostaining examination of TNBC and FL. (A) Hematoxylin and eosin (H&E) staining of right breast specimen showing invasive ductal carcinoma. Magnification, x 400. Right breast specimen immunostaining negative for HER-2 (B), positive for P53 (C) and with a Ki-67 index of 70% (D). Magnification, x 400. (E) H&E staining of right axillary lymph nodes suggesting lymphoma infiltration. Magnification, x 100. Lymphoid follicles immunostaining positive for CD20 (F), CD10 (G), and BCL-2 (H), suggesting FL. Magnification, x 100. H&E staining (I) and AE1/AE3 immunostaining (J) of right axillary lymph node suggesting TNBC metastases. Magnification, x 100. (K) H&E staining of bone marrow specimen showing FL infiltration. Magnification, x 400. (L) Bone marrow specimen immunostaining positive for CD20. Magnification, x 400.
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case_images: Biopsy of the right breast mass was then performed and the pathological examination revealed no special type, histological grade 3 TNBC with a Ki-67 index of 70% (Figure 3A-D). Bone marrow aspiration and biopsy confirmed bone marrow infiltration by FL (Figure 3K and L). TNBC (1/50) and FL infiltration (49/50) (Figure 3E-J). The pathological staging of TNBC was T3N1M0, IIIA.
case_images: Axial CT of the breast (red arrow) before neoadjuvant therapy (A). The right breast mass decreased from 8.5x6.7 cm to 4.9x5.6 cm (red arrow) after two-cycle of R-CHOP (B), rapidly increased to 7.4x8.7 cm (red arrow) after three-cycle of R-CHOP (C), and decreased to 3.9x3.7 cm (red arrow) after R-TP (D). The corresponding photos of the right breast mass before neoadjuvant therapy (E), after two-cycle of R-CHOP (F), after three-cycle of R-CHOP (G), and after R-TP (H).
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case_images: After two cycles of R-CHOP, the right breast mass decreased from 8.5 x 6.7 cm to 4.9 x 5.6 cm based on CT examination (Figure 4A, B, E and F), showing a partial response (PR) according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. However, the mass in the right breast increased rapidly after the completion of the third cycle of R-CHOP (Figure 4C and G). According to the NGS results, the neoadjuvant regimen was changed to R-TP (rituximab, nab-paclitaxel, and cisplatin). The patient responded well to the R-TP regimen with a rapid reduction in tumor size, from 7.4 x 8.7 cm to 3.9 x 3.7 cm (Figure 4D and H). After three cycles of R-TP, CA15-3 descended to 51.8 U/mL.