Primary Non-Hodgkin’s Lymphoma of Breast Masquerading as Inflammatory Breast Cancer Clinically in a Patient on TNF Alpha Inhibitors

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