Hematolymphoid Neoplasms Involving the Breast: A Single Institution Clinicopathologic Study of 59 Patients

Hematolymphoid Neoplasms Involving the Breast: A Single Institution Clinicopathologic Study of 59 Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Hematolymphoid Neoplasms Involving the Breast: A Single Institution Clinicopathologic Study of 59 Patients Jasmine Vickery, Rayne Peerenboom, Faiza Siddiqui, Jeeva Alphonsa Joy, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7724874/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Apr, 2026 Read the published version in Annals of Hematology → Version 1 posted 8 You are reading this latest preprint version Abstract Background: Breast hematopoietic neoplasms (BHN) are rare and may be either primarily (PBHN) or secondarily (SBHN) involving breast tissue. Due to the widespread use of needle biopsy for initial diagnosis of breast lesions, knowledge of their presentation, radiologic aspects, histomorphology, and outcomes are critical for seeking appropriate hematopathology consultation. Herein, we present our clinical experience as an academic institution and referral center of BHN in the past 20 years. Methods/Design: We identified 59 patients diagnosed at the University of Chicago Medical Center between 2002-2021. Demographic, pathologic, radiologic, therapy, relapse data, and vital status were abstracted. Data were examined using univariable statistics with event-free and overall survival (EFS, OS) as primary outcomes examined with the lymphoma subgroup using Cox PH regression adjusted for age. Results: The cases included 27 (46%) PBHN and 32 (54%) SBHN in a cohort comprising 93% females, mostly white (56%) (Table 1). The mean age at diagnosis was 58.8 years. Lymphomas were the most frequent BHN (Figure 1). Examining the lymphoma cohort (86.4% of all cases), patients with primary breast lymphomas (PBL) were significantly older than those with secondary breast lymphomas (SBL) (61.2 vs. 49.8 yrs, p<0.02). The most frequent lymphomas were extranodal marginal zone lymphoma (MZL) (32.2%) and diffuse large B-cell lymphoma/high grade B-cell lymphoma, not otherwise specified (DLBCL/HGBCL, NOS) (33.9%). Over half of MZLs and DLBCLs were primary in the breast. 5 of 59 patients presented with concurrent breast carcinoma (Table 2). Although 2 patients had breast implants, no cases of implant-associated anaplastic large cell lymphoma (ALCL) were diagnosed. Within B-cell lymphomas, 20 (37%) were high grade with inferior 10-yr overall survival (OS) (age-adjusted HR 5.47, 95% CI 1.38, 21.64) compared to low-grade without any impact on event free survival (EFS) (Figure 2). Conclusion: This is one of the largest cohorts so far describing HNs in the breast. DLBCL and MZL remain the most common lymphomas involving this site. The majority of patients were diagnosed via core needle biopsy (CNB) and did not have a prior diagnosis of a BHN. Radiographically, the presentation may closely mimic breast carcinoma. Breast Lymphoma Primary breast lymphoma Secondary breast lymphoma Extranodal lymphoma Hematolymphoid neoplasm Hematopoietic neoplasm Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Breast hematopoietic neoplasms (BHN) comprise a group of lesions that are morphologically and biologically heterogeneous [ 1 ]. They may occur as a “primary” disease with mammary tissue as the site of origin or as a “secondary” phenomenon with involvement of breast parenchyma by a preceding extramammary neoplasm, concurrent widespread systemic disease at the time of diagnosis, or as a disease recurrence. By some reports lymphoma is the most common of all malignancies to metastasize from non-breast solid tumors to the breast [ 2 , 3 ]. Despite lymphomas being the most common metastatic lesion the overall prevalence of lymphoma among breast cancers is low. One study found out of 42,505 breast biopsies 19,354 malignancies and of these 11 patients were affected by primary breast lymphoma (0.06% of breast malignancies) and 23 cases of secondary breast lymphoma (0.12% of breast malignancies) [ 4 ]. On the other hand, lymphomas involving the breast account for < 5% of extranodal lymphomas and < 1% of non-Hodgkins lymphomas [ 5 ]. Even in the presence of a past history of an extramammary hematopoietic malignancy, given the rarity of metastases to the breast coupled with the prevalence of primary breast cancer, a breast mass is likely to represent a new primary breast tumor [ 3 ]. Despite the overall paucity of BHN, their recognition is imperative for patient management. Core needle biopsies (CNB) are now the standard procedure for inital diagnosis of all breast lesions. Core needle biopsies are extremely useful and many patients can forego the morbidity of a larger surgery to make an accurate diagnosis of a BHN [ 6 ]. BHN remain a group of challenging lesions especially due to their relatively small numbers, lack of pathologist experience with these rare cases, potentially limited amount of material on a CNB, and broad differential diagnosis. Several entities within the BHN classification may closely morphologically mimic the much more common epithelial breast neoplasms. The cytologic features of a high-grade lymphoid neoplasm appearing similar to a poorly differentiated carcinoma is a well-documented pitfall [ 6 ]. A retrospective review of amended pathology reports for breast surgical specimens at a large academic medical center (during a a 5-year period) found lymphoma mistaken for invasive carcinoma was one of fourteen major diagnostic changes [ 7 ]. Although lymphoma can masquerade as carcinoma, an accurate definitive diagnosis of a BHN can be made in the majority of cases on a CNB. A series assessing diagnostic accurary on core needle biopsies found an accurate definitive diagnosis was provided in 86% of cases, an “atypical” but not definitive diagnosis in 11% of cases, and 1 misdiagnosis as carcinoma (3%) [ 6 ]. When faced with these situations it is important to be as accurate and definitive as possible as the rendered final diagnosis may drastically change clinical management. Some BHNs do not need invasive surgery and if misdiagnosed as a breast carcinoma, patients with a BHN may undergo unecessary surgery (in the breast and/or axilla) and receive inappropriate systemic therapy. Conversely, if a breast carcinoma with a dense lymphoid infiltrate is misclassified as benign or a breast carcinoma is misdiagnosed as a BHN this may delay the primary treatment which is surgery. It is essential to be aware of these many entities for primary diagnosis and seeking appropriate hematopathology consultation. Before describing our findings we acknowledge that designation as primary versus secondary breast involvement by a BHN, particularly lymphomas, has been somewhat controversial and will be briefly discussed for clarification. Most studies, including ours, on BHNs and breast lymphomas have restricted the definition of primary tumors to those limited to the breast (one or both breasts), excluding cases that have disseminated disease at diagnosis [ 7 ]. Many authors included synchronous ipsilateral axillary lymph node involvement to be designated as a primary lymphoma if breast tissue was the first clinical presentation and in the absence of systemic disease. However, some studies use diagnostic criteria that are less stringent than those for other extranodal lymphomas to include cases in which the breast was the first or major site of presentation as primary tumors, even if on subsequent staging investigations the lymphomatous process was shown to involve distant nodal sites (Stage III) or bone marrow (Stage IV) [ 8 ]. Some authors have tried to exclude lymphomas arising or suspected to arise from an intramammary lymph node from primary breast lymphomas by requiring close association of the lymphomatous infiltrate and breast parenchyma, although this may be to distinguish [ 9 ]. Microscopically, studies to date have failed to demonstrate a morphologic difference between primary and secondary hematopoietic neoplasms involving the breast [ 9 ]. For clarity and consistency, many authors have used the distinction between primary breast lymphoma (PBL) and secondary breast lymphoma (SBL) based on criteria first defined by Wiseman and Liao in 1972 [ 10 ]. In our study we have used this same criteria and categorization which is defined briefly. PBL is a lymphoid neoplasm which at the time of the diagnosis clinically the breast was considered the site of primary or major manifestation of the lymphoma, is present exclusively at the level of the breast, with or without ipsilateral involvement of the axillary lymph nodes (only patients categorized at Ann-Arbor’s stages IE or IIE) and without a prior history of lymphoma of a similar histologic type in other areas of the body. The remaining lymphomas are categorized as secondary. Notably, studies including this one by restricting the use of primary tumors to those limited to the breast and excluding cases that have disseminated disease at diagnosis may underestimate the actual incidence of BHNs originating in the breast. With this consideration we undertook this study to investigate the epidemiologic, clinicopathologic, and radiologic characteristics of our experience with the full spectrum of breast hematopoietic neoplasms. Examining the relative frequency of primary versus secondary mammary lymphomas and in selected cases the relationship with primary breast carcinoma. Herein, we present our clinical experience as an academic institution and referral center of breast HN in the past 20 years Methods After obtaining approval from the University of Chicago Medical Center Institutional Review Board, our health system's pathology database was searched from January 1, 2002, to July 31, 2021 for hematopoietic neoplasms involving the breast that were diagnosed on core needle biopsy, core needle biopsy with ultrasound guidance, fine needle aspiration, or excisional biopsy/lumpectomy. For patients diagnosed within this period demographic, pathologic, radiologic, therapy, relapse/follow-up information, and vital status were abstracted from clinical, radiology, and pathology notes. For this cohort we reviewed the following: specimen type for initial diagnosis, gross size of breast lesion, site of breast involvement (right, left, or bilateral), histologic type of BHN, if the initial presentation was a relapse in the breast, if breast involvement was an incidental finding at the time of diagnosis, and presence of local or distant involvement at presentation. The initial diagnostic site whether it was nodal, extranodal within the breast, or elsewhere were recorded. Other sites of involvement nodal and/or extranodal at diagnosis or later were investigated. Recurrence date, first relapse site, and histologic type were reviewed. Morphologic review was performed for all cases and included immunohistochemistry stains when available. If the lesion had progressed to a higher grade, for example follicular lymphoma that transformed to a diffuse large B-cell lymphoma, this was noted separately. For a subset of patients with a history of an epithelial breast cancer the histologic type, grade, day of diagnosis and the time interval to HN involvement was assessed. Certain radiologic information if available was abstracted from mammography reports including presence or absence of calcifications, round or irregular margins, if the mass was described as circumscribed, spiculated or ill-defined, and if the lesion was uni- or multifocal. If the patient had no mammographic abnormality but one was performed this was also noted. Clinical information including whether the lesion was clinically palpable and presence or absence of an implant were also investigated. Data were examined using univariable statistics with event-free and overall survival (EFS, OS) as primary outcomes examined with the lymphoma subgroup using Cox PH regression adjusted for age. Results A total of 59 cases were identified, 4 males and 55 females. Most patients were white (56%) (See Table 1 ). The majority of patients 47 (80%) were diagnosed via core needle biopsy (CNB) as the only specimen type. For the remaining patients 3 had an ultrasound guided CNB, 3 had an excisional biopsy alone, 1 had both a CNB and excisional biopsy, 2 had both a fine needle aspiration (FNA) and CNB, 1 FNA alone, 1 lumpectomy, and 1 punch biopsy. The cases included 27 (46%) primary breast hematopoietic neoplasms (PBHN) and 32 (54%) secondary breast hematopoietic neoplasms (SBHN). The mean age at diagnosis was 58.8 years. The size of the dominant breast lesion when reported ranged from 0.6 to 10.0 cm. There was no significant side predominance (p > 0.05). Approximately half of the patients in our cohort presented with a palpable mass (29, 49%). The initial diagnostic site was breast for most patients (32, 54%). Other sites included 5 cervical lymph node only, 1 concurrent breast and cervical lymph node biopsy, 1 breast concurrent and ipsilatertal axillary lymph node, 1 axillary lymph node only, 1 both breast and chest wall, 1 breast skin, 6 peripheral blood and/or bone marrow. Other less common initial diagnostic sites included orbit, parotid, and stomach. The diagnosis of a BHN was incidental for 38 patients (64%) and the breast was the site of relapse for 37 (63%). 27 patients had lymph nodes as other sites of involvement, 29 patients had extranodal disease outside of the breast, and 17 had both nodal and extranodal involvement elsewhere. The most common nodal site of involvement were the axillary lymph nodes (14 patients total, 13 unilateral, 1 bilateral). Of these, 5 patients had ipsilateral axillary lymph nodes as their only other site of involvement. The most common other involved extranodal sites were bone marrow (14, 24%), skin/dermis (6, 10%), and peripheral blood (5, 8%). Table 1 Comparison of demographic, clinical, radiologic, and pathologic characteristics between primary and secondary breast lymphomas Characteristics Total (59) Primary (32) Secondary (27) P-value Age at diagnosis, median (IQR) 59 (46–67) 60 (46–68) 48 (41–63) 0.056 Race White 33 (56) 17 (53) 16 (59) 0.25 Black or African-American 7 (12) 5 (16) 2 (7) Latinx 2 (3) 0 (0) 2 (7) Unknown 17 (29) 10 (31) 7 (26) Sex, Female 55 (93) 30 (94) 25 (93) 1.00 Side Right 27 (46) 15 (47) 4 (15) 0.061 Left 27 (46) 17 (53) 10 (37) Bilateral 4 (7) 0 (0) 12 (44) Unknown 1 (2) 0 (0) 1 (4) Palpable 0.28 Yes 29 (49) 14 (44) 15 (56) No 17 (29) 11 (34) 6 (22) Unknown 13 (22) 7 (22) 6 (22) Other nodal site Present 27 (46) 9 (28) 18 (67) 0.003 Absent 32 (54) 23 (72) 9 (33) Other extra-nodal site Present 29 (49) 8 (25) 21 (78) < .001 Absent 30 (51) 24 (75) 6 (22) Concurrent breast CA Present 5 (9) 3 (9) 2 (7) 1.00 Absent 54 (92) 29 (91) 25 (93) Incidental < 0.01 Yes 38 (64) 16 (50) 4 (15) No 20 (34) 15 (47) 23 (85) Unknown 1 (2) 1 (3) 0 (0) Size, median (IQR) 2.2 (1.3–3.6) 2.2 (1-5.4) 2.1 (1.6–3.1) 0.73 Calcifications 0.68 Present 10 (17) 5 (16) 5 (19) Absent 19 (32) 11 (34) 8 (30) Unknown 30 (51) 16 (50) 14 (52) Radiographic shape 0.15 Round 13 (22) 9 (28) 4 (15) Irregular 15 (25) 6 (19) 9 (33) Unknown 31 (53) 17 (53) 14 (52) Margin 0.44 Circumscribed 10 (17) 7 (22) 3 (9) Ill-Defined 12 (20) 5 (16) 7 (22) Spiculated 6 (10) 3 (9) 3 (9) Unknown 31 (53) 17 (53) 14 (44) Focality 0.099 Multifocal 7 (12) 2 (6) 5 (19) Unifocal 24 (41) 16 (50) 8 (30) Unknown 28 (47) 14 (44) 14 (52) Histologic Type -- MZL 19 (32) 13 (41) 6 (22) DLBCL 18 (30) 10 (31) 8 (30) FL 9 (15) 5 (16) 4 (15) CLL/SLLL 3 (5) 2 (6) 1 (4) HGBCL, NOS 2 (3) 1 (3) 1 (4) B-lymphoblastic 2 (3) 0 (0) 2 (7) Histiocytic Sarcoma 1 (2) 0 (0) 1 (4) PTCL, NOS 1 (2) 1 (3) 0 (0) T-lymphoblastic 1 (2) 0 (0) 1 (4) ALCL, ALK+ 1 (2) 0 (0) 1 (4) Mycosis Fungoides 1 (2) 0 (0) 1 (4) Extramedullary myeloid 1 (2) 0 (0) 1 (4) EBV 1.00 Positive 7 (12) 4 (13) 5 (19) Negative 9 (15) 3 (9) 4 (15) Unknown 43 (73) 25 (78) 18 (67) Treatment 0.023 Chemo/radiation 47 (80) 22 (69) 25 (93) Untreated 12 (20) 10 (31) 2 (7) Percentages may not sum to 100 due to rounding. P-values represent Chi-Square or Fisher’s exact for categorical variables (as appropriate for sample size), or Wilcoxon rank sum for continuous variables. The radiologic features are summarized in Table 1 . Calcifications were identified on mammogram associated with the breast lesion for 10 patients and absent for 32 patients. When available the radiographic shape was most commonly described as irregular (25%) and ill-defined (20%). Most lesions were reported as unifocal (24 patients). One patient had a mammogram with no mammographic evidence of malignancy. Of note, 4 patients were reported to have PET scans and for all 4 the breast masses were PET-FDG avid by radiologic impression. Lymphomas were the most frequent hematopoietic neoplasm (Fig. 1), but unusual BHN types were also identified at this site including histiocytic sarcoma. Examining the breast lymphoid neoplasms (BLN) the lymphoma cohort comprised 86.4% of all cases. Patients with primary breast lymphoma (PBL) were significantly older than those with secondary breast lymphoma (SBL) (61.2 vs. 49.8 yrs, p < 0.02). There was no tumor size difference between PBL vs. SBL (median 2.1 cm). The most frequent lymphomas were MZL (32.2%) and DLBCL/HGBCL, NOS (33.9%), followed by FL (15%) (Fig. 1) including two DLBCLs that transformed from a preceeding FL. Over half of MZL and DLBCLs were primary in the breast with two MZL patients having underlying autoimmune disease. Although 2 patients had breast implants, no cases of implant-associated ALCL were diagnosed. Interestingly, of the patients who had breast implants one was diagnosed with histiocytic sarcoma and was noted on MRI to have a unifocal predominantly hyperintense mass that was described as abutting the implant capsule. The other patient with a history of breast implants was diagnosed with B-lymphoblastic lymphoma and had a prior history of chronic myelogenous leukemia. However, this patient’s disease involved both breasts and was multifocal on imaging. It is unclear if these lesions were associated with or involved the implant capsule. Within B-cell lymphomas, 20 (37%) were high grade with inferior 10-yr OS (age-adjusted HR 5.47, 95% CI 1.38, 21.64) compared to low-grade without any impact on EFS (Fig. 2). After reviewing the histologic types and lesion progression two patients has an initial follicular grade 1–2 which transformed to DLBCL on relapse and that relapse was within the breast parenchyma. Another breast biopsy performed in 2008 showed follicular lymphoma grade "1–2/3" and subsequent left axillary lymph node biopsy in 2010 was diagnosed as "DLBCL grade 3B". There was one patient who had a prior history of T-cell large granular lymphocytic leukemia then DLBCL (non-germinal center subtype) was diagnosed on a subsequent breast core needle biopsy. As noted above, one patient developed B-lymphoblastic lymphoma that involved both breasts with a prior history of chronic myelogenous leukemia. Five patients were identified with both a history of breast lymphoma and breast carcinoma (BC). There were 3 primary and 2 secondary breast lymphomas, all of B-cell lineage (Table 2 ). Four patients had invasive ductal carcinoma (invasive breast carcinoma of no special type) Nottingham grade II/III and one patient had high grade ductal carcinoma in situ (DCIS). 2 patients had BC preceding; 1 concurrent; and 2 following the diagnosis of a BHN. The patients with available follow-up information are alive with follow-up time ranging from 18–197 months. Table 2 Clinical and pathologic characteristics of patients with both breast lymphoma and breast carcinoma Lymphoma Carcinoma Patient number Category Side Histology Side Histology Timing Outcome after BL 1 PBL L DLBCL L IDC and DCIS Concurrent Unknown 2 SBL R FL R DCIS FL preceding A, 197 months 3 SBL L CLL/SLL L IDC CLL/SLL preceding A, 122 months 4 PBL L FL L IDC Breast carc preceding A, 48 months 5 PBL L DLBCL Bil. IDC Breast carc preceding A, 18 months Abbreviations: A, alive; Bil., bilateral; BL, breast lymphoma, carc, carcinoma; CLL/SLL, chronic lymphocytic leukemia/small lymphocytic leukemia; DCIS, ductal carcinoma in situ; DLBCL, diffuse large B-cell lymphoma; IDC, invasive ductal carcinoma; FL, follicular lymphoma, L, left; PBL, primary breast lymphoma; R, right; SBL; secondary breast lymphoma Discussion Hematopoietic neoplasms involving breast (BHN) are rare and most often a diagnosis of exclusion of more common entities. Morphologic mimics of BHN range from benign to malignant including benign inflammatory conditions such as chronic inflammatory infiltrates related to infection, foreign body/surgical site reactions, fat necrosis, lymphocytic (formerly known as diabetic) mastopathy, IgG4-sclerosing mastitis, cystic neutrophilic granulomatous mastitis, and chronic granulomatous mastitis [5,11]. Distinguishing a low grade B-cell neoplasm from physiologic chronic inflammatory infiltrates and other disease processes especially lymphocytic mastopathy can be challenging. Extranodal marginal zone lymphoma (MZL), the most common histotype of BHN in our study, is a low-grade primary extranodal B-cell lymphoma composed mainly of small lymphoid cells that can have prominent plasmacytic differentiation. Of extranodal MZLs monoclonal plasma cells are most commonly found in cases involving the breast and the frequency of lymphoepithelial lesions is the lowest [12]. Chronic inflammatory processes do not express monotypic immunoglobulin or show clonal rearrangement of IGH, and are usually associated with a less dense lymphoid infiltrate and more fibrosis [13]. Immunohistochemistry may be helpful as the neoplastic cells are positive for CD20 and in MZL there is usually a predominace of these cells. Studies of in the breast have shown greater than 60% of CD20+ B cells were present in 23% (7/30) of benign cases versus 75% (15/20) of MZL (P=.0003) [13]. Greater than 40% CD3+ T-cells was exclusively seen in benign cases (P<.0001) [13]. The t(11;18)(q21;q21), seen in extranodal MZL, has also been identified in the majority of breast MZL analyzed by fluorescent in situ hybridization and may aid in the diagnosis [5]. Malignant BHNs can be extremely difficult to distinguish from epithelial derived neoplasms such as breast carcinoma with abundant tumor infiltrating lymphocytes (TILS) otherwise previously known as “medullary carcinoma” or “invasive breast carcinoma of no special type with medullary features”. The rare entity lymphoepithelioma-like carcinoma of the breast notoriously may have such an intense lymphocytic infiltration that it obscures the presence of the malignant epithelial component [14,15]. Of particular diagnostic interest, are a few exceptional reported cases such as a follicular dendritic cell sarcoma with abundant myxoid stroma and mucoid pools, mimicking a primary mucinous carcinoma of the breast [16]. Additionally, the sarcomatoid variant of Anaplastic Large Cell Lymphoma (ALCL) presenting as a rapidly enlarging palpable breast lesion has been reported in a patient without breast implants [17]. Certain BHN such as leukemic involvement of the breast or myeloid sarcoma may be particularly difficult to distinguish from invasive lobular carcinoma (ILC) because of the presence of relatively small, infiltrative neoplastic cells, single-file non-cohesive growth pattern, and lack of immunoreactivity for E-cadherin [18]. Both B and T-cell phenotypes of breast lymphomas can display frequent signet ring cells [19]. Diffuse large B-cell lymphoma can closely morphologically mimic poorly differentiated breast carcinoma by presenting as solid nests, cords, and/or single epithelioid cells with moderate cytoplasm, and vesicular nuclei. Although most BHN will have a triple negative immunohistochemical profile, low positivity for ERα can rarely be observed [6]. Immunohistochemistry for keratins such as AE1/3 can become vital for diagnosis. Lymphoid neoplasms will be negative for keratin. However, p63 can be positive in B-cell lymphomas and up to 45% of DLBCL can show p63 expression [20]. Negative staining for keratins with p63 positivity can also be seen in metaplastic breast carcinomas and is not a specific finding. Although these situations highlight the diagnostic difficulties of distinguishing these lesions from other breast tumors it is important to note that BHN may not just mimic but occur in association with in-situ and invasive breast carcinomas. Co-existent metastatic carcinoma and lymphoma has been reported previously in axillary lymph nodes [21] (also see our Figure 4). Even a “collision tumor” consisting of synchronous carcinoma with closely associated malignant lymphoma presenting as a single mass in the breast has been described [22]. The vast majority of hematopoietic neoplasms occurring in the breast are lymphoid neoplasms (BLN) which includes the infrequent but site-specific breast implant associated anaplastic large cell lymphoma (BI-ALCL) that has been heavily focused on in the available literature. Any lymphoma histotype may occur but overall diffuse large B cell lymphoma (DLBCL) is the most common histologic subtype followed by MZL, and follicular lymphoma (FL) [1,5]. Involvement of the breast by BHN other than lymphomas including leukemic, myeloid, histiocytic, plasma cell, and T-cell neoplasms are rare, generally being reported as case reports or small case series. Our findings reflect this as we had a few uncommon diagnoses in our cohort including single cases of extramedullary myeloid tumor, anaplastic large cell lymphoma (ALK+), and histiocytic sarcoma. Other less common but notable hematolymphoid neoplasms that have been reported to involve breast tissue include Burkitt lymphoma, plasmacytoma/plasma cell myeloma, myeloid sarcoma, Hodgkin’s Lymphoma, Rosai-Dorfman disease, ALK-positive histiocytosis of the breast, histiocytic sarcoma, follicular dendritic cell sarcoma, interdigitating dendritic cell sarcoma, Hairy cell leukemia, and blastic plasmacytoid dendritic cell neoplasm [23-25]. Although most primary lymphomas of the breast are of B-cell lineage T-cell malignancies such as extranodal NK/T cell lymphoma, T-cell lymphoblastic lymphoma, and subcutaneous panniculitis-like T-cell lymphoma have also been reported [26-29]. Although the most common BHN arising in association with breast implants is BI-ALCL, it is important to note that this histotype is not specific to this location and rarely other histologic types of lymphoma including B-cell lymphomas have been reported in association with breast implants [30]. Although histiocytic sarcomas have been described in the breast and axilla, there have been no other reported cases of a histiocytic sarcoma associated with a breast implant [31, 32]. Although some authors have reported aggressive lymphomas arising in women of childbearing age during pregnancy we did not observe this in our cohort [33-35]. Like other studies we found overlapping imaging features of breast lymphomas with primary breast carcinoma, making prospective clinical suspicion of breast lymphoma challenging [36]. We found that 17% of patients with a BHN including lymphomas in our study were described in radiology reports as associated with mammographic calcifications. This is in contrast to prior studies of BLN in which calcifications are almost always absent [36, 37]. Interestingly, a case report of primary MZL in the breast has been documented presenting as grouped calcifications discovered during screening mammography [38]. This clinical presentation seems outstandingly rare. The occurrence of BLN and BC in the same patient has been reported to be relatively common. In a study 24% of patients with a BLN had either a history of or a concurrent BC [39]. We observed a much lower incidence, 5 of 59 patients (0.08%). It is interesting that most patients in our study developed BLN and BC in the same breast but this is most likely due to small sample size. Some have asserted the occurrence of BLN and BC in the same patient does not appear to have an adverse clinical significance in terms of prognosis [39]. Our data is too limited to draw any conclusions regarding prognosis in this regard. After stratifying the most common BHNs the B-cell lymphomas into low and high grade, the high-grade lymphomas were found to have inferior 10 year overall survival. Transformation of PBL histological subtypes has been documented and our results further support that different histological subtypes of lymphoma have distinct prognoses [40]. Despite the low prevalence it is still important to consider all BHN as in up to 40% of patients a breast core-needle biopsy may be the first diagnosis of a hematologic malignancy [6]. In our study 38 of the 59 patients (64%) the diagnosis of a hematologic malignancy was incidental and not known prior to tissue sampling. This includes a case of follicular lymphoma involving all lymph nodes of an axillary lymph node dissection in which five of forty-four were also involved by metastatic carcinoma (Figure 4). In conclusion, although hematopoietic neoplasms involving the breast are much less common than epithelial malignancies it is important to consider the full spectrum of hematolymphoid tumors while viewing a breast core needle biopsy. The main limitation of this study is its retrospective nature. The true incidence of hematolymphoid lesions involving the breast is difficult to estimate, and many of the cases in this study were seen in consultation. Low-grade lesions especially B-cell lymphomas can masquerade as benign reactive inflammatory infiltrates, yet high grade neoplasms can appear virtually identical to invasive breast carcinoma. On limited material like a CNB making an accurate diagnosis can be especially challenging. However, it is clinically important for treatment and management of patients. It is crucial to be aware of these entities for primary diagnosis and appropriate hematopathology consultation, even in patients without a prior history of a hematologic malignancy. Abbreviations General Abbreviations: Hematopoietic neoplasms involving breast (BHN), Breast Primary breast hematopoietic neoplasms (PBHN), Secondary breast hematopoietic neoplasms (SBHN), Primary breast lymphoma (PBL), Secondary breast lymphoma (SBL), Breast lymphoid neoplasms (BLN), Breast carcinoma (BC), Invasive ductal carcinoma (IDC), Ductal carcinoma in situ (DCIS), Scarff-Bloom-Richardson (SBR), Tumor infiltrating lymphocytes (TILS), Invasive lobular carcinoma (ILC), Core Needle Biopsy (CNB), Fine Needle Aspiration (FNA), Hematoxylin and Eosin (H&E), Terminal duct lobular unit (TDLU), Event free survival (EFS), Overall survival (OS), Hazard ratio (HR). See Figure 1 for Hematopoietic neoplasm abbreviations. Hematopoietic neoplasm abbreviations: Non-Hodgkin Lymphoma (NHL),Marginal zone lymphoma (MZL), Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT), Diffuse large B-cell lymphoma (DLBCL), Follicular lymphoma (FL), Chronic lymphocytic/Small lymphocytic leukemia/lymphoma (CLL/SLL), High-grade B-cell Lymphoma Not Otherwise Specified (HGBCL, NOS), Peripheral T-cell lymphoma (PTCL), Extramedullary myeloid tumor/Acute myeloid lymphoma (AML), Breast implant associated Anaplastic Large Cell Lymphoma (BI-ALCL), Anaplastic Large Cell Lymphoma Anaplastic lymphoma kinase–positive (ALCL, ALK+) Declarations Ethics Declaration: The institutional IRB at the University of Chicago Biological Sciencese Division determined that the protocol is considered exempt because the retrospective research involves no more than minimal risk to the subjects, the research could not practicably be carried out without the requested waiver or alteration, the reasearch does not use identifiable private information or identifiable biospecimens, the waiver or alteration will not adversely affect the rights and welfare of the subjects and whenever appropriate, the subjects or legally authorized representatives will be provided with additional pertinent information after participation. Consent to Publish Declaration: The authors affirm that human research participants provided informed consent for publication of the anonymized patient information to be published in this article including the images and information in Tables 1, 2 and Figures 1, 2, 3 (a-f), and 4. The participants have consented to the submission of the cases reported to the journal. Futhermore, the covered entity does not have actual knowledge that the information could be used alone or in combination with other information to identify an individual who is a subject of the information. Declaration of Conflicting Interests: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Data Availability: The data supporting the findings of this study are available within the article. The additional data are not publicly available due to containing clinical information that could compromise the privacy of research participants. Additional data are available on reasonable request from the corresponding author. Funding Statement: The authors received no financial support for the research and authorship of this article. If accepted for publication the corresponding author Dr. Jasmine Vickery, MD with support from the Hospital of the University of Pennsylvania department of pathology will be responsible for arranging payment of the article publication charge. References Talwalkar SS, Miranda RN, Valbuena JR, Routbort MJ, Martin AW, Medeiros LJ (2008) Lymphomas involving the breast: a study of 106 cases comparing localized and disseminated neoplasms. Am J Surg Pathol 32(9):1299–1309. 10.1097/PAS.0b013e318165eb50 Qi Y, Kong X, Wang X, Zhai J, Fang Y, Wang J (2022) Metastasis to Breast from Extramammary Solid Tumors and Lymphomas: A 20-Year Population-Based Study. Cancer Invest 40(4):325–336 Epub 2021 Dec 23. PMID: 34937471 Williams SA, Ehlers RA 2nd, Hunt KK, Yi M, Kuerer HM, Singletary SE, Ross MI, Feig BW, Symmans WF, Meric-Bernstam F (2007) Metastases to the breast from nonbreast solid neoplasms: presentation and determinants of survival. Cancer. ;110(4):731-7. 10.1002/cncr.22835 . PMID: 17582626 Picasso R, Tagliafico A, Calabrese M, Martinoli C, Pistoia F, Rossi A, Zaottini F, Derchi L (2020) Primary and Secondary Breast Lymphoma: Focus on Epidemiology and Imaging Features. Pathol Oncol Res 26(3):1483–1488. 10.1007/s12253-019-00730-0 Epub 2019 Aug 20. PMID: 31428995 Hoffmann J, Ohgami RS (2017) Hematolymphoid lesions of the breast. Semin Diagn Pathol 34(5):462–469. 10.1053/j.semdp.2017.05.007 Epub 2017 May 28. PMID: 28662998 Guilbert MC, Hornick JL, Chikarmane SA, Lester SC (2019) Hematologic Malignancies of the Breast: A Contemporary Series Investigating Incidence, Presentation, Accuracy of Diagnosis on Core Needle Biopsy, and Hormone Receptor Expression. Breast Cancer (Auckl) 13:1178223419830982. 10.1177/1178223419830982 PMID: 30814841; PMCID: PMC6385330 Harrison BT, Dillon DA, Richardson AL, Brock JE, Guidi AJ, Lester SC (2017) Quality Assurance in Breast Pathology: Lessons Learned From a Review of Amended Reports. Arch Pathol Lab Med 141(2):260–266. 10.5858/arpa.2016-0018-OA Epub 2016 Dec 13. PMID: 27959581 Kuper-Hommel MJ, Snijder S, Janssen-Heijnen ML, Vrints LW, Kluin-Nelemans JC, Coebergh JW, Noordijk EM, Vreugdenhil G (2003) Treatment and survival of 38 female breast lymphomas: a population-based study with clinical and pathological reviews. Ann Hematol 82(7):397–404. 10.1007/s00277-003-0664-7 Epub 2003 May 23. PMID: 12764549 Topalovski M, Crisan D, Mattson JC (1999) Lymphoma of the breast. A clinicopathologic study of primary and secondary cases. Arch Pathol Lab Med 123(12):1208–1218. 10.5858/1999-123-1208-LOTB Wiseman C, Liao KT (1972) Primary lymphoma of the breast. Cancer. ;29(6):1705-12. 10.1002/1097-0142(197206)29:6%3C1705::aid-cncr2820290640%3E3.0.co;2-i . PMID: 4555557 Campos GC, Castro MV, de Mattos VF, Pinto LZ, Boechat MC, Dos Santos AA (2014 Jul-Aug) Lymphocytic mastopathy mimicking breast malignancy: a case report. Radiol Bras 47(4):256–258. 10.1590/0100-3984.2013.1847 PMID: 25741094; PMCID: PMC4337124 Rawal A, Finn WG, Schnitzer B, Valdez R (2007) Site-specific morphologic differences in extranodal marginal zone B-cell lymphomas. Arch Pathol Lab Med. ;131(11):1673-8. 10.5858/2007-131-1673-SMDIEM . PMID: 17979485 Berg AN, Soma L, Clark BZ, Swerdlow SH, Roth CG (2015) Evaluating breast lymphoplasmacytic infiltrates: a multiparameter immunohistochemical study, including assessment of IgG4. Hum Pathol 46(8):1162–1170. 10.1016/j.humpath.2015.04.006 Epub 2015 Apr 28. PMID: 26026200 Naidoo P, Chetty R (2001) Lymphoepithelioma-like carcinoma of the breast with associated sclerosing lymphocytic lobulitis. Arch Pathol Lab Med. ;125(5):669 – 72. 10.5858/2001-125-0669-LLCOTB . PMID: 11300942 Nieto-Coronel MT, Perez-Sanchez VM, Salazar-Campos JE, Diaz-Molina R, Arce-Salinas CH Lymphoepithelioma-like carcinoma of breast: A case report and review of the literature. Indian J Pathol Microbiol 2019 Jan-Mar ;62(1):125–128. doi: 10.4103/IJPM.IJPM_761_17. PMID: 30706876. Fisher C, Magnusson B, Hardarson S, Smith ME (1999) Myxoid variant of follicular dendritic cell sarcoma arising in the breast. Ann Diagn Pathol. ;3(2):92 – 8. 10.1016/s1092-9134(99)80036-7 . PMID: 10196389 Pereira EM, Maeda SA, Reis-Filho JS (2002) Sarcomatoid variant of anaplastic large cell lymphoma mimicking a primary breast cancer: a challenging diagnosis. Arch Pathol Lab Med. ;126(6):723-6. 10.5858/2002-126-0723-SVOALC . PMID: 12033965 Ishikawa MK, Pinsky RW, Smith LB, Jorns JM (2015) Morphologic Mimics of Invasive Lobular Carcinoma. Arch Pathol Lab Med. ;139(10):1253-7. 10.5858/arpa.2015-0190-RA . PMID: 26414470 Gualco G, Bacchi CE (2008) B-cell and T-cell lymphomas of the breast: clinical–pathological features of 53 cases. Int J Surg Pathol 16(4):407–413. 10.1177/1066896908316784 Epub 2008 May 14. PMID: 18480397 Moreno JCA, Bahmad HF, Aljamal AA, Delgado R, Salami A, Guillot C, Castellano-Sánchez AA, Medina AM, Sriganeshan V (2023) Prognostic Significance of p53 and p63 in Diffuse Large B-Cell Lymphoma: A Single-Institution Experience. Curr Oncol 30(2):1314–1331. 10.3390/curroncol30020102 PMID: 36826063; PMCID: PMC9955855 Ambrosiani L, Bellone S, Declich P, Tavani E, Pavia GF (1999) Breast carcinoma metastatic to a lymphoma: report of a case with review of literature Histopathology. 34(1):87–89. 10.1046/j.1365-2559.1999.00555.x Susnik B, Jordi Rowe J, Redlich PN, Chitambar C, Chang CC, Kampalath B (2004) A unique collision tumor in breast: invasive ductal carcinoma and mucosa-associated lymphoid tissue lymphoma. Arch Pathol Lab Med. ;128(1):99–101. 10.5858/2004-128-99-AUCTIB . PMID: 14692838 Kashima J, Yoshida M, Jimbo K, Izutsu K, Ushiku T, Yonemori K, Yoshida (2021) Akihiko. ALK-positive Histiocytosis of the Breast: A Clinicopathologic Study Highlighting Spindle Cell Histology. The American Journal of Surgical Pathology 45(3):p 347–355, March | 10.1097/PAS.0000000000001567 Tan PH, Ellis I, Allison K, Brogi E, Fox SB, Lakhani S, Lazar AJ, Morris EA, Sahin A, Salgado R, Sapino A, Sasano H, Schnitt S, Sotiriou C, van Diest P, White VA, Lokuhetty D, Cree IA, WHO Classification of Tumours Editorial Board (2020) The 2019 World Health Organization classification of tumours of the breast. Histopathology 77(2):181–185. 10.1111/his.14091 Epub 2020 Jul 29. PMID: 32056259 Chen KC, Su TC, Chen DR, Liou JH (2015) A case report: Blastic plasmacytoid dendritic cell neoplasm is misdiagnosed as breast infiltrating ductal carcinoma. Int J Surg Pathol 23(1):84–88 Epub 2014 Oct 7. PMID: 25297609 Zhang Y, Wang K, Tan Q, Yang K, Wu D, Xu Y, Zhao X, Jiang Z (2021) Primary breast CD20-positive extranodal NK/T cell lymphoma with stomach involvement: a case report and literature review. Diagn Pathol 16(1):103. 10.1186/s13000-021-01166-4 PMID: 34749754; PMCID: PMC8573996 Wu H, Jin SY (2023) Primary Breast Natural Killer/T-cell lymphoma with Cutaneous Involvement: A Case Report. Altern Ther Health Med 29(8):252–254 PMID: 37573597 Yumuk PF, Aydiner A, Topuz E, Cabioglu N, Dogan O (2004) T-cell lymphoblastic lymphoma presenting with a breast mass. Leuk Lymphoma. ;45(4):833-6. 10.1080/10428190310001617277 . PMID: 15160967 Jeong SI, Lim HS, Choi YR, Kim JW, Park MH, Cho JS, Lee JS, Kang HK (2013 May-Jun) Subcutaneous panniculitis-like T-cell lymphoma of the breast. Korean J Radiol 14(3):391–394. 10.3348/kjr.2013.14.3.391 Epub 2013 May 2. PMID: 23690702; PMCID: PMC3655289 Evans MG, Miranda RN, Young PA, Pai L, Wang HY, Konoplev SN, Medeiros LJ, Pinter-Brown LC (2020) B-cell lymphomas associated with breast implants: Report of three cases and review of the literature. Ann Diagn Pathol 46:151512 Epub 2020 Mar 28. PMID: 32315816 Bang S, Kim Y, Chung MS, Park JS, Choi YY, Shin SJ (2019) Primary Histiocytic Sarcoma Presenting as a Breast Mass: A Case Report. J Breast Cancer 22(3):491–496. 10.4048/jbc.2019.22.e32 PMID: 31598348; PMCID: PMC6769387 Nangal JK, Kapoor A, Narayan S, Singhal MK, Beniwal S, Kumar HS (2014) A case of CD68 negative histiocytic sarcoma of axilla masquerading as metastatic breast cancer. J Surg Case Rep 2014(7):rju071. 10.1093/jscr/rju071 PMID: 25031040; PMCID: PMC4100750 Altshuler E, Wheeler S, Daily K (2023) Bilateral primary breast Burkitt's lymphoma in pregnancy. BMJ Case Rep 16(1):e251896. 10.1136/bcr-2022-251896 PMID: 36653041; PMCID: PMC9853133 Gowda V, Shelar D, Harbade S, Jadhav S, Jadhav R (2023) Primary breast lymphoma in pregnancy: A case report. Int J Surg Case Rep 107:108273. 10.1016/j.ijscr.2023.108273 Epub 2023 Apr 28. PMID: 37216730; PMCID: PMC10213345 Arber DA, Simpson JF, Weiss LM, Rappaport H (1994) Non-Hodgkin's lymphoma involving the breast. Am J Surg Pathol. ;18(3):288 – 95. 10.1097/00000478-199403000-00009 . PMID: 8116797 Raj SD, Shurafa M, Shah Z, Raj KM, Fishman MDC, Dialani VM (2019) May-Jun;39(3):610–625 Primary and Secondary Breast Lymphoma: Clinical, Pathologic, and Multimodality Imaging Review. Radiographics. 10.1148/rg.2019180097 . Epub 2019 Mar 29. PMID: 30924754 Sabaté JM, Gómez A, Torrubia S, Camins A, Roson N, De Las Heras P, Villalba-Nuño V (2002) Sep-Oct;8(5):294–304 Lymphoma of the breast: clinical and radiologic features with pathologic correlation in 28 patients. Breast J. 10.1046/j.1524-4741.2002.08509.x . PMID: 12199758 Steven W, Szarmach JL, Raghu M, Bakhru S, Everett T, Flaherty F, Boroumand G (2024) A rare case of primary breast lymphoma presenting as calcifications on screening mammography. Radiol Case Rep 19(5):1734–1739 PMID: 38384692; PMCID: PMC10877128 Genco IS, Gur H, Hajiyeva S (2021) Lymphoma of the breast: A clinicopathologic analysis of 51 cases with a specific emphasis on patients with a history of breast carcinoma. Breast J 27(5):456–460. 10.1111/tbj.14198 Peng F, Li J, Mu S, Cai L, Fan F, Qin Y, Ai L, Hu Y (2021) Epidemiological features of primary breast lymphoma patients and development of a nomogram to predict survival. Breast 57:49–61. 10.1016/j.breast.2021.03.006 Epub 2021 Mar 17. PMID: 33774459; PMCID: PMC8027901 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Apr, 2026 Read the published version in Annals of Hematology → Version 1 posted Editorial decision: Revision requested 13 Oct, 2025 Reviews received at journal 12 Oct, 2025 Reviewers agreed at journal 10 Oct, 2025 Reviewers agreed at journal 09 Oct, 2025 Reviewers invited by journal 08 Oct, 2025 Editor assigned by journal 08 Oct, 2025 Submission checks completed at journal 08 Oct, 2025 First submitted to journal 26 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7724874","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":528566880,"identity":"e92813b9-8f91-420d-abb1-5c40145c12ec","order_by":0,"name":"Jasmine Vickery","email":"data:image/png;base64,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","orcid":"","institution":"Hospital of the University of Pennsylvania","correspondingAuthor":true,"prefix":"","firstName":"Jasmine","middleName":"","lastName":"Vickery","suffix":""},{"id":528566881,"identity":"994c5373-3580-40bb-84b2-0fd6773e0407","order_by":1,"name":"Rayne Peerenboom","email":"","orcid":"","institution":"University of Chicago Pritzker School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Rayne","middleName":"","lastName":"Peerenboom","suffix":""},{"id":528566884,"identity":"c9a3e7ad-4aff-4cb3-8a3e-af9e81adaa0b","order_by":2,"name":"Faiza Siddiqui","email":"","orcid":"","institution":"University of Chicago","correspondingAuthor":false,"prefix":"","firstName":"Faiza","middleName":"","lastName":"Siddiqui","suffix":""},{"id":528566886,"identity":"d7286993-b943-4ebe-b6e4-67d9c13a3fd3","order_by":3,"name":"Jeeva Alphonsa Joy","email":"","orcid":"","institution":"Government Medical College, HMT Colony P.O, Kalamassery","correspondingAuthor":false,"prefix":"","firstName":"Jeeva","middleName":"Alphonsa","lastName":"Joy","suffix":""},{"id":528566887,"identity":"7f2db41b-d7c9-4c22-a5bf-314a5b8b6573","order_by":4,"name":"Swetha S. Prabu","email":"","orcid":"","institution":"Government Medical College, HMT Colony P.O, Kalamassery","correspondingAuthor":false,"prefix":"","firstName":"Swetha","middleName":"S.","lastName":"Prabu","suffix":""},{"id":528566889,"identity":"2d187dff-d676-46fd-ad5e-c814a26b946e","order_by":5,"name":"Daniel A. Arber","email":"","orcid":"","institution":"University of Chicago","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"A.","lastName":"Arber","suffix":""},{"id":528566890,"identity":"24539ba0-241b-4c34-913a-a5d8ce1d1aa5","order_by":6,"name":"Sandeep Gurbuxani","email":"","orcid":"","institution":"University of Chicago","correspondingAuthor":false,"prefix":"","firstName":"Sandeep","middleName":"","lastName":"Gurbuxani","suffix":""},{"id":528566891,"identity":"810d6f3a-67ff-4e65-9808-360cfe388cc9","order_by":7,"name":"Anna Biernacka","email":"","orcid":"","institution":"University of Chicago","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Biernacka","suffix":""},{"id":528566892,"identity":"655fdf44-10bb-4891-ac29-612f77c8d7b5","order_by":8,"name":"Girish Venkataraman","email":"","orcid":"","institution":"University of Chicago","correspondingAuthor":false,"prefix":"","firstName":"Girish","middleName":"","lastName":"Venkataraman","suffix":""}],"badges":[],"createdAt":"2025-09-26 22:32:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7724874/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7724874/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00277-026-06901-9","type":"published","date":"2026-04-10T15:58:10+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":94048915,"identity":"1231c367-7adc-4887-8394-602475e3e4bf","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8088201,"visible":true,"origin":"","legend":"","description":"","filename":"HematolymphoidNeoplasmsInvolvingtheBreastwithDeclarations.docx","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/6a42d719d84382d567e9f343.docx"},{"id":94048908,"identity":"078395d5-f6e5-4709-a3c7-c38a115383da","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9307,"visible":true,"origin":"","legend":"","description":"","filename":"57b9e9b82c834b31a407832672d44096.json","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/1765bec255706097b9a8f655.json"},{"id":94048910,"identity":"d190d62e-9fe2-4e4a-a097-359fbe78e202","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":138310,"visible":true,"origin":"","legend":"","description":"","filename":"57b9e9b82c834b31a407832672d440961enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/2522a62eed81f543a3080208.xml"},{"id":94048914,"identity":"faa50115-21cb-4e66-b895-1c5ee0d1748f","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"jpeg","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5821240,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/a6c043a8e1ed3e490bafd277.jpeg"},{"id":94048919,"identity":"3eb9ab72-2404-4c57-ae9a-9010375e248e","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":229681,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/39f938f6387da4f6b0bbef16.jpeg"},{"id":94048920,"identity":"b3ffbf67-6c82-4901-a0a5-c3f32c48dadd","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"jpeg","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":971808,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/da34dd7094491c09a9d5a883.jpeg"},{"id":94048916,"identity":"78107388-2fab-454c-94eb-12f3156f1008","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"jpeg","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1001996,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/06106ca8dba2011b6a467433.jpeg"},{"id":94048911,"identity":"fc36b7a4-621d-4ea6-b65b-9f75a495f9a8","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":100337,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/0d2e9268d98ac7a03f258fc3.png"},{"id":94049390,"identity":"131f0bd3-0fd2-482d-b8cf-976b7d89699c","added_by":"auto","created_at":"2025-10-21 23:35:10","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":72240,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/d1a93fb8cbe5510a58801829.png"},{"id":94048917,"identity":"9a76b329-0178-432b-a853-5e35bd767fbf","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":123291,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/ba47da4a56d07ef9c327b08b.png"},{"id":94048918,"identity":"9513ddee-8b25-410a-a5a5-c581b1fd50bf","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":138301,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/db83982556315659c34951e7.png"},{"id":94049391,"identity":"939e8f37-e31a-4eb3-8c87-3ea8a2247681","added_by":"auto","created_at":"2025-10-21 23:35:10","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":136274,"visible":true,"origin":"","legend":"","description":"","filename":"57b9e9b82c834b31a407832672d440961structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/a0314f2a03a4599d02b18238.xml"},{"id":94048922,"identity":"2a9b2613-b22b-4eb9-897c-74b417f856dd","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":148350,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/671da6bd1109795c2c89e7d1.html"},{"id":94048909,"identity":"c8b8ae4b-e45a-4fc5-8cdf-11775b941e0e","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":6023580,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/61b67cda2abae18e1b1ea427.png"},{"id":94048907,"identity":"86d7d43d-6c33-4c51-b7e7-296919d6be8a","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":159106,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/ee5564fb95a57d3c1db1cad8.jpg"},{"id":94048913,"identity":"e68bef28-5be6-4c4f-859b-2b720358ee8d","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":24634196,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/29e5c81a98b75cce8d189fec.png"},{"id":94048923,"identity":"b1ba5f60-9e2e-446f-9f8f-d778b8ab73a0","added_by":"auto","created_at":"2025-10-21 23:27:10","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":25363809,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/6246413b1f942dc6c314bbce.png"},{"id":106808900,"identity":"ad3c1ab5-9d94-4edb-87ad-aef053e89105","added_by":"auto","created_at":"2026-04-13 16:04:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":51505965,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7724874/v1/fca0a71a-bb9c-407e-a8a4-aa942ecc96dd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Hematolymphoid Neoplasms Involving the Breast: A Single Institution Clinicopathologic Study of 59 Patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast hematopoietic neoplasms (BHN) comprise a group of lesions that are morphologically and biologically heterogeneous [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. They may occur as a \u0026ldquo;primary\u0026rdquo; disease with mammary tissue as the site of origin or as a \u0026ldquo;secondary\u0026rdquo; phenomenon with involvement of breast parenchyma by a preceding extramammary neoplasm, concurrent widespread systemic disease at the time of diagnosis, or as a disease recurrence. By some reports lymphoma is the most common of all malignancies to metastasize from non-breast solid tumors to the breast [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite lymphomas being the most common metastatic lesion the overall prevalence of lymphoma among breast cancers is low. One study found out of 42,505 breast biopsies 19,354 malignancies and of these 11 patients were affected by primary breast lymphoma (0.06% of breast malignancies) and 23 cases of secondary breast lymphoma (0.12% of breast malignancies) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. On the other hand, lymphomas involving the breast account for \u0026lt;\u0026thinsp;5% of extranodal lymphomas and \u0026lt;\u0026thinsp;1% of non-Hodgkins lymphomas [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Even in the presence of a past history of an extramammary hematopoietic malignancy, given the rarity of metastases to the breast coupled with the prevalence of primary breast cancer, a breast mass is likely to represent a new primary breast tumor [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite the overall paucity of BHN, their recognition is imperative for patient management. Core needle biopsies (CNB) are now the standard procedure for inital diagnosis of all breast lesions. Core needle biopsies are extremely useful and many patients can forego the morbidity of a larger surgery to make an accurate diagnosis of a BHN [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. BHN remain a group of challenging lesions especially due to their relatively small numbers, lack of pathologist experience with these rare cases, potentially limited amount of material on a CNB, and broad differential diagnosis.\u003c/p\u003e\u003cp\u003eSeveral entities within the BHN classification may closely morphologically mimic the much more common epithelial breast neoplasms. The cytologic features of a high-grade lymphoid neoplasm appearing similar to a poorly differentiated carcinoma is a well-documented pitfall [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A retrospective review of amended pathology reports for breast surgical specimens at a large academic medical center (during a a 5-year period) found lymphoma mistaken for invasive carcinoma was one of fourteen major diagnostic changes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Although lymphoma can masquerade as carcinoma, an accurate definitive diagnosis of a BHN can be made in the majority of cases on a CNB. A series assessing diagnostic accurary on core needle biopsies found an accurate definitive diagnosis was provided in 86% of cases, an \u0026ldquo;atypical\u0026rdquo; but not definitive diagnosis in 11% of cases, and 1 misdiagnosis as carcinoma (3%) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. When faced with these situations it is important to be as accurate and definitive as possible as the rendered final diagnosis may drastically change clinical management. Some BHNs do not need invasive surgery and if misdiagnosed as a breast carcinoma, patients with a BHN may undergo unecessary surgery (in the breast and/or axilla) and receive inappropriate systemic therapy. Conversely, if a breast carcinoma with a dense lymphoid infiltrate is misclassified as benign or a breast carcinoma is misdiagnosed as a BHN this may delay the primary treatment which is surgery. It is essential to be aware of these many entities for primary diagnosis and seeking appropriate hematopathology consultation.\u003c/p\u003e\u003cp\u003eBefore describing our findings we acknowledge that designation as primary versus secondary breast involvement by a BHN, particularly lymphomas, has been somewhat controversial and will be briefly discussed for clarification. Most studies, including ours, on BHNs and breast lymphomas have restricted the definition of primary tumors to those limited to the breast (one or both breasts), excluding cases that have disseminated disease at diagnosis [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Many authors included synchronous ipsilateral axillary lymph node involvement to be designated as a primary lymphoma if breast tissue was the first clinical presentation and in the absence of systemic disease. However, some studies use diagnostic criteria that are less stringent than those for other extranodal lymphomas to include cases in which the breast was the first or major site of presentation as primary tumors, even if on subsequent staging investigations the lymphomatous process was shown to involve distant nodal sites (Stage III) or bone marrow (Stage IV) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Some authors have tried to exclude lymphomas arising or suspected to arise from an intramammary lymph node from primary breast lymphomas by requiring close association of the lymphomatous infiltrate and breast parenchyma, although this may be to distinguish [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Microscopically, studies to date have failed to demonstrate a morphologic difference between primary and secondary hematopoietic neoplasms involving the breast [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. For clarity and consistency, many authors have used the distinction between primary breast lymphoma (PBL) and secondary breast lymphoma (SBL) based on criteria first defined by Wiseman and Liao in 1972 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In our study we have used this same criteria and categorization which is defined briefly. PBL is a lymphoid neoplasm which at the time of the diagnosis clinically the breast was considered the site of primary or major manifestation of the lymphoma, is present exclusively at the level of the breast, with or without ipsilateral involvement of the axillary lymph nodes (only patients categorized at Ann-Arbor\u0026rsquo;s stages IE or IIE) and without a prior history of lymphoma of a similar histologic type in other areas of the body. The remaining lymphomas are categorized as secondary. Notably, studies including this one by restricting the use of primary tumors to those limited to the breast and excluding cases that have disseminated disease at diagnosis may underestimate the actual incidence of BHNs originating in the breast. With this consideration we undertook this study to investigate the epidemiologic, clinicopathologic, and radiologic characteristics of our experience with the full spectrum of breast hematopoietic neoplasms. Examining the relative frequency of primary versus secondary mammary lymphomas and in selected cases the relationship with primary breast carcinoma. Herein, we present our clinical experience as an academic institution and referral center of breast HN in the past 20 years\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eAfter obtaining approval from the University of Chicago Medical Center Institutional Review Board, our health system's pathology database was searched from January 1, 2002, to July 31, 2021 for hematopoietic neoplasms involving the breast that were diagnosed on core needle biopsy, core needle biopsy with ultrasound guidance, fine needle aspiration, or excisional biopsy/lumpectomy. For patients diagnosed within this period demographic, pathologic, radiologic, therapy, relapse/follow-up information, and vital status were abstracted from clinical, radiology, and pathology notes. For this cohort we reviewed the following: specimen type for initial diagnosis, gross size of breast lesion, site of breast involvement (right, left, or bilateral), histologic type of BHN, if the initial presentation was a relapse in the breast, if breast involvement was an incidental finding at the time of diagnosis, and presence of local or distant involvement at presentation. The initial diagnostic site whether it was nodal, extranodal within the breast, or elsewhere were recorded. Other sites of involvement nodal and/or extranodal at diagnosis or later were investigated. Recurrence date, first relapse site, and histologic type were reviewed. Morphologic review was performed for all cases and included immunohistochemistry stains when available. If the lesion had progressed to a higher grade, for example follicular lymphoma that transformed to a diffuse large B-cell lymphoma, this was noted separately. For a subset of patients with a history of an epithelial breast cancer the histologic type, grade, day of diagnosis and the time interval to HN involvement was assessed. Certain radiologic information if available was abstracted from mammography reports including presence or absence of calcifications, round or irregular margins, if the mass was described as circumscribed, spiculated or ill-defined, and if the lesion was uni- or multifocal. If the patient had no mammographic abnormality but one was performed this was also noted. Clinical information including whether the lesion was clinically palpable and presence or absence of an implant were also investigated. Data were examined using univariable statistics with event-free and overall survival (EFS, OS) as primary outcomes examined with the lymphoma subgroup using Cox PH regression adjusted for age.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 59 cases were identified, 4 males and 55 females. Most patients were white (56%) (See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The majority of patients 47 (80%) were diagnosed via core needle biopsy (CNB) as the only specimen type. For the remaining patients 3 had an ultrasound guided CNB, 3 had an excisional biopsy alone, 1 had both a CNB and excisional biopsy, 2 had both a fine needle aspiration (FNA) and CNB, 1 FNA alone, 1 lumpectomy, and 1 punch biopsy. The cases included 27 (46%) primary breast hematopoietic neoplasms (PBHN) and 32 (54%) secondary breast hematopoietic neoplasms (SBHN). The mean age at diagnosis was 58.8 years. The size of the dominant breast lesion when reported ranged from 0.6 to 10.0 cm. There was no significant side predominance (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Approximately half of the patients in our cohort presented with a palpable mass (29, 49%). The initial diagnostic site was breast for most patients (32, 54%). Other sites included 5 cervical lymph node only, 1 concurrent breast and cervical lymph node biopsy, 1 breast concurrent and ipsilatertal axillary lymph node, 1 axillary lymph node only, 1 both breast and chest wall, 1 breast skin, 6 peripheral blood and/or bone marrow. Other less common initial diagnostic sites included orbit, parotid, and stomach. The diagnosis of a BHN was incidental for 38 patients (64%) and the breast was the site of relapse for 37 (63%). 27 patients had lymph nodes as other sites of involvement, 29 patients had extranodal disease outside of the breast, and 17 had both nodal and extranodal involvement elsewhere. The most common nodal site of involvement were the axillary lymph nodes (14 patients total, 13 unilateral, 1 bilateral). Of these, 5 patients had ipsilateral axillary lymph nodes as their only other site of involvement. The most common other involved extranodal sites were bone marrow (14, 24%), skin/dermis (6, 10%), and peripheral blood (5, 8%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of demographic, clinical, radiologic, and pathologic characteristics between primary and secondary breast lymphomas\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal (59)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrimary (32)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSecondary (27)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge at diagnosis, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59 (46\u0026ndash;67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (46\u0026ndash;68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48 (41\u0026ndash;63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.056\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.25\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack or African-American\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLatinx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex, Female\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55 (93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e1.00\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSide\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.061\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilateral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePalpable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.28\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther nodal site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther extra-nodal site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConcurrent breast CA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e1.00\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54 (92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncidental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSize, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.2 (1.3\u0026ndash;3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.2 (1-5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.1 (1.6\u0026ndash;3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.73\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCalcifications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.68\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadiographic shape\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.15\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRound\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIrregular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMargin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.44\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCircumscribed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIll-Defined\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpiculated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFocality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e0.099\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultifocal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnifocal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistologic Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMZL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDLBCL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCLL/SLLL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHGBCL, NOS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB-lymphoblastic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistiocytic Sarcoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTCL, NOS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT-lymphoblastic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALCL, ALK+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMycosis Fungoides\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtramedullary myeloid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEBV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e1.00\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTreatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.023\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChemo/radiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47 (80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUntreated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003ePercentages may not sum to 100 due to rounding.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eP-values\u003c/em\u003e represent Chi-Square or Fisher\u0026rsquo;s exact for categorical variables (as appropriate for sample size), or Wilcoxon rank sum for continuous variables.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe radiologic features are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Calcifications were identified on mammogram associated with the breast lesion for 10 patients and absent for 32 patients. When available the radiographic shape was most commonly described as irregular (25%) and ill-defined (20%). Most lesions were reported as unifocal (24 patients). One patient had a mammogram with no mammographic evidence of malignancy. Of note, 4 patients were reported to have PET scans and for all 4 the breast masses were PET-FDG avid by radiologic impression.\u003c/p\u003e\u003cp\u003eLymphomas were the most frequent hematopoietic neoplasm (Fig.\u0026nbsp;1), but unusual BHN types were also identified at this site including histiocytic sarcoma. Examining the breast lymphoid neoplasms (BLN) the lymphoma cohort comprised 86.4% of all cases. Patients with primary breast lymphoma (PBL) were significantly older than those with secondary breast lymphoma (SBL) (61.2 vs. 49.8 yrs, p\u0026thinsp;\u0026lt;\u0026thinsp;0.02). There was no tumor size difference between PBL vs. SBL (median 2.1 cm). The most frequent lymphomas were MZL (32.2%) and DLBCL/HGBCL, NOS (33.9%), followed by FL (15%) (Fig.\u0026nbsp;1) including two DLBCLs that transformed from a preceeding FL. Over half of MZL and DLBCLs were primary in the breast with two MZL patients having underlying autoimmune disease. Although 2 patients had breast implants, no cases of implant-associated ALCL were diagnosed. Interestingly, of the patients who had breast implants one was diagnosed with histiocytic sarcoma and was noted on MRI to have a unifocal predominantly hyperintense mass that was described as abutting the implant capsule. The other patient with a history of breast implants was diagnosed with B-lymphoblastic lymphoma and had a prior history of chronic myelogenous leukemia. However, this patient\u0026rsquo;s disease involved both breasts and was multifocal on imaging. It is unclear if these lesions were associated with or involved the implant capsule.\u003c/p\u003e\u003cp\u003eWithin B-cell lymphomas, 20 (37%) were high grade with inferior 10-yr OS (age-adjusted HR 5.47, 95% CI 1.38, 21.64) compared to low-grade without any impact on EFS (Fig.\u0026nbsp;2). After reviewing the histologic types and lesion progression two patients has an initial follicular grade 1\u0026ndash;2 which transformed to DLBCL on relapse and that relapse was within the breast parenchyma. Another breast biopsy performed in 2008 showed follicular lymphoma grade \"1\u0026ndash;2/3\" and subsequent left axillary lymph node biopsy in 2010 was diagnosed as \"DLBCL grade 3B\". There was one patient who had a prior history of T-cell large granular lymphocytic leukemia then DLBCL (non-germinal center subtype) was diagnosed on a subsequent breast core needle biopsy. As noted above, one patient developed B-lymphoblastic lymphoma that involved both breasts with a prior history of chronic myelogenous leukemia.\u003c/p\u003e\u003cp\u003eFive patients were identified with both a history of breast lymphoma and breast carcinoma (BC). There were 3 primary and 2 secondary breast lymphomas, all of B-cell lineage (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Four patients had invasive ductal carcinoma (invasive breast carcinoma of no special type) Nottingham grade II/III and one patient had high grade ductal carcinoma in situ (DCIS). 2 patients had BC preceding; 1 concurrent; and 2 following the diagnosis of a BHN. The patients with available follow-up information are alive with follow-up time ranging from 18\u0026ndash;197 months.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical and pathologic characteristics of patients with both breast lymphoma and breast carcinoma\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eLymphoma\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eCarcinoma\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient number\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSide\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHistology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSide\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eHistology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTiming\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eOutcome after BL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePBL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDLBCL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eIDC and DCIS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eConcurrent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSBL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDCIS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eFL preceding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eA, 197 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSBL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCLL/SLL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eIDC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCLL/SLL preceding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eA, 122 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePBL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eIDC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eBreast carc preceding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eA, 48 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePBL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDLBCL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBil.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eIDC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eBreast carc preceding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eA, 18 months\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eAbbreviations: A, alive; Bil., bilateral; BL, breast lymphoma, carc, carcinoma; CLL/SLL, chronic lymphocytic leukemia/small lymphocytic leukemia; DCIS, ductal carcinoma in situ; DLBCL, diffuse large B-cell lymphoma; IDC, invasive ductal carcinoma; FL, follicular lymphoma, L, left; PBL, primary breast lymphoma; R, right; SBL; secondary breast lymphoma\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHematopoietic neoplasms involving breast (BHN) are rare and most often a diagnosis of exclusion of more common entities. Morphologic mimics of BHN range from benign to malignant including benign inflammatory conditions such as chronic inflammatory infiltrates related to infection, foreign body/surgical site reactions, fat necrosis, lymphocytic (formerly known as diabetic) mastopathy, IgG4-sclerosing mastitis, cystic neutrophilic granulomatous mastitis, and chronic granulomatous mastitis [5,11]. Distinguishing a low grade B-cell neoplasm from physiologic chronic inflammatory infiltrates and other disease processes especially lymphocytic mastopathy can be challenging. Extranodal marginal zone lymphoma (MZL), the most common histotype of BHN in our study, is a low-grade primary extranodal B-cell lymphoma composed mainly of small lymphoid cells that can have prominent plasmacytic differentiation. Of extranodal MZLs monoclonal plasma cells are most commonly found in cases involving the breast and the frequency of lymphoepithelial lesions is the lowest [12]. Chronic inflammatory processes do not express monotypic immunoglobulin or show clonal rearrangement of IGH, and are usually associated with a less dense lymphoid infiltrate and more fibrosis [13]. Immunohistochemistry may be helpful as the neoplastic cells are positive for CD20 and in MZL there is usually a predominace of these cells. Studies of in the breast have shown greater than 60% of CD20+ B cells were present in 23% (7/30) of benign cases versus 75% (15/20) of MZL (P=.0003) [13]. Greater than 40% CD3+ T-cells was exclusively seen in benign cases (P\u0026lt;.0001) [13]. The t(11;18)(q21;q21), seen in extranodal MZL, has also been identified in the majority of breast MZL analyzed by fluorescent in situ hybridization and may aid in the diagnosis [5].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMalignant BHNs can be extremely difficult to distinguish from epithelial derived neoplasms such as breast carcinoma with abundant tumor infiltrating lymphocytes (TILS) otherwise previously known as “medullary carcinoma” or “invasive breast carcinoma of no special type with medullary features”. The rare entity lymphoepithelioma-like carcinoma of the breast notoriously may have such an intense lymphocytic infiltration that it obscures the presence of the malignant epithelial component [14,15]. Of particular diagnostic interest, are a few exceptional reported cases such as a follicular dendritic cell sarcoma with abundant myxoid stroma and mucoid pools, mimicking a primary mucinous carcinoma of the breast [16]. Additionally, the sarcomatoid variant of Anaplastic Large Cell Lymphoma (ALCL) presenting as a rapidly enlarging palpable breast lesion has been reported in a patient without breast implants [17]. Certain BHN such as leukemic involvement of the breast or myeloid sarcoma may be particularly difficult to distinguish from invasive lobular carcinoma (ILC) because of the presence of relatively small, infiltrative neoplastic cells, single-file non-cohesive growth pattern, and lack of immunoreactivity for E-cadherin [18]. Both B and T-cell phenotypes of breast lymphomas can display frequent signet ring cells [19]. Diffuse large B-cell lymphoma can closely morphologically mimic poorly differentiated breast carcinoma by presenting as solid nests, cords, and/or single epithelioid cells with moderate cytoplasm, and vesicular nuclei. Although most BHN will have a triple negative immunohistochemical profile, low positivity for ERα can rarely be observed [6]. Immunohistochemistry for keratins such as AE1/3 can become vital for diagnosis. Lymphoid neoplasms will be negative for keratin. However, p63 can be positive in B-cell lymphomas and up to 45% of DLBCL can show p63 expression [20]. Negative staining for keratins with p63 positivity can also be seen in metaplastic breast carcinomas and is not a specific finding.\u0026nbsp;Although these situations highlight the diagnostic difficulties of distinguishing these lesions from other breast tumors it is important to note that BHN may not just mimic but occur in association with in-situ and invasive breast carcinomas. Co-existent metastatic carcinoma and lymphoma has been reported previously in axillary lymph nodes [21]\u0026nbsp;(also see our Figure 4).\u0026nbsp;Even a “collision tumor” consisting of synchronous carcinoma with closely associated malignant lymphoma presenting as a single mass in the breast has been described [22].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe vast majority of hematopoietic neoplasms occurring in the breast are lymphoid neoplasms (BLN) which includes the infrequent but site-specific breast implant associated anaplastic large cell lymphoma (BI-ALCL) that has been heavily focused on in the available literature. Any lymphoma histotype may occur but overall diffuse large B cell lymphoma (DLBCL) is the most common histologic subtype followed by MZL, and follicular lymphoma (FL) [1,5]. Involvement of the breast by BHN other than lymphomas including leukemic, myeloid, histiocytic, plasma cell, and T-cell neoplasms are rare, generally being reported as case reports or small case series. Our findings reflect this as we had a few uncommon diagnoses in our cohort including single cases of extramedullary myeloid tumor, anaplastic large cell lymphoma (ALK+), and histiocytic sarcoma. Other less common but notable hematolymphoid neoplasms that have been reported to involve breast tissue include Burkitt lymphoma, plasmacytoma/plasma cell myeloma, myeloid sarcoma, Hodgkin’s Lymphoma, Rosai-Dorfman disease, ALK-positive histiocytosis of the breast, histiocytic sarcoma, follicular dendritic cell sarcoma, interdigitating dendritic cell sarcoma, Hairy cell leukemia, and blastic plasmacytoid dendritic cell neoplasm [23-25]. Although most primary lymphomas of the breast are of B-cell lineage T-cell malignancies such as extranodal NK/T cell lymphoma, T-cell lymphoblastic lymphoma, and subcutaneous panniculitis-like T-cell lymphoma have also been reported [26-29]. Although the most common BHN arising in association with breast implants is BI-ALCL, it is important to note that this histotype is not specific to this location and rarely other histologic types of lymphoma including B-cell lymphomas have been reported in association with breast implants [30]. Although histiocytic sarcomas have been described in the breast and axilla, there have been no other reported cases of a histiocytic sarcoma associated with a breast implant [31, 32].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough some authors have reported aggressive lymphomas arising in women of childbearing age during pregnancy we did not observe this in our cohort [33-35]. Like other studies we found overlapping imaging features of breast lymphomas with primary breast carcinoma, making prospective clinical suspicion of breast lymphoma challenging [36]. We found that 17% of patients with a BHN including lymphomas in our study were described in radiology reports as associated with mammographic calcifications. This is in contrast to prior studies of BLN in which calcifications are almost always absent [36, 37].\u0026nbsp;Interestingly, a case report of primary MZL in the breast has been documented presenting as grouped calcifications discovered during screening mammography [38]. This clinical presentation seems outstandingly rare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe occurrence of BLN and BC in the same patient has been reported to be relatively common. In a study 24% of patients with a BLN had either a history of or a concurrent BC [39]. We observed a much lower incidence, 5 of 59 patients (0.08%). It is interesting that most patients in our study developed BLN and BC in the same breast but this is most likely due to small sample size. Some have asserted the occurrence of BLN and BC in the same patient does not appear to have an adverse clinical significance in terms of prognosis [39]. Our data is too limited to draw any conclusions regarding prognosis in this regard. After stratifying the most common BHNs the B-cell lymphomas into low and high grade, the high-grade lymphomas were found to have inferior 10 year overall survival. Transformation of PBL histological subtypes has been documented and\u0026nbsp;our results further support that different histological subtypes of lymphoma have distinct prognoses [40].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite the low prevalence it is still important to consider all BHN as in up to 40% of patients a breast core-needle biopsy may be the first diagnosis of a hematologic malignancy [6]. In our study 38 of the 59 patients (64%) the diagnosis of a hematologic malignancy was incidental and not known prior to tissue sampling. This includes a case of follicular lymphoma involving all lymph nodes of an axillary lymph node dissection in which five of forty-four were also involved by metastatic carcinoma (Figure 4).\u003c/p\u003e\n\u003cp\u003eIn conclusion, although hematopoietic neoplasms involving the breast are much less common than epithelial malignancies it is important to consider the full spectrum of hematolymphoid tumors while viewing a breast core needle biopsy. The main limitation of this study is its retrospective nature. The true incidence of hematolymphoid lesions involving the breast is difficult to estimate, and many of the cases in this study were seen in consultation. \u0026nbsp;Low-grade lesions especially B-cell lymphomas can masquerade as benign reactive inflammatory infiltrates, yet high grade neoplasms can appear virtually identical to invasive breast carcinoma. On limited material like a CNB making an accurate diagnosis can be especially challenging. However, it is clinically important for treatment and management of patients. It is crucial to be aware of these entities for primary diagnosis and appropriate hematopathology consultation, even in patients without a prior history of a hematologic malignancy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eGeneral Abbreviations:\u0026nbsp;\u003c/strong\u003eHematopoietic neoplasms involving breast (BHN), Breast Primary breast hematopoietic neoplasms (PBHN), Secondary breast hematopoietic neoplasms (SBHN), Primary breast lymphoma (PBL), Secondary breast lymphoma (SBL), Breast lymphoid neoplasms (BLN), Breast carcinoma (BC), Invasive ductal carcinoma (IDC), Ductal carcinoma in situ (DCIS), Scarff-Bloom-Richardson (SBR),\u0026nbsp;Tumor infiltrating lymphocytes (TILS), Invasive lobular carcinoma (ILC), Core Needle Biopsy (CNB), Fine Needle Aspiration (FNA), Hematoxylin and Eosin (H\u0026amp;E), Terminal duct lobular unit (TDLU), Event free survival (EFS), Overall survival (OS), Hazard ratio (HR). See Figure 1 for Hematopoietic neoplasm abbreviations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHematopoietic neoplasm abbreviations:\u0026nbsp;\u003c/strong\u003eNon-Hodgkin Lymphoma (NHL),Marginal zone lymphoma (MZL), Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT), Diffuse large B-cell lymphoma (DLBCL), Follicular lymphoma (FL), Chronic lymphocytic/Small lymphocytic leukemia/lymphoma (CLL/SLL), High-grade B-cell Lymphoma Not Otherwise Specified (HGBCL, NOS), Peripheral T-cell lymphoma (PTCL), Extramedullary myeloid tumor/Acute myeloid lymphoma (AML), Breast implant associated Anaplastic Large Cell Lymphoma (BI-ALCL), Anaplastic Large Cell Lymphoma Anaplastic lymphoma kinase–positive (ALCL, ALK+)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Declaration:\u003c/strong\u003e The institutional IRB at the University of Chicago Biological Sciencese Division determined that the protocol is considered exempt because the retrospective research involves no more than minimal risk to the subjects, the research could not practicably be carried out without the requested waiver or alteration, the reasearch does not use identifiable private information or identifiable biospecimens, the waiver or alteration will not adversely affect the rights and welfare of the subjects and whenever appropriate, the subjects or legally authorized representatives will be provided with additional pertinent information after participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish Declaration:\u003c/strong\u003e The authors affirm that human research participants provided informed consent for publication of the anonymized patient information to be published in this article including the images and information in Tables 1, 2 and Figures 1, 2, 3 (a-f), and 4. The participants have consented to the submission of the cases reported to the journal. Futhermore, the covered entity does not have actual knowledge that the information could be used alone or in combination with other information to identify an individual who is a subject of the information.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Conflicting Interests:\u003c/strong\u003e The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e The data supporting the findings of this study are available within the article. The additional data are not publicly available due to containing clinical information that could compromise the privacy of research participants. Additional data are available on reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u003c/strong\u003e The authors received no financial support for the research and authorship of this article. If accepted for publication the corresponding author Dr. Jasmine Vickery, MD with support from the Hospital of the University of Pennsylvania department of pathology will be responsible for arranging payment of the article publication charge.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTalwalkar SS, Miranda RN, Valbuena JR, Routbort MJ, Martin AW, Medeiros LJ (2008) Lymphomas involving the breast: a study of 106 cases comparing localized and disseminated neoplasms. Am J Surg Pathol 32(9):1299\u0026ndash;1309. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PAS.0b013e318165eb50\u003c/span\u003e\u003cspan address=\"10.1097/PAS.0b013e318165eb50\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQi Y, Kong X, Wang X, Zhai J, Fang Y, Wang J (2022) Metastasis to Breast from Extramammary Solid Tumors and Lymphomas: A 20-Year Population-Based Study. Cancer Invest 40(4):325\u0026ndash;336 Epub 2021 Dec 23. PMID: 34937471\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilliams SA, Ehlers RA 2nd, Hunt KK, Yi M, Kuerer HM, Singletary SE, Ross MI, Feig BW, Symmans WF, Meric-Bernstam F (2007) Metastases to the breast from nonbreast solid neoplasms: presentation and determinants of survival. Cancer. ;110(4):731-7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/cncr.22835\u003c/span\u003e\u003cspan address=\"10.1002/cncr.22835\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 17582626\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePicasso R, Tagliafico A, Calabrese M, Martinoli C, Pistoia F, Rossi A, Zaottini F, Derchi L (2020) Primary and Secondary Breast Lymphoma: Focus on Epidemiology and Imaging Features. Pathol Oncol Res 26(3):1483\u0026ndash;1488. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12253-019-00730-0\u003c/span\u003e\u003cspan address=\"10.1007/s12253-019-00730-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2019 Aug 20. PMID: 31428995\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoffmann J, Ohgami RS (2017) Hematolymphoid lesions of the breast. Semin Diagn Pathol 34(5):462\u0026ndash;469. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1053/j.semdp.2017.05.007\u003c/span\u003e\u003cspan address=\"10.1053/j.semdp.2017.05.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2017 May 28. PMID: 28662998\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuilbert MC, Hornick JL, Chikarmane SA, Lester SC (2019) Hematologic Malignancies of the Breast: A Contemporary Series Investigating Incidence, Presentation, Accuracy of Diagnosis on Core Needle Biopsy, and Hormone Receptor Expression. Breast Cancer (Auckl) 13:1178223419830982. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1178223419830982\u003c/span\u003e\u003cspan address=\"10.1177/1178223419830982\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 30814841; PMCID: PMC6385330\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarrison BT, Dillon DA, Richardson AL, Brock JE, Guidi AJ, Lester SC (2017) Quality Assurance in Breast Pathology: Lessons Learned From a Review of Amended Reports. Arch Pathol Lab Med 141(2):260\u0026ndash;266. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5858/arpa.2016-0018-OA\u003c/span\u003e\u003cspan address=\"10.5858/arpa.2016-0018-OA\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2016 Dec 13. PMID: 27959581\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKuper-Hommel MJ, Snijder S, Janssen-Heijnen ML, Vrints LW, Kluin-Nelemans JC, Coebergh JW, Noordijk EM, Vreugdenhil G (2003) Treatment and survival of 38 female breast lymphomas: a population-based study with clinical and pathological reviews. Ann Hematol 82(7):397\u0026ndash;404. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00277-003-0664-7\u003c/span\u003e\u003cspan address=\"10.1007/s00277-003-0664-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2003 May 23. PMID: 12764549\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTopalovski M, Crisan D, Mattson JC (1999) Lymphoma of the breast. A clinicopathologic study of primary and secondary cases. Arch Pathol Lab Med 123(12):1208\u0026ndash;1218. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5858/1999-123-1208-LOTB\u003c/span\u003e\u003cspan address=\"10.5858/1999-123-1208-LOTB\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWiseman C, Liao KT (1972) Primary lymphoma of the breast. Cancer. ;29(6):1705-12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/1097-0142(197206)29:6%3C1705::aid-cncr2820290640%3E3.0.co;2-i\u003c/span\u003e\u003cspan address=\"10.1002/1097-0142(197206)29:6%3C1705::aid-cncr2820290640%3E3.0.co;2-i\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 4555557\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCampos GC, Castro MV, de Mattos VF, Pinto LZ, Boechat MC, Dos Santos AA (2014 Jul-Aug) Lymphocytic mastopathy mimicking breast malignancy: a case report. Radiol Bras 47(4):256\u0026ndash;258. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/0100-3984.2013.1847\u003c/span\u003e\u003cspan address=\"10.1590/0100-3984.2013.1847\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 25741094; PMCID: PMC4337124\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRawal A, Finn WG, Schnitzer B, Valdez R (2007) Site-specific morphologic differences in extranodal marginal zone B-cell lymphomas. Arch Pathol Lab Med. ;131(11):1673-8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5858/2007-131-1673-SMDIEM\u003c/span\u003e\u003cspan address=\"10.5858/2007-131-1673-SMDIEM\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 17979485\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBerg AN, Soma L, Clark BZ, Swerdlow SH, Roth CG (2015) Evaluating breast lymphoplasmacytic infiltrates: a multiparameter immunohistochemical study, including assessment of IgG4. Hum Pathol 46(8):1162\u0026ndash;1170. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.humpath.2015.04.006\u003c/span\u003e\u003cspan address=\"10.1016/j.humpath.2015.04.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2015 Apr 28. PMID: 26026200\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNaidoo P, Chetty R (2001) Lymphoepithelioma-like carcinoma of the breast with associated sclerosing lymphocytic lobulitis. Arch Pathol Lab Med. ;125(5):669\u0026thinsp;\u0026ndash;\u0026thinsp;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5858/2001-125-0669-LLCOTB\u003c/span\u003e\u003cspan address=\"10.5858/2001-125-0669-LLCOTB\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 11300942\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNieto-Coronel MT, Perez-Sanchez VM, Salazar-Campos JE, Diaz-Molina R, Arce-Salinas CH Lymphoepithelioma-like carcinoma of breast: A case report and review of the literature. Indian J Pathol Microbiol 2019 Jan-Mar ;62(1):125\u0026ndash;128. doi: 10.4103/IJPM.IJPM_761_17. PMID: 30706876.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFisher C, Magnusson B, Hardarson S, Smith ME (1999) Myxoid variant of follicular dendritic cell sarcoma arising in the breast. Ann Diagn Pathol. ;3(2):92\u0026thinsp;\u0026ndash;\u0026thinsp;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s1092-9134(99)80036-7\u003c/span\u003e\u003cspan address=\"10.1016/s1092-9134(99)80036-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 10196389\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePereira EM, Maeda SA, Reis-Filho JS (2002) Sarcomatoid variant of anaplastic large cell lymphoma mimicking a primary breast cancer: a challenging diagnosis. Arch Pathol Lab Med. ;126(6):723-6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5858/2002-126-0723-SVOALC\u003c/span\u003e\u003cspan address=\"10.5858/2002-126-0723-SVOALC\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 12033965\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIshikawa MK, Pinsky RW, Smith LB, Jorns JM (2015) Morphologic Mimics of Invasive Lobular Carcinoma. Arch Pathol Lab Med. ;139(10):1253-7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5858/arpa.2015-0190-RA\u003c/span\u003e\u003cspan address=\"10.5858/arpa.2015-0190-RA\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 26414470\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGualco G, Bacchi CE (2008) B-cell and T-cell lymphomas of the breast: clinical\u0026ndash;pathological features of 53 cases. Int J Surg Pathol 16(4):407\u0026ndash;413. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1066896908316784\u003c/span\u003e\u003cspan address=\"10.1177/1066896908316784\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2008 May 14. PMID: 18480397\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoreno JCA, Bahmad HF, Aljamal AA, Delgado R, Salami A, Guillot C, Castellano-S\u0026aacute;nchez AA, Medina AM, Sriganeshan V (2023) Prognostic Significance of p53 and p63 in Diffuse Large B-Cell Lymphoma: A Single-Institution Experience. Curr Oncol 30(2):1314\u0026ndash;1331. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/curroncol30020102\u003c/span\u003e\u003cspan address=\"10.3390/curroncol30020102\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 36826063; PMCID: PMC9955855\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmbrosiani L, Bellone S, Declich P, Tavani E, Pavia GF (1999) Breast carcinoma metastatic to a lymphoma: report of a case with review of literature Histopathology. 34(1):87\u0026ndash;89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1046/j.1365-2559.1999.00555.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1365-2559.1999.00555.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSusnik B, Jordi Rowe J, Redlich PN, Chitambar C, Chang CC, Kampalath B (2004) A unique collision tumor in breast: invasive ductal carcinoma and mucosa-associated lymphoid tissue lymphoma. Arch Pathol Lab Med. ;128(1):99\u0026ndash;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5858/2004-128-99-AUCTIB\u003c/span\u003e\u003cspan address=\"10.5858/2004-128-99-AUCTIB\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 14692838\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKashima J, Yoshida M, Jimbo K, Izutsu K, Ushiku T, Yonemori K, Yoshida (2021) Akihiko. ALK-positive Histiocytosis of the Breast: A Clinicopathologic Study Highlighting Spindle Cell Histology. The American Journal of Surgical Pathology 45(3):p 347\u0026ndash;355, March | \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PAS.0000000000001567\u003c/span\u003e\u003cspan address=\"10.1097/PAS.0000000000001567\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTan PH, Ellis I, Allison K, Brogi E, Fox SB, Lakhani S, Lazar AJ, Morris EA, Sahin A, Salgado R, Sapino A, Sasano H, Schnitt S, Sotiriou C, van Diest P, White VA, Lokuhetty D, Cree IA, WHO Classification of Tumours Editorial Board (2020) The 2019 World Health Organization classification of tumours of the breast. Histopathology 77(2):181\u0026ndash;185. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/his.14091\u003c/span\u003e\u003cspan address=\"10.1111/his.14091\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2020 Jul 29. PMID: 32056259\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen KC, Su TC, Chen DR, Liou JH (2015) A case report: Blastic plasmacytoid dendritic cell neoplasm is misdiagnosed as breast infiltrating ductal carcinoma. Int J Surg Pathol 23(1):84\u0026ndash;88 Epub 2014 Oct 7. PMID: 25297609\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang Y, Wang K, Tan Q, Yang K, Wu D, Xu Y, Zhao X, Jiang Z (2021) Primary breast CD20-positive extranodal NK/T cell lymphoma with stomach involvement: a case report and literature review. Diagn Pathol 16(1):103. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13000-021-01166-4\u003c/span\u003e\u003cspan address=\"10.1186/s13000-021-01166-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 34749754; PMCID: PMC8573996\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu H, Jin SY (2023) Primary Breast Natural Killer/T-cell lymphoma with Cutaneous Involvement: A Case Report. Altern Ther Health Med 29(8):252\u0026ndash;254 PMID: 37573597\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYumuk PF, Aydiner A, Topuz E, Cabioglu N, Dogan O (2004) T-cell lymphoblastic lymphoma presenting with a breast mass. Leuk Lymphoma. ;45(4):833-6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/10428190310001617277\u003c/span\u003e\u003cspan address=\"10.1080/10428190310001617277\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 15160967\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJeong SI, Lim HS, Choi YR, Kim JW, Park MH, Cho JS, Lee JS, Kang HK (2013 May-Jun) Subcutaneous panniculitis-like T-cell lymphoma of the breast. Korean J Radiol 14(3):391\u0026ndash;394. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3348/kjr.2013.14.3.391\u003c/span\u003e\u003cspan address=\"10.3348/kjr.2013.14.3.391\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2013 May 2. PMID: 23690702; PMCID: PMC3655289\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEvans MG, Miranda RN, Young PA, Pai L, Wang HY, Konoplev SN, Medeiros LJ, Pinter-Brown LC (2020) B-cell lymphomas associated with breast implants: Report of three cases and review of the literature. Ann Diagn Pathol 46:151512 Epub 2020 Mar 28. PMID: 32315816\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBang S, Kim Y, Chung MS, Park JS, Choi YY, Shin SJ (2019) Primary Histiocytic Sarcoma Presenting as a Breast Mass: A Case Report. J Breast Cancer 22(3):491\u0026ndash;496. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4048/jbc.2019.22.e32\u003c/span\u003e\u003cspan address=\"10.4048/jbc.2019.22.e32\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 31598348; PMCID: PMC6769387\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNangal JK, Kapoor A, Narayan S, Singhal MK, Beniwal S, Kumar HS (2014) A case of CD68 negative histiocytic sarcoma of axilla masquerading as metastatic breast cancer. J Surg Case Rep 2014(7):rju071. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/jscr/rju071\u003c/span\u003e\u003cspan address=\"10.1093/jscr/rju071\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 25031040; PMCID: PMC4100750\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAltshuler E, Wheeler S, Daily K (2023) Bilateral primary breast Burkitt's lymphoma in pregnancy. BMJ Case Rep 16(1):e251896. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bcr-2022-251896\u003c/span\u003e\u003cspan address=\"10.1136/bcr-2022-251896\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 36653041; PMCID: PMC9853133\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGowda V, Shelar D, Harbade S, Jadhav S, Jadhav R (2023) Primary breast lymphoma in pregnancy: A case report. Int J Surg Case Rep 107:108273. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijscr.2023.108273\u003c/span\u003e\u003cspan address=\"10.1016/j.ijscr.2023.108273\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2023 Apr 28. PMID: 37216730; PMCID: PMC10213345\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArber DA, Simpson JF, Weiss LM, Rappaport H (1994) Non-Hodgkin's lymphoma involving the breast. Am J Surg Pathol. ;18(3):288\u0026thinsp;\u0026ndash;\u0026thinsp;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00000478-199403000-00009\u003c/span\u003e\u003cspan address=\"10.1097/00000478-199403000-00009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 8116797\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRaj SD, Shurafa M, Shah Z, Raj KM, Fishman MDC, Dialani VM (2019) May-Jun;39(3):610\u0026ndash;625 Primary and Secondary Breast Lymphoma: Clinical, Pathologic, and Multimodality Imaging Review. Radiographics. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1148/rg.2019180097\u003c/span\u003e\u003cspan address=\"10.1148/rg.2019180097\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2019 Mar 29. PMID: 30924754\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSabat\u0026eacute; JM, G\u0026oacute;mez A, Torrubia S, Camins A, Roson N, De Las Heras P, Villalba-Nu\u0026ntilde;o V (2002) Sep-Oct;8(5):294\u0026ndash;304 Lymphoma of the breast: clinical and radiologic features with pathologic correlation in 28 patients. Breast J. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1046/j.1524-4741.2002.08509.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1524-4741.2002.08509.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 12199758\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSteven W, Szarmach JL, Raghu M, Bakhru S, Everett T, Flaherty F, Boroumand G (2024) A rare case of primary breast lymphoma presenting as calcifications on screening mammography. Radiol Case Rep 19(5):1734\u0026ndash;1739 PMID: 38384692; PMCID: PMC10877128\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGenco IS, Gur H, Hajiyeva S (2021) Lymphoma of the breast: A clinicopathologic analysis of 51 cases with a specific emphasis on patients with a history of breast carcinoma. Breast J 27(5):456\u0026ndash;460. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/tbj.14198\u003c/span\u003e\u003cspan address=\"10.1111/tbj.14198\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePeng F, Li J, Mu S, Cai L, Fan F, Qin Y, Ai L, Hu Y (2021) Epidemiological features of primary breast lymphoma patients and development of a nomogram to predict survival. Breast 57:49\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.breast.2021.03.006\u003c/span\u003e\u003cspan address=\"10.1016/j.breast.2021.03.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2021 Mar 17. PMID: 33774459; PMCID: PMC8027901\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"annals-of-hematology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aohe","sideBox":"Learn more about [Annals of Hematology](http://link.springer.com/journal/277)","snPcode":"277","submissionUrl":"https://submission.nature.com/new-submission/277/3","title":"Annals of Hematology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Breast, Lymphoma, Primary breast lymphoma, Secondary breast lymphoma, Extranodal lymphoma, Hematolymphoid neoplasm, Hematopoietic neoplasm ","lastPublishedDoi":"10.21203/rs.3.rs-7724874/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7724874/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground:\u003c/p\u003e\n\u003cp\u003eBreast hematopoietic neoplasms (BHN) are rare and may be either primarily (PBHN) or secondarily (SBHN) involving breast tissue. Due to the widespread use of needle biopsy for initial diagnosis of breast lesions, knowledge of their presentation, radiologic aspects, histomorphology, and outcomes are critical for seeking appropriate hematopathology consultation. Herein, we present our clinical experience as an academic institution and referral center of BHN in the past 20 years.\u003c/p\u003e\n\u003cp\u003eMethods/Design:\u003c/p\u003e\n\u003cp\u003eWe identified 59 patients diagnosed at the University of Chicago Medical Center between 2002-2021. Demographic, pathologic, radiologic, therapy, relapse data, and vital status were abstracted. Data were examined using univariable statistics with event-free and overall survival (EFS, OS) as primary outcomes examined with the lymphoma subgroup using Cox PH regression adjusted for age.\u003c/p\u003e\n\u003cp\u003eResults:\u003c/p\u003e\n\u003cp\u003eThe cases included 27 (46%) PBHN and 32 (54%) SBHN in a cohort comprising 93% females, mostly white (56%) (Table 1). The mean age at diagnosis was 58.8 years. Lymphomas were the most frequent BHN (Figure 1). Examining the lymphoma cohort (86.4% of all cases), patients with primary breast lymphomas (PBL) were significantly older than those with secondary breast lymphomas (SBL) (61.2 vs. 49.8 yrs, p\u0026lt;0.02). The most frequent lymphomas were extranodal marginal zone lymphoma (MZL) (32.2%) and diffuse large B-cell lymphoma/high grade B-cell lymphoma, not otherwise specified (DLBCL/HGBCL, NOS) (33.9%). Over half of MZLs and DLBCLs were primary in the breast. 5 of 59 patients presented with concurrent breast carcinoma (Table 2). Although 2 patients had breast implants, no cases of implant-associated anaplastic large cell lymphoma (ALCL) were diagnosed. Within B-cell lymphomas, 20 (37%) were high grade with inferior 10-yr overall survival (OS) (age-adjusted HR 5.47, 95% CI 1.38, 21.64) compared to low-grade without any impact on event free survival (EFS) (Figure 2).\u003c/p\u003e\n\u003cp\u003eConclusion:\u003c/p\u003e\n\u003cp\u003eThis is one of the largest cohorts so far describing HNs in the breast. DLBCL and MZL remain the most common lymphomas involving this site. The majority of patients were diagnosed via core needle biopsy (CNB) and did not have a prior diagnosis of a BHN. Radiographically, the presentation may closely mimic breast carcinoma.\u003c/p\u003e","manuscriptTitle":"Hematolymphoid Neoplasms Involving the Breast: A Single Institution Clinicopathologic Study of 59 Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-21 23:27:05","doi":"10.21203/rs.3.rs-7724874/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-13T05:43:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-12T19:12:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"41831608495843747823540123010094562118","date":"2025-10-10T15:12:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"129221876169982842648131824340641156178","date":"2025-10-09T15:28:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-08T15:10:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-08T12:14:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-08T12:14:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"Annals of Hematology","date":"2025-09-26T21:58:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"annals-of-hematology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aohe","sideBox":"Learn more about [Annals of Hematology](http://link.springer.com/journal/277)","snPcode":"277","submissionUrl":"https://submission.nature.com/new-submission/277/3","title":"Annals of Hematology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e9f7c445-cb21-463e-b518-d3bb7df63baf","owner":[],"postedDate":"October 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T16:01:41+00:00","versionOfRecord":{"articleIdentity":"rs-7724874","link":"https://doi.org/10.1007/s00277-026-06901-9","journal":{"identity":"annals-of-hematology","isVorOnly":false,"title":"Annals of Hematology"},"publishedOn":"2026-04-10 15:58:10","publishedOnDateReadable":"April 10th, 2026"},"versionCreatedAt":"2025-10-21 23:27:05","video":"","vorDoi":"10.1007/s00277-026-06901-9","vorDoiUrl":"https://doi.org/10.1007/s00277-026-06901-9","workflowStages":[]},"version":"v1","identity":"rs-7724874","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7724874","identity":"rs-7724874","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}