Introduction: Pregnancy associated breast cancer is defined as "The diagnosis of breast cancer is made during pregnancy or within one year afterward." The incidences of breast carcinoma are 1 in 3000 pregnancy in west. Risk is increasing because of increased number of late pregnancies. Young age, lactating breast (dense) and paucity of incidences not only delay but confuse the pathologist for accurate diagnosis. Case report A 28 year lactating female with 2 months old baby, presented with breast lump. Lump was mobile, non-tender and of size 2x1 cm since 3 months and gradually increasing in size. On USG, it was benign. On FNAC, aspirate was milky mixed with blood, showing monotonous cells with abundant cytoplasm, bland nuclei in a secretary background. Final diagnosis was lactational changes in breast. After six months, lady came back with previous lump which was increased in size up to 6X5 cm. On FNAC, smear was having bizarre cells, reported as malignant and confirmed on histopathology. Patient was responded to chemotherapy and lump reduced in size. Conclusion: Pregnancy associated breast cancer is on rise. High grade of suspicion and complete evaluation including trucut biopsy will lead to correct diagnosis. DOI: 10.21276/AWCH.1806