1
|
Ciliberti V, Maffei E, Giudice V, Ciancia G, Zeppa P, Caputo A. COVID-19 vaccine-associated lymphadenopathy: a review. LE INFEZIONI IN MEDICINA 2024; 32:119-130. [PMID: 38827838 PMCID: PMC11142413 DOI: 10.53854/liim-3202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/30/2024] [Indexed: 06/05/2024]
Abstract
Following the introduction of RNA-based vaccines, COVID-19 vaccine-associated clinical lymphadenopathy (C19-LAP) has been reported as a side effect. Moreover, subclinical lymphadenopathy detected on imaging (SLDI) has also been observed, mainly as incidental findings while performing screening tests on oncological patients. In these cases, surgical lymphadenectomy, fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) have been used as a valuable diagnostic tool for SLDI and C19-LAP. In this review the clinical, histologic and cytologic features of SLDI and C19-LAP have been investigated. A search for studies that reported on C19-LAP and SLDI histopathology and cytopathology was performed on PubMed and Google Scholar, on 11 January 2023. Thirty-one reports on SLDI and C19-LAP were retrieved and included in a pooled analysis. In total, we included 54 patients with a median age of 47 years. In our research, surgical excision, CNB and/or FNAC of C19-LAP or SLDI enlarged lymph nodes have been performed in 54 cases. Of all cases, only two metastases were diagnosed and one case was diagnosed as reactive hyperplasia with atypical follicles. The remaining cases were reactive lymphadenopathy (28 cases), follicular hyperplasia (13 cases), Kikuchi-Fujimoto disease (6 cases), granulomatous lymphadenitis (2 cases), eosinophilic lymph node abscesses (1 case), Langherans cell histiocytosis (1 case), Rosai-Dorfman disease (1 case). SLDI and C19-LAP have represented a diagnostic dilemma, especially in oncologic patients. The role of different diagnostic tools for SLDI and C19-LAP has been discussed.
Collapse
Affiliation(s)
- Valeria Ciliberti
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Elisabetta Maffei
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Valentina Giudice
- Hematology and Transplant Center, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Giuseppe Ciancia
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Pio Zeppa
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Alessandro Caputo
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| |
Collapse
|
2
|
Caputo A, Caleo A, Cozzolino I, Zeppa P, Ciancia G, Ciliberti V. COVID-19 post-vaccination lymphadenopathy: A review of the use of fine needle aspiration cytology. Cytopathology 2023; 34:423-432. [PMID: 36807950 DOI: 10.1111/cyt.13221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/20/2023]
Abstract
COVID-19 vaccine-associated clinical lymphadenopathy (C19-LAP) and subclinical lymphadenopathy (SLDI), which are mainly detected by 18F-FDG PET-CT, have been observed after the introduction of RNA-based vaccines during the pandemic. Lymph node (LN) fine needle aspiration cytology (FNAC) has been used to diagnose single cases or small series of SLDI and C19-LAP. In this review, clinical and LN-FNAC features of SLDI and C19-LAP are reported and compared to non-Covid (NC)-LAP. A search for studies on C19-LAP and SLDI histopathology and cytopathology was performed on PubMed and Google Scholar, on 11 January 2023. Reports on LN-FNAC of C19-LAP were retrieved. A total of 14 reports, plus one unpublished case of C19-LAP observed in our institution, diagnosed by LN-FNAC were included in a pooled analysis and compared to the corresponding histopathological reports. In total, 26 cases were included in this review, with a mean age of 50.5 years. Twenty-one lymphadenopathies assessed by LN-FNAC were diagnosed as benign, and three cases as atypical lymphoid hyperplasia; the latter were subsequently confirmed as benign (one by repetition of LN-FNAC, two by histological control). One case of mediastinal lymphadenopathy in a patient suffering from melanoma was reported as reactive granulomatous inflammation, while one unsuspected case was diagnosed as metastasis from melanoma. In all cases, the cytological diagnoses were confirmed by follow-up or excisional biopsy. The high diagnostic value of LN-FNAC in excluding malignant processes was extremely useful in this context and may be particularly valuable when CNB or histological excisions are difficult to perform, as was the case during Covid lockdowns.
Collapse
Affiliation(s)
- Alessandro Caputo
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
| | - Alessia Caleo
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
| | - Immacolata Cozzolino
- Dipartimento di Salute Mentale e Fisica e Medicina, Università degli studi della Campania Luigi Vanvitelli, Naples (IT), Naples, Italy
| | - Pio Zeppa
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
| | - Giuseppe Ciancia
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
| | - Valeria Ciliberti
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
| |
Collapse
|
3
|
Ho TC, Shen DHY, Chang CC, Chan HP, Chuang KP, Yuan CH, Chen CN, Yang MH, Tyan YC. Immune Response Related to Lymphadenopathy Post COVID-19 Vaccination. Vaccines (Basel) 2023; 11:vaccines11030696. [PMID: 36992280 DOI: 10.3390/vaccines11030696] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Mass vaccination against coronavirus disease 2019 (COVID-19) is a global health strategy to control the COVID-19 pandemic. With the increasing number of vaccinations, COVID-19 vaccine-associated lymphadenopathy (C19-VAL) has been frequently reported. Current findings emphasize the characteristics of C19-VAL. The mechanism of C19-VAL is complicated to explore. Accumulated reports separately show that C19-VAL incidence is associated with receiver age and gender, reactive change within lymph nodes (LN), etc. We constructed a systematic review to evaluate the associated elements of C19-VAL and provide the mechanism of C19-VAL. Articles were searched from PubMed, Web of Science and EMBASE by using the processing of PRISMA. The search terms included combinations of the COVID-19 vaccine, COVID-19 vaccination and lymphadenopathy. Finally, sixty-two articles have been included in this study. Our results show that days post-vaccination and B cell germinal center response are negatively correlated with C19-VAL incidence. The reactive change within LN is highly related to C19-VAL development. The study results suggested that strong vaccine immune response may contribute to the C19-VAL development and perhaps through the B cell germinal center response post vaccination. From the perspective of imaging interpretation, it is important to carefully distinguish reactive lymph nodes from metastatic lymph node enlargement through medical history collection or evaluation, especially in patients with underlying malignancy.
Collapse
Affiliation(s)
- Tzu-Chuan Ho
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Daniel Hueng-Yuan Shen
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Chin-Chuan Chang
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Electrical Engineering, I-Shou University, Kaohsiung 840, Taiwan
| | - Hung-Pin Chan
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Kuo-Pin Chuang
- Graduate Institute of Animal Vaccine Technology, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 912, Taiwan
| | - Cheng-Hui Yuan
- Mass Spectrometry Laboratory, Department of Chemistry, National University of Singapore, Singapore 119077, Singapore
| | - Ciao-Ning Chen
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ming-Hui Yang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Center of General Education, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
| | - Yu-Chang Tyan
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Animal Vaccine Technology, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 912, Taiwan
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Center for Tropical Medicine and Infectious Disease Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| |
Collapse
|
4
|
Lucas F, Sadigh S. Hematopathology of SARS-CoV-2 infection and COVID-19 disease. Surg Pathol Clin 2023; 16:197-211. [PMID: 37149356 PMCID: PMC9892324 DOI: 10.1016/j.path.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2 and is associated with pronounced hematopathologic findings. Peripheral blood features are heterogeneous and very often include neutrophilia, lymphopenia, myeloid left shift, abnormally segmented neutrophils, atypical lymphocytes/plasmacytoid lymphocytes, and atypical monocytes. Bone marrow biopsies and aspirates are often notable for histiocytosis and hemophagocytosis, whereas secondary lymphoid organs may exhibit lymphocyte depletion, pronounced plasmacytoid infiltrates, and hemophagocytosis. These changes are reflective of profound innate and adaptive immune dysregulation, and ongoing research efforts continue to identify clinically applicable biomarkers of disease severity and outcome.
Collapse
Affiliation(s)
- Fabienne Lucas
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Sam Sadigh
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| |
Collapse
|
5
|
Aimo C, Mariotti EB, Corrà A, Quintarelli L, Bianchi B, Verdelli A, Ruffo di Calabria V, Caproni M. Lymphedema of the Arm after COVID-19 Vaccination in a Patient with Hidden Breast Cancer and Paraneoplastic Dermatomyositis. Vaccines (Basel) 2022; 10:vaccines10081219. [PMID: 36016107 PMCID: PMC9416749 DOI: 10.3390/vaccines10081219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 12/17/2022] Open
Abstract
The pandemic outbreak of Coronavirus Disease 2019 (COVID-19) led to the development of mRNA vaccines. With the extensive vaccination campaign performed worldwide, many adverse reactions to these drugs have been reported in the literature. Although most of them are mild and self-limiting, they may sometimes cause psychological stress and require efforts to make a differential diagnosis with other conditions. This is the case of lymphadenopathies and lymphedema in patients with a history of cancer. Herein we present a case of lymphedema of the arm developed ten days after a VAXZEVRIA COVID-19 vaccine shot in a patient who had concomitant signs and symptoms compatible with a diagnosis of dermatomyositis. It was later classified as paraneoplastic as instrumental investigation revealed a breast carcinoma contralateral to the site of vaccine injection. With this report we ponder an adverse reaction to COVID-19 vaccination with the aim of bringing new data for clinicians who face similar clinical presentations, particularly controversial for radiologists and oncologists.
Collapse
Affiliation(s)
- Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
- Correspondence:
| | - Elena Biancamaria Mariotti
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
- Rare Diseases Unit, Azienda USL Toscana Centro, Section of Dermatology, Department of Health Sciences, University of Florence, European Reference Network Skin Member, 50125 Florence, Italy
| | - Beatrice Bianchi
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
| | - Alice Verdelli
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
- Rare Diseases Unit, Azienda USL Toscana Centro, Section of Dermatology, Department of Health Sciences, University of Florence, European Reference Network Skin Member, 50125 Florence, Italy
| | - Valentina Ruffo di Calabria
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
| | - Marzia Caproni
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
- Rare Diseases Unit, Azienda USL Toscana Centro, Section of Dermatology, Department of Health Sciences, University of Florence, European Reference Network Skin Member, 50125 Florence, Italy
| |
Collapse
|