Sekizawa Akinori, Hashimoto Kenichi, Kobayashi Shinichi, Kozono Sawako, Kobayashi Takahiro, Kawamura Yusuke, Kimata Motohiro, Fujita Naoya, Ono Yosuke, Obuchi Yasuhiro, Tanaka Yuji
Department of General Medicine, National Defense Medical College, Tokorozawa, Japan.
Department of Hematology, National Defense Medical College, Tokorozawa, Japan.
Front Med (Lausanne). 2022 Aug 1;9:963393. doi: 10.3389/fmed.2022.963393. eCollection 2022.
B-cell lymphomas are neoplastic diseases occasionally associated with chronic inflammation. mRNA vaccines for coronavirus disease 2019 (COVID-19) induce inflammatory responses, which often lead to fever and lymphadenopathies indistinguishable from lymphomas. Although both lymphadenopathies and lymphomas can be influential, the correlation between them is unclear. Herein, we present the first case of marginal zone B-cell lymphoma following mRNA COVID-19 vaccination. An 80-year-old Japanese woman presented with a right temporal mass that appeared the morning after she was administered her first mRNA COVID-19 vaccination (BNT162b2). The mass gradually decreased in size but persisted over 6 weeks after her first vaccination (3 weeks after her second vaccination). At her first visit to our hospital, ultrasound revealed the size of the mass to be 28.5 × 5.7 mm, and computed tomography revealed multiple lymphadenopathies in the right parotid, submandibular, jugular, and supraclavicular regions. Initially, we suspected head-and-neck benign lymphadenopathy as a side effect of vaccination. Nine weeks later, the number of swollen submandibular and parotid glands increased, and the lymph nodes further enlarged. Finally, the right temporal mass was diagnosed as marginal zone B-cell lymphoma based on immunohistochemical and flow cytometry findings of biopsy specimens. Our findings suggest that although 4-6 weeks of observation for lymph node inflammation after the second vaccination is recommended, malignancy should also be considered in the differential diagnosis of lymphadenopathy following vaccination.
B细胞淋巴瘤是偶尔与慢性炎症相关的肿瘤性疾病。2019冠状病毒病（COVID-19）的mRNA疫苗会引发炎症反应，这常常导致发热和淋巴结病，与淋巴瘤难以区分。虽然淋巴结病和淋巴瘤都可能有影响，但它们之间的相关性尚不清楚。在此，我们报告首例mRNA COVID-19疫苗接种后发生的边缘区B细胞淋巴瘤病例。一名80岁的日本女性在接种第一剂mRNA COVID-19疫苗（BNT162b2）后的早晨出现右颞部肿块。肿块大小逐渐减小，但在首次接种后持续了6周（第二次接种后3周）。在她首次就诊于我院时，超声显示肿块大小为28.5×5.7毫米，计算机断层扫描显示右侧腮腺、颌下、颈静脉和锁骨上区域有多处淋巴结病。最初，我们怀疑头颈部良性淋巴结病是疫苗接种的副作用。9周后，颌下腺和腮腺肿大的数量增加，淋巴结进一步肿大。最终，根据活检标本的免疫组织化学和流式细胞术结果，右颞部肿块被诊断为边缘区B细胞淋巴瘤。我们的研究结果表明，虽然建议在第二次接种后对淋巴结炎症进行4至6周的观察，但在接种后淋巴结病的鉴别诊断中也应考虑恶性肿瘤的可能性。
