Taşçı Cengiz, Dirican Ahmet, Sözbilen Ethem Murat, Pehlivan Fatma Seher, Serter Selim
İzmir University of Economics Faculty of Medicine, Medical Point Hospital, Department of Nuclear Medicine, İzmir, Turkey.
İzmir University of Economics Faculty of Medicine, Medical Point Hospital, Department of Medical Oncology, İzmir, Turkey.
Mol Imaging Radionucl Ther. 2023 Jun 20;32(2):181-185. doi: 10.4274/mirt.galenos.2023.82712.
A 42-year-old female patient diagnosed with invasive ductal breast ca underwent F-fluorodeoxyglucose (FDG) positron emission tomography/ computed tomography (PET/CT) scan for staging, 1.5 cm diameter hypermetabolic lesion was observed in the lower inner quadrant of the right breast that was compatible with primary tumor [maximum standardized uptake value (SUV): 10.5]. No pathological F-FDG uptake was observed in lymph nodes whose fatty hilum was seen in the right axilla. However, in the left axilla and left deep axilla, hypermetabolic lymph nodes with a maksimum diameter of 19 mm and fatty hilum were observed (SUV: 8.0). In a detailed CT evaluation, these lymph nodes have thicker walls than the ones in the right axilla. The patient was questioned again and coronavirus disease-2019 (COVID-19) vaccination history (with BNT162b2, COVID-19 mRNA vaccine) was determined that was administrated to the left arm 5 days ago. Tru-cut biopsy was performed from the left aksillary lymph nodes and proved to be reactive lymphoid tissue and there was no primary or metastatic tumor in these axillary lymph node tissues. The patient was given neoadjuvant chemotherapy 4.5 months after the first F-FDG PET/CT, and the second was performed for the treatment response evaluation. Significant regression was determined from the findings. The patient underwent right total mastechtomy. She was being followed up with adjuvant chemotherapy and radiotherapy. In conclusion, hypermetabolic lymph nodes in the axillas should be interrogated for vaccination in patients with breast cancer. Hypermetabolic lymph nodes observed on the same side of the vaccinated arm in the F-FDG PET/CT scan may be related to vaccine-induced reactive lymph node enlargement. Lymph node metastasis may be excluded, especially if there are hypermetabolic lymph nodes with preserved fatty hilum in the contralateral axilla on the same side as the vaccinated arm. Active lymph nodes reactive to the vaccine become inactive after a while.
一名42岁被诊断为浸润性导管癌的女性患者接受了F-氟脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）以进行分期，在右乳房内下象限观察到一个直径1.5厘米的高代谢病灶，与原发性肿瘤相符[最大标准化摄取值（SUV）：10.5]。在右侧腋窝可见脂肪门的淋巴结中未观察到病理性F-FDG摄取。然而，在左侧腋窝和左腋窝深部，观察到最大直径为19毫米且有脂肪门的高代谢淋巴结（SUV：8.0）。在详细的CT评估中，这些淋巴结的壁比右侧腋窝的淋巴结厚。再次询问患者后，确定其有2019冠状病毒病（COVID-19）疫苗接种史（使用BNT162b2，COVID-19信使核糖核酸疫苗），5天前在左臂接种。对左侧腋窝淋巴结进行了粗针穿刺活检，结果证明是反应性淋巴组织，这些腋窝淋巴结组织中没有原发性或转移性肿瘤。在首次F-FDG PET/CT检查4.5个月后，患者接受了新辅助化疗，并进行了第二次检查以评估治疗反应。从检查结果来看有明显的消退。患者接受了右乳全切术。她正在接受辅助化疗和放疗。总之，对于乳腺癌患者，腋窝处的高代谢淋巴结应询问其疫苗接种情况。在F-FDG PET/CT扫描中，在接种疫苗的手臂同侧观察到的高代谢淋巴结可能与疫苗诱导的反应性淋巴结肿大有关。特别是如果在接种疫苗的手臂同侧的对侧腋窝有脂肪门保留的高代谢淋巴结，则可以排除淋巴结转移。对疫苗有反应的活跃淋巴结一段时间后会变得不活跃。
