Coronavirus disease 2019 vaccine mimics lymph node metastases in patients undergoing skin cancer follow-up: A monocentre study

Abstract

Introduction The Covid-19 pandemic has changed the lives of people around the world. Fortunately, sufficient vaccines are now available. Local reactions with ipsilateral lymphadenopathy are among the most common side effects. We investigated the impact of lymphadenopathy after Covid-19 vaccination on the value of ultrasound in tumor patients. Patients and methods Patients with melanoma or merkel cell carcinoma were included who underwent lymph node excision and received Covid-19 vaccination within 6 weeks before surgery. The consistency of the preoperative ultrasound findings with the histopathologic findings was investigated. Results Eight patients were included (two Merkel cell carcinoma and six melanoma patients) who underwent lymph node excision between April 16, 2021, and May 19, 2021, and had previously received Covid-19 vaccination. In three of the eight patients (one Merkel cell carcinoma and two melanoma patients), lymph node metastases were erroneously diagnosed preoperatively during tumor follow-up with physical examination, ultrasound, and or FDG PET/CT. In these three patients, the suspected lymph node metastases were located in the left axilla after Covid19 vaccination in the left upper arm, which resulted in selective lymph node removal in two patients and complete lymphadenectomy in one patient. Conclusion Covid-19 vaccine-associated lymphadenopathy is expected to be observed much more frequently in the near future due to increasing vaccination rates. This cause of lymphadenopathy, which may in ultrasound as well as in FDG PET/CT resemble lymph node metastases, must be considered, especially in oncologic patients undergoing tumor follow-up. In addition, Covid-19 vaccination should be given as far away as possible from an underlying primary on the contralateral side to avoid oncologic misdiagnosis followed by malpractice.

Lymphadenopathy post‐COVID‐19 vaccination with increased FDG uptake may be falsely attributed to oncological disorders: A systematic review

“… 53 Furthermore, 18 cases who developed lymphadenopathy following COVID‐19 vaccination conducted different tests such as FDG‐PET‐CT scan, MRI, US, and/or FNA biopsy without having any malignancies. 21 , 22 , 28 , 33 , 34 , 37 , 49 In a recent study, Placke et al, 67 reported 8 patients (with melanoma or Merkel cell carcinoma) who were misdiagnosed with lymph nodes metastases and underwent lymph node excision following COVID‐19 vaccination. 68 Therefore, care must be taken before suspecting lymph node metastasis or deciding for lymphadenectomy following COVID‐19 vaccination.…”

Kikuchi–Fujimoto Disease Post COVID-19 Vaccination: Case Report and Review of Literature

“…KFD very uncommonly occurs following vaccination, with only rare reports in the literature describing its occurrence after influenza vaccination [7], human papillomavirus vaccination and Japanese encephalitis virus vaccination [8]. A literature search yielded only one case report of KFD following COVID-19 vaccination at the time of writing [3], with many other papers describing cytologic or histologic findings of reactive follicular hyperplasia or reactive lymphadenopathy [9][10][11][12][13][14]. Table 1 details the key features of published cases of lymphadenopathy post COVID-19 vaccination, which also had cytologic and/or histologic follow-up.…”

FDG PET/CT radiomics as a tool to differentiate between reactive axillary lymphadenopathy following COVID-19 vaccination and metastatic breast cancer axillary lymphadenopathy: a pilot study

“…Unfortunately, to date, no studies have examined lymph nodes histologically after COVID-19 mRNA vaccination in such a way that would have allowed conclusions to be drawn; however, Placke et al reported a lymph node dissection due to suspected malignancy in a patient who received a COVID-19 vaccine. Only marked follicular hyperplasia was found [ 31 ]. In this type of reaction, the lymph node follicles enlarge at the expense of other nodal structures and therefore, the lymph node becomes relatively more homogenous.…”