Atypical follicular hyperplasia with light chain–restricted germinal centers after COVID-19 booster: a diagnostic pitfall

There has been a surge in COVID-19 vaccine–associated lymphadenopathy (LAD), including after the booster dose of vaccine. This can create diagnostic dilemmas in oncology patients as the relatively sudden LAD can mimic metastasis or cancer recurrence, at a risk of leading to additional but unnecessar...

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Bibliographic Details
Published in:Virchows Archiv : an international journal of pathology 2023-05, Vol.482 (5), p.905-910
Main Authors: Patil, Ashish, Swerdlow, Steven H., Lossos, Izidore S., Chapman, Jennifer R.
Format: Article
Language:English
Subjects:
Biopsy
Breast cancer
Breast Neoplasms - pathology
Brief Report
Cancer
Coronaviruses
COVID-19
COVID-19 - pathology
COVID-19 Testing
COVID-19 vaccines
COVID-19 Vaccines - adverse effects
Diagnostic systems
Drug dosages
Female
Gene amplification
Germinal Center - pathology
Germinal centers
Humans
Hyperplasia
Hyperplasia - pathology
Immunization
Infections
Lymphadenopathy
Lymphadenopathy - pathology
Lymphatic system
Lymphocytes
Lymphoma
Lymphoma, Follicular - pathology
Medical diagnosis
Medicine
Medicine & Public Health
Metastases
Metastasis
Neoplasm Recurrence, Local - pathology
Pathology
Patients
Precancerous Conditions - pathology
Vaccines
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Summary:There has been a surge in COVID-19 vaccine–associated lymphadenopathy (LAD), including after the booster dose of vaccine. This can create diagnostic dilemmas in oncology patients as the relatively sudden LAD can mimic metastasis or cancer recurrence, at a risk of leading to additional but unnecessary anti-neoplastic therapy. Here we report the histopathologic features in a case of persistent LAD occurring in a patient with history of breast invasive ductal carcinoma which followed a COVID-19 vaccine booster. A needle core and then excisional biopsy showed atypical follicular hyperplasia with features that histologically and phenotypically could mimic follicular lymphoma, but the findings were ultimately interpreted to be reactive in nature and related temporally to COVID-19 vaccine. To our knowledge, this is the first case of an atypical lymphoproliferative lesion with features potentially mimicking lymphoma associated with COVID-19 vaccine.
ISSN:0945-6317
1432-2307
DOI:10.1007/s00428-022-03400-w