case_images: PMC10682704_01
case_images: Morphology of the COVID-19 vaccination-associated lymphadenopathies (A) Patient 1, showing paracortical hyperplasia and prominence of extrafollicular B-blasts and plasmablasts (H&E, 400x); (B) Patient 2, showing follicular (left) and moncytoid B-cell hyperplasia (right) and presence of extrafollicular B-blasts (bottom right) (H&E, 200x); (C, D) Patient 3, showing extrafollicular B-blasts and plasmablasts, which are polytypic with respect to light chain expression (insert) [C: H&E, 600x, D: Giemsa 600x, insert: immunohistochemistry for Kappa (brown) and Lambda (red) light chains, 650x].
case_images: fimmu-14-1285168-g001.jpg
case_images: PMC10682704_01_fimmu-14-1285168-g001.jpg
case_images: f1
case_images: The axillary lymph nodes were biopsied and showed an increase of polyclonal plasma cells and extrafollicular proliferation of B-blasts/plasmablasts ( Figure 1A ). As symptoms became even more pronounced after receiving the second dose of mRNA-1273 and she developed a bilateral cervical lymphadenopathy, a supraclavicular lymph node excised in a regional (cantonal) hospital in Switzerland showed florid follicular and paracortical hyperplasia with excess of monocytoid B-cells, extrafollicular B-blasts and an increase of plasmacytoid dendritic cells ( Figure 1B ), but no evidence of EBV as assessed by in situ hybridization for EBV small RNA. FDG-PET/CT performed at an university hospital (tertiary care center) in Switzerland showed generalized FDG+ lymphadenopathy and hypermetabolic activity of the spleen ( Supplementary Figure 1 ). Morphologic examination of this lymph node showed florid follicular hyperplasia and extrafollicular B-blasts ( Figures 1C, D ).