PMC9377515_01
Photograph of the right temporal mass (red arrows) seen the morning after the patient's first coronavirus disease 2019 vaccination (BNT162b1) (photograph taken by the patient's family member).
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F1
An 80-year-old Japanese woman with a medical history of hypertension, angina pectoris, mitral valve regurgitation, and ovarian tumor resection was referred for further examination of a right temporal mass (Figure 1) that suddenly appeared the morning after she received her first COVID-19 vaccine (BNT162b2) in her left deltoid muscle. The number of swollen submandibular and parotid glands had also increased from 14 glands at the last visit to >22 glands, and the maximum size of the pre-existing lymphadenopathies had enlarged from 7.5 to 13.3 mm (Figures 3E-G). 18F-fluorodeoxyglucose (FDG) positron emission tomography-CT demonstrated abnormal FDG uptake in the mass, right parotid glands, and lymphadenopathies (maximum standardized uptake value, 6.92) (Supplementary Figure 1).
Grayscale (A) and color Doppler (B) images of the right temporal mass showing a uniformly hypoechoic teardrop-shaped mass with well-defined margins (A) and decreased vascularity (B).
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F2
US revealed the size of the mass to be 28.5 x 5.7 mm (Figures 2A,B), and the palpable lymph nodes were <= 10.2 mm in diameter.
Axial computed tomography image obtained at the first visit shows 14 lymphadenopathies, with a maximum diameter <= 7.5 mm (red arrows) in the right parotid region (A), submandibular and jugular regions (B), and supraclavicular region (C). Measurement of the right temporal mass (68.3 x 17.1 mm) on an axial contrast-enhanced computed tomography image 9 weeks after the first visit to our institution (D). The lymphadenopathies (maximum size <= 13.3 mm, yellow arrows) in the right parotid region (E), submandibular and jugular region (F), and supraclavicular region (G).
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F3
CT of the neck, thorax, abdomen, and pelvis revealed 14 lymphadenopathies in the right parotid, submandibular, jugular, and supraclavicular regions, all of which were <= 7.5 mm (Figures 3A-C). The size of the right temporal mass had increased from 28.5 x 5.7 mm to 68.3 x 17.1 mm in 10 weeks (from weeks 6 week 16 after the first vaccination) (Figure 3D). The number of swollen submandibular and parotid glands had also increased from 14 glands at the last visit to >22 glands, and the maximum size of the pre-existing lymphadenopathies had enlarged from 7.5 to 13.3 mm (Figures 3E-G). 18F-fluorodeoxyglucose (FDG) positron emission tomography-CT demonstrated abnormal FDG uptake in the mass, right parotid glands, and lymphadenopathies (maximum standardized uptake value, 6.92) (Supplementary Figure 1).
Hematoxylin and eosin staining of the biopsy specimen showing diffuse proliferation of small- to medium-sized lymphoid cells with slightly enlarged round nuclei (magnification, x 200) (A). Immunohistochemical staining showing lymphoid cells positive for CD20 (x 100) (B) and bcl-2 (x 100) (C) and negative for CD5 (x 100) (D), CD10 (x 100) (E), and cyclin D (x 100) (F).
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Pathological examination showed diffuse proliferation of small- to medium-sized lymphoid cells with slightly enlarged round nuclei (Figure 4A).