Axillary lymphangioma that developed following COVID-19 vaccination: a case report.

BACKGROUND: Extensive vaccination programs are being implemented worldwide for coronavirus disease 2019 (COVID-19). With the spread of vaccination, swelling of the lymph nodes after vaccination is frequently seen. We encountered a patient who developed left axillary lymphadenoma following vaccine administration. CASE PRESENTATION: The patient was a Japanese woman in her 80 s who had previously undergone surgery for right breast cancer. She received two injections of the Pfizer-BioNTech COVID-19 vaccine in her left arm. Approximately 3 months later, she complained of left axillary swelling, and imaging resulted in a diagnosis of left axillary lymphangioma. In accordance with the patient's wishes, we performed axillary mass resection. The pathological diagnosis was lymphangioma. CONCLUSION: Our examination findings indicated that congestion of the axillary lymph vessels might have been caused by upper-arm injections of the COVID-19 vaccine.

Clinical efficacy and problems with CT lymphography in identifying the sentinel node in breast cancer.

BACKGROUND: Combining a radioisotope with a dye-guided method is the best method for identification of the sentinel lymph nodes (SNs) in breast cancer. However, some institutions are limited to use of a dye-guided method alone. Recently, computed tomographic lymphography (CTLG) employing a nonionic contrast medium has achieved SN identification. PATIENTS AND METHODS: 218 patients with primary breast cancer and no clinical evidence of lymph node metastasis were studied. SN identification was performed by CTLG and a dye-guided method. The SN identification rate was analyzed for correlations with the clinicopathological findings. RESULTS: The SN identification rates were 96% with CTLG, 92% with the dye-guided method and 99% with both methods combined. The identification rates with CTLG and the combined method were significantly lower in node-positive patients compared to node-negative patients, and significantly lower with the combined method in vascular invasion-positive patients compared to negative patients. In addition, the SN identification rate with the dye-guided method was significantly lower in patients with a body mass index (BMI) of > or = 25, whereas the BMI did not affect the identification rate with CTLG or the combined method. Multiple SNs were detected in approximately 20% of the patients. CONCLUSION: Combined performance of CTLG and a dye-guided method enables identification of SNs prior to breast cancer surgery. That SN identification is easier compared with by the dye-guided method alone, and the identification rate is improved compared with either method alone. The combination of methods was especially useful in obese patients. For patients with multiple SNs, the combination has the further advantage of enabling accurate SN biopsy. CTLG may yield false-negative findings in node-positive patients and patients with lymph vessel obstruction.

3-dimensional computed tomography lymphography-guided identification of sentinel lymph nodes in breast cancer patients using subcutaneous injection of nonionic contrast medium: a clinical trial.

OBJECTIVE: Simple and reliable identification methods for sentinel lymph nodes (SLNs) which do not use radioisotope are essential for early breast cancer patients in community hospitals in Japan. The purpose of this paper is to demonstrate the feasibility and efficacy of computed tomography (CT) lymphography for SLN detection. METHODS: The study included 15 cases with T1 or T2 breast cancer. After subcutaneous injection of 1 mL of iopamidol in 1 subareolar area of the affected breast, CT scanning was carried out and 3-dimensional (3D) CT images were created. SLNs predicted from images and CT values were assessed as to whether they were identical to those identified by the dye method. RESULTS: An enhanced lymph vessel draining into SLN was demonstrated in 11 cases (73%) and an enhanced SLN in 10 cases (67%). 3D images clearly revealed the anatomic relationship between lymph vessels, SLN, and the surrounding structures. In addition, SLN could be predicted by the change of CT value in the time-course in another case. In total, SLN in 13 cases (87%) could be predicted. All SLNs suggested from CT lymphography were identified by the dye method. No significant adverse effect was noted in any case. CONCLUSIONS: The present clinical trial indicated that subcutaneous injection of nonionic contrast medium with CT scanning seems to be a promising method for the demonstration of a draining lymph vessel and SLN. The CT value time-course may also provide some important information. Further trials will be needed for the successful establishment of this CT lymphography-guided method for SLN identification.

Axillary 3D CT imaging with lymphoscintigraphy is useful for sentinel node biopsy in breast cancer.

BACKGROUND: This study examined whether 3D CT imaging with lymphoscintigraphy (LSG) is useful when performing sentinel node biopsy (SNB) in a community hospital where radioisotope with gamma-probe (RI method) is unavailable. MATERIALS AND METHODS: From June to November 2002, 35 T1/T2 clinically node-negative breast cancer patients underwent LSG in a university nuclear medicine department. Skin areas above LSG hot spots were marked, helical CT scanning was performed and axillary 3D images were created in our hospital. The SLN predicted from the 3D images were examined for agreement with the dye method. RESULTS: SLNs were detected with dye in 32 out of 35 patients (91.4%). In 31 of those 32 (96.9%), the SLN predicted from 3D CT images was the same. Even in the 3 dye-negative patients, CT imaging predicted the SLN. SNB including sampling was successful in 34 patients (97.1%). CONCLUSION: 3D CT imaging with LSG enables SNB even if the RI method is impossible.