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Purpose Over 1 billion doses of COVID-19 vaccines have been already administered across the United States, the United Kingdom and the European Union at the time of writing. Furthermore, 1.82 million booster doses have been administered in the US since 13th August, and similar booster programmes are currently planned or under consideration in the UK and the EU beginning in the autumn of 2021. Early reports showed an association between vaccine administration and the development of ipsilateral axillary and supraclavicular lymphadenopathy, which could interfere with the diagnosis, treatment and follow-up of breast cancer patients. In this paper, we review the available evidence on vaccine-related lymphadenopathy, and we discuss the clinical implications of the same on breast cancer diagnosis and management. Methods A literature search was performed - PubMed, Ovid Medline, Scopus, CINHAL, Springer Nature, ScienceDirect, Academic Search Premier and the Directory of Open Access Journals were searched for articles reporting on regional palpable or image-detected lymphadenopathy following COVID-19 vaccination. Separately, we compiled a series of case studies from the University Hospitals of Derby and Burton, United Kingdom and the Mayo Clinic in Minnesota, United States of America, to illustrate the impact that regional lymphadenopathy post-COVID-19 vaccination can have on the diagnosis and management of patients being seen in diagnostic and therapeutic breast clinics. Results From the literature search, 15 studies met the inclusion criteria (n = 2057 patients, 737 with lymphadenopathy). The incidence of lymphadenopathy ranged between 14.5% and 53% and persisted for >6 weeks in 29% of patients. Conclusions Clinicians managing breast cancer patients should be aware that the COVID-19 vaccination may result in regional lymphadenopathy in a significant number of patients, which can result in unnecessary investigations, treatment and increased patient anxiety. An accurate COVID-19 vaccination history should be collected from all patients where regional lymphadenopathy is a clinical and/or an imaging finding and then combined with clinical judgement when managing individual cases.

We present serial sonographic findings of a case of supraclavicular lymphadenopathy that occurred after COVID-19 vaccination. Ipsilateral lymphadenopathy near the vaccine injection site following COVID-19 vaccination is a rather uncommon but expected adverse reaction. While axillary lymphadenopathy is more common, cases of supraclavicular lymphadenopathy in the setting of recent vaccination against COVID-19 are also being reported. Radiologists as well as referring physicians should be aware of this self-limiting process along with its ultrasonographic features and manage patients conservatively rather than performing an unnecessary immediate biopsy.

Hodgkin lymphoma (HL) is a great mimicker of a variety of pathologies 1. In the hands of an experienced oncologist the diagnosis of HL is straightforward. HL usually presents with involvement of cervical or supraclavicular lymphadenopathy that are easily palpable on physical exam in 60–70% of the cases. Almost two thirds of patients with newly diagnosed HL have evidence of mediastinal adenopathy. The association of systemic symptoms like fever, night sweats or weight loss is also common. Here we present a case series of patients whose clinical presentation and lack of superficial palpable adenopathy lead to suspect a diagnosis different from HL.

Kikuchi-Fujimoto Disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare cause of cervical lymphadenopathy. Patients usually present with localized lymphadenopathy, fever and fatigue. Because of the poorly understood etiology, it can be mistaken for an infectious disease or even malignance. Here we discuss a case of KFD that initially presented with left sided cervical lymphadenopathy that later progressed to left supraclavicular lymph nodes. Due to its characteristic overlap with other disorders like tuberculous lymphadenitis and lymphoma, KFD remains an arduous diagnosis for physicians. Therefore, one should be made aware of symptoms that can lead to misdiagnosis in patients.

The first COVID-19 vaccination was given in December 2020 and there is an effort to vaccinate the international population on a massive scale. Common side effects from the vaccine include headache and tiredness. Regional lymphadenopathy has been described in relation to other vaccines. We describe two cases of supraclavicular reactive lymphadenopathy presenting in patients who had the COVID vaccination in the ipsilateral arm. Awareness of this diagnosis is important for patients presenting to the neck lump clinic.

Monitoring adverse reactions following immunisation is essential, particularly for new vaccines such as those against COVID-19. We describe 20 cases of acute onset of a single supraclavicular lymphadenopathy manifesting between 24 h and 9 days after ipsilateral intramuscular administration of an mRNA-based COVID-19 vaccine, referred to our WHO Collaborating Centre for Vaccine Safety. Our results indicate that the swelling of supraclavicular lymph nodes following immunisation may constitute a benign and self-limited condition, related to a higher than recommended injection site.

We report herein the case of a 33-year-old woman who was referred for FDG PET/CT staging prior to pregnancy after a 4-year lost to follow-up for a breast invasive ductal carcinoma (pT2N1 SBRII). FDG PET/CT revealed right supraclavicular lymphadenopathy potentially caused by breast carcinoma recurrence. No additional site was involved. Supraclavicular ultrasonography showed typical "snowstorm" appearance. MRI revealed signs of breast implant intracapsular rupture and signal intensity of silicone within a supraclavicular node. Fine-needle aspiration and microbiopsy of adenopathy finally confirmed silicone granuloma and ruled out breast cancer recurrence.

BACKGROUND Lymphadenopathy especially in the supraclavicular region is often associated with an underlying pathology. Fine needle aspiration cytology of lymph nodes is a cost effective and simple procedure that can be carried out in the outpatient department itself which helps in deciding the management. MATERIALS AND METHODS The study was done in Department of Pathology, Govt. Medical College, Kozhikode. Data of past 3 years (January 2014 - December 2016) was retrieved from records of the pathology department and reviewed. Relevant history, clinical examination findings and investigations were documented. Aspiration was done routinely using 23 gauge needle and smears wet fixed in isopropyl alcohol and Papanicolaou staining was done. Cases in which aspirate was inadequate were excluded from the study. The cases were broadly divided into following groups, viz., reactive lymphoid hyperplasia, acute suppurative lymphadenitis, granulomatous lymphadenitis, metastatic malignancy, lymphoma and miscellaneous cases. RESULTS A total number of 724 cases were included in the study, males constituted 66% and females 34%. Metastatic malignancy constituting 65% was the commonest cause of lymph node enlargement, followed by reactive hyperplasia 22%. Granulomatous lymphadenitis was diagnosed in 64 cases (8.8%). Rest of the causes like lymphoma, suppurative and non-specific causes constituted only a minor category. Most common site of lymphadenopathy was left side, constituting 59.4%. Metastatic malignancy was the commonest cause of supraclavicular enlargement in the age group of 40-80 yrs. On analyzing histopathology adenocarcinoma was the most common type in this study constituting 55% followed by squamous cell carcinoma in 27%. Approximately 11% were metastasis from small cell carcinoma and 5% from poorly differentiated carcinoma. In metastatic adenocarcinoma, the most common primary site was lung, constituting 54.2%. CONCLUSION Supraclavicular lymphadenopathy is most often associated with an underlying pathology and it has to be evaluated especially in the elderly. FNAC is a cheap and reliable diagnostic tool in the initial evaluation as well as follow up of patients attending outpatient department and provides valuable information that helps in treating patients.

Key Clinical Message Prostate cancer typically presents with osteoblastic metastases; however, patients with prostate cancer may have osteolytic metastases, as seen in this case. Patients with osteolytic metastases require a thorough evaluation to rule out malignancies including multiple myeloma, but prostate cancer is a very important differential diagnosis.

Prostate cancer usually metastasis to the regional lymph nodes and can rarely metastases to nonregional supradiaphragmatic lymph nodes. Cervical lymph node metastasis of prostate cancer is extremely rare. However, it should be considered in the differential diagnosis of cervical lymphadenopathy in male patients with adenocarcinoma of unknown primary site. In this report we present a rare case of metastatic prostate adenocarcinoma with left supraclavicular lymphadenopathy as the only clinical presentation with no other evidence of metastasis to the regional lymph nodes or bone metastasis.

Rapid on-site evaluation (ROSE) with routine fine-needle aspiration cytology (FNAC) is a simple, economical, highly accurate tool in the diagnosis of tuberculous lesions. The sample collected can be used for ancillary studies, i.e., Ziehl–Neelsen stain, Cartridge-based nuclei acid amplification testing (CB-NAAT) and bacterial culture for confirmation of the tubercular species. We report a case of a 31-year-old male who presented with left supraclavicular lymphadenopathy. ROSE with FNAC helped in the diagnosis of the patient. FNAC is a rapid minimally invasive method for the early detection of tubercular lesions and helps in proper treatment.

A 63-year-old male presented with complaints of an enlarging left supraclavicular mass and weight loss. Computed tomography demonstrated a large retroperitoneal mass causing displacement of the adjacent organs, and moderate left hydroureteronephrosis. Multiple pulmonary nodules, lytic spinal lesions, and generalized lymphadenopathy including the left supraclavicular region were seen. Serum prostate-specific antigen level was 2064.0 ng/mL. Digital rectal exam revealed an enlarged prostate without nodularity. Biopsy of the supraclavicular node demonstrated prostatic adenocarcinoma. The diagnosis of lymphoma may be initially suggested, however, prostatic origin should be considered even when the prostate exam is not grossly abnormal.

a Department of Obstetrics and Gynecology, Zeynep Kamil Education and Research Hospital, Istanbul, Turkey b Department of Pathology, Zeynep Kamil Education and Research Hospital, Istanbul, Turkey c Department of Obstetrics and Gynecology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey d Department of Obstetrics and Gynecology, Suleymaniye Education and Research Hospital, Istanbul, Turkey

[Figure][1] An 18-year-old man presented with a 2-month history of unintentional 23-kg weight loss, night sweats, and left-sided neck swelling. Physical examination revealed left supraclavicular lymphadenopathy. A complete blood count was within normal limits (white blood cells, 6.6 × 109/L

Background: In this study, we aimed to determine the correlation between supraclavicular lymph node involvement (SLNI) and metastatic potential, frequency, and metastases predilection sites in patients diagnosed with various head and neck tumors (HNT) and staged via positron emission tomography/computed tomography (PET/CT) imaging. We also investigated the impact of different variables on SLNI. Patients and Methods: 270 patients diagnosed with HNT were enrolled in the study (194 males and 96 females, mean age 54.9 ± 14.7 years (range 18-89 years)). Results: Nasopharyngeal carcinoma demonstrated significant SLNI (p < 0.01); however, other subtypes of HNT did not. In all HNT studied, no apparent metastatic predilection tendency for the supraclavicular region was observed, as opposed to the well-described Virchow's node. Age, gender, tumor size, and systemic metastases were not identified as statistically significant variables contributing to SLNI. Multivariate regression analysis revealed an increased cervical (p < 0.01) and thoracic (p = 0.001) lymph node involvement in patients with SLNI. Conclusion: SLNI with the possibility of metastasis was more frequently observed in nasopharyngeal carcinoma, advancing the nodal status without significantly influencing the T and M stages. A careful evaluation of this very small region is of critical importance for proper nodal staging in nasopharyngeal cancer patients.

Carcinoma of the cervix has been considered as a preventable disease. However, it continues to be a significant health problem worldwide and is the second most frequent cause of cancer death among women in developing countries. It rarely metastasizes to the supraclavicular group of lymph nodes during the initial presentation, and few cases have been reported in the literature. Here, we report a case of cervical carcinoma in a 40-year-female with unusual manifestation at the time of initial presentation. The patient was diagnosed with squamous cell carcinoma of the cervix with supraclavicular lymph node metastatic FIGO Clinical Stage IVB and treated in the line of concurrent chemoradiotherapy followed by adjuvant chemotherapy. The patient is reported to be disease-free after 1 year of completion of therapy.

RESUMO: A neoplasia da próstata na sua forma avançada tem geralmente metastização óssea ou para gânglios pélvicos. O envolvimento de gânglios supraclaviculares é raro (0,4-1% de todos os casos) [1] e a sua apresentação como adenopatia supraclavicular é ainda mais rara, com apenas alguns casos descritos na literatura [2,3]. Neste contexto, apresentamos o caso de um homem de 62 anos, saudável, com tumefação de novo na fossa supraclavicular esquerda, sem sintomas associados. Após a investigação estabeleceu-se o diagnóstico de adenocarcinoma da próstata em fase avançada, com metastização disseminada. Alertamos para uma forma rara de apresentação de adenocarcinoma da próstata e discutimos a abordagem diagnóstica em casos de adenopatias isoladas. ABSTRACT: Prostate cancer in its advanced form usually metastasizes to the bone or pelvic ganglia. The involvement of the supraclavicular lymph nodes is rare (0.4% to 1% of all cases)1. Its presentation as a supraclavicular lymphadenopathy is even more unusual with only a few cases described in the literature2-7. In this context, we describe the case of a 62 year old man presenting with a left supraclavicular mass without any other signs or associated symptoms. After all the workup, we established the diagnosis of widely metastasized prostate adenocarcinoma. We bring forward this case as an example of a rare form of presentation of prostate cancer and we use it as a base for discussing an approach to isolated peripheral lymphadenopathy.

A previously healthy 31-year-old man was seen at our institution for evaluation of severe fatigue, night sweats, and supraclavicular lymphadenopathy. About 9 months earlier, he experienced symptoms...

A 26-year-old woman developed significant unilateral anterior cervical and supraclavicular lymphadenopathy 3 days after receiving her first dose (of a total of three doses) of human papilloma virus (HPV) vaccine. She had no history of lymphadenopathy after other previous immunizations, and had received no vaccines other than HPV at that time. The left-sided lymphadenopathy developed after she was vaccinated in the left deltoid muscle. The spatial and temporal relationships between the appearance of the lymphadenopathy and receipt of the vaccine in the absence of other causal agents strongly suggest that the HPV vaccine was the causal agent. Use of the Naranjo adverse drug reaction probability scale indicated that the HPV vaccine was a probable (score of 6) cause of the patient's adverse reaction. The patient received her second dose of the HPV vaccine 2 months later without further lymphadenopathy. To prevent unnecessary lymph node biopsies and patient concern, clinicians should be aware that lymphadenopathy may occur after HPV vaccination.

SUMMARY A 34-year-old female who had supraclavicular lymphadenopathy applied to our clinic. Pathological examination of the lymph node excised via biopsy was reported as Kikuchi-Fujimoto disease (KFD) also called histiocytic necrotising lymphadenitis. The clinical course was self limited with lymph node excision and nonsteroid anti-inflammatory drugs. Spontaneous resolution was seen within two months as reported in the literature. KFD’s etiology is unknown and it is one of the reasons of benign lymphadenopathy. It is important because of the possibility of misdiagnosis with many diseases including lymphoma.

WOS: 000305856300009, PubMed: 23788855, Clinical examination is very important in the practice of medicine. In patients presenting with a supraclavicular mass, a number of diseases including cancer should be ruled out. Two patients who presented with a bulky left supraclavicular mass were evaluated. Their medical history revealed complaints attributed to lower urinary tract infection. We performed histopathological examination of the lymph nodes with radiological evaluation of the thorax and abdomen. The final diagnoses were prostate cancer in both patients. It should always be kept in mind that prostate cancer is the most frequent cancer in elderly men, and although very unusual, the presenting finding can be cervical or supraclavicular lymphadenopathy; thus clinicians should be aware of urological examinations in such cases.

China is a country with a low morbidity of prostate carcinoma. The incidence of prostate carcinoma in China is 1.6/100,000, which is much lower than the rate in the United States, i.e., 119.9/100,000 [1]. Due to changes of lifestyle and improved measurement of serum prostate specifi c antigen (PSA) over the past decades, the incidence of prostate carcinoma in China also showed a yearly increase. However, the misdiagnosis and mistreatment of this disease commonly occur. The aim of this study is to report the case of a patient with prostate carcinoma presenting asymptomatic but with left supraclavicular lymphadenopathy, and analyze the reasons of misdiagnosis and mistreatment.

[Figure][1] A 91-year-old woman was found to have bilateral cervical and right supraclavicular lymphadenopathy by computed tomography scan following an accident. There was no M-paraprotein in serum and there were no lytic bone lesions. Fine needle aspiration of the right cervical lymph node

A 60-year-old man presented with a six-week history of fever, weight loss, anorexia and cough, with no dyspnoea or hemoptysis. He was previously healthy, and had no contact history for tuberculosis. He was febrile (39°C) and tachycardic (110 beats/min), with bilateral supraclavicular lymphadenopathy (2–3 cm in diameter) and distended neck veins. Erythrocyte sedimentation rate (ESR) was 118 mm/h, hemoglobin 11.5 g/dl, WBC 9.8 × 109/l, …

Kikuchis-Fujimoto's is a benign, self-limiting, cervical lymphadenitis, fine-needle aspiration cytology (FNAC) plays a very important role in the diagnosis and management of these patients. We present a case of 30-year-old female presenting with supraclavicular lymphadenopathy and fever, diagnosed as Kikuchis-Fujimoto's lymphadenitis on FNAC with no recurrence or development of Lupus lymphadenitis even after 1-year of follow-up. Although Kikuchis-Fujimoto's is a rare cause of lymphadenopathy, FNAC is an important tool in diagnosing this entity and differentiating from tubercular lymphadenitis and Lupus adenitis. Presence of cresentric nucleated histiocytes engulfed karryorrhectic debris and monocytoid cells aids in the diagnosing. A definitive diagnosis made on FNAC can avoid biopsy and unnecessary diagnostic and therapeutic interventions in these patients. However, a look out for recurrence and development of Lupus with regular followup and serological examination is imperative.

A 67-year-old male presented with supraclavicular lymphadenopathy. Morphological and immunohistochemical findings in the excised lymph node were interpreted as those of a B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma, with MYC protein and BCL2 protein coexpression. Fluorescence in situ hybridisation of formalin fixed, paraffin embedded tissue confirmed the presence of both IGH/MYC and BCL2 rearrangement, consistent with a so-called ‘double hit' lymphoma.

A 26-year-old woman presented with high fever, marked supraclavicular lymphadenopathy, and morbilliform eruptions and was diagnosed with Kikuchi's disease (KD) based on pathologic findings from biopsied lymph nodes. All her manifestations of KD improved, however, without any specific treatment. The picture of transient morbilliform eruptions typified in KD here is seldom shown in the literature. In general, KD would run a benign course of supraclavicular lymphadenopathy.

Two patients, one with previously undiagnosed liver disease, presenting with right supraclavicular lymphadenopathy were subsequently diagnosed with hepatocellular carcinoma. This presentation has only been previously described once, and the mechanism of this unusual presentation is discussed.