{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:05:25Z","timestamp":1789538725857,"version":"build-2803163510"},"reference-count":64,"publisher":"Societatea Romana de Morfologie","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rom J Morphol Embryol"],"published-print":{"date-parts":[[2026,9,15]]},"abstract":"<jats:p>Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related immune dysregulation has generated interest in diagnostic pathology because infection-related inflammation, long coronavirus disease (COVID)-related immune disturbance, and post-vaccination lymphoid reactions may overlap with lymphoid-biological mechanisms and complicate the distinction between reactive lymphoid proliferations and lymphoid neoplasia. Aim: This scoping review aimed to map biologically plausible pathways through which SARS-CoV-2-associated immune perturbation may intersect with lymphomagenesis-related mechanisms, emphasizing diagnostic implications rather than causality. Materials and Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed\/MEDLINE, Scopus, and Web of Science were searched from January 2020 to March 2026, with selected pre-2020 sources retained for mechanistic or diagnostic relevance. Sources were charted across mechanistic, immunological, virological, clinicopathological, and diagnostic domains. Results: After screening and eligibility assessment, 63 sources were retained for thematic synthesis. Evidence clustered around lymphoma-relevant but non-specific mechanisms, including inflammatory signaling, impaired immune surveillance, latent oncogenic viral reactivation, prolonged germinal-center activity with activation-induced cytidine deaminase (AID)-related genomic vulnerability, and lymphoid microenvironment remodeling. These mechanisms appear most relevant in predisposed hosts with chronic immune dysregulation, latent viral infection, defective deoxyribonucleic acid (DNA) repair, or occult abnormal lymphoid clones. Infection and vaccination are distinct contexts, because infection may produce broader immune disruption, whereas most post-vaccination nodal events are reactive and self-limited. Conclusions: Current evidence supports biological plausibility rather than a direct or generalizable causal relationship. The main diagnostic implication is careful clinicopathological correlation and distinction between reactive lymphoid proliferations and lymphoid neoplasia in post-COVID-19 and post-vaccination settings.<\/jats:p>","DOI":"10.47162\/rjme.67.2.02","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:08:14Z","timestamp":1789495694000},"page":"213-224","source":"Crossref","is-referenced-by-count":0,"title":["SARS-CoV-2-related immune dysregulation and biologically plausible pathways to lymphomagenesis: a PRISMA-ScR-based scoping review"],"prefix":"10.47162","volume":"67","author":[{"name":"Department of Pathology, Emergency County Clinical Hospital, Sibiu, Romania; Doctoral School of Medicine, Institute for the Organization of Doctoral and Postdoctoral Studies, Lucian Blaga University of Sibiu, Romania","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul-C\u0103t\u0103lin","family":"Toboltoc","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adela","family":"Vekony","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Pathology, Emergency County Clinical Hospital, Sibiu, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"Gagiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Pathology, Emergency County Clinical Hospital, Sibiu, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"26736","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"\"[1] Wasik MA, Kim PM, Nejati R. Diverse and reprogrammable mechanisms of malignant cell transformation in lymphocytes: pathogenetic insights and translational implications. Front Oncol, 2024, 14:1383741. https:\/\/doi.org\/10.3389\/fonc.2024.1383741","DOI":"10.3389\/fonc.2024.1383741"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"[2] Ganapathi KA, Pittaluga S, Odejide OO, Freedman AS, Jaffe ES. Early lymphoid lesions: conceptual, diagnostic and clinical challenges. Haematologica, 2014, 99(9):1421-1432. https:\/\/doi.org\/10.3324\/haematol.2014.107938","DOI":"10.3324\/haematol.2014.107938"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"[3] Gergely L, Udvardy M, Illes A. The possible role of pathogens and chronic immune stimulation in the development of diffuse large B-cell lymphoma. Biomedicines, 2024, 12(3):648. https:\/\/doi.org\/10.3390\/biomedicines12030648","DOI":"10.3390\/biomedicines12030648"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"[4] Thurner L, Hartmann S, Neumann F, Hoth M, Stilgenbauer S, K\u00fcppers R, Preuss KD, Bewarder M. Role of specific B-cell receptor antigens in lymphomagenesis. Front Oncol, 2020, 10:604685. https:\/\/doi.org\/10.3389\/fonc.2020.604685","DOI":"10.3389\/fonc.2020.604685"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"[5] Thieblemont C, Bertoni F, Copie-Bergman C, Ferreri AJM, Ponzoni M. Chronic inflammation and extra-nodal marginal-zone lymphomas of MALT-type. Semin Cancer Biol, 2014, 24:33-42. https:\/\/doi.org\/10.1016\/j.semcancer.2013.11.005","DOI":"10.1016\/j.semcancer.2013.11.005"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"[6] Phetsouphanh C, Darley DR, Wilson DB, Howe A, Munier CML, Patel SK, Juno JA, Burrell LM, Kent SJ, Dore GJ, Kelleher AD, Matthews GV. Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection. Nat Immunol, 2022, 23(2):210-216. https:\/\/doi.org\/10.1038\/s41590-021-01113-x","DOI":"10.1038\/s41590-021-01113-x"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"[7] Peluso MJ, Abdel-Mohsen M, Henrich TJ, Roan NR. Systems analysis of innate and adaptive immunity in long COVID. Semin Immunol, 2024, 72:101873. https:\/\/doi.org\/10.1016\/j.smim.2024.101873","DOI":"10.1016\/j.smim.2024.101873"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"[8] Aid M, Boero-Teyssier V, McMahan K, Dang R, Doyle M, Belabbaci N, Borducchi E, Collier AY, Mullington J, Barouch DH. Long COVID involves activation of proinflammatory and immune exhaustion pathways. Nat Immunol, 2026, 27(1):61-71. https:\/\/doi.org\/10.1038\/s41590-025-02353-x","DOI":"10.1038\/s41590-025-02353-x"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"[9] Miao Y, Medeiros LJ, Xu-Monette ZY, Li J, Young KH. Dysregulation of cell survival in diffuse large B cell lymphoma: mechanisms and therapeutic targets. Front Oncol, 2019, 9:107. https:\/\/doi.org\/10.3389\/fonc.2019.00107","DOI":"10.3389\/fonc.2019.00107"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"[10] Kolijn PM, Langerak AW. Immune dysregulation as a leading principle for lymphoma development in diverse immunological backgrounds. Immunol Lett, 2023, 263:46-59. https:\/\/doi.org\/10.1016\/j.imlet.2023.08.007","DOI":"10.1016\/j.imlet.2023.08.007"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"[11] Frederiksen LSF, Zhang Y, Foged C, Thakur A. The long road toward COVID-19 herd immunity: vaccine platform technologies and mass immunization strategies. Front Immunol, 2020, 11:1817. https:\/\/doi.org\/10.3389\/fimmu.2020.01817","DOI":"10.3389\/fimmu.2020.01817"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"[12] Turner JS, O'Halloran JA, Kalaidina E, Kim W, Schmitz AJ, Zhou JQ, Lei T, Thapa M, Chen RE, Case JB, Amanat F, Rauseo AM, Haile A, Xie X, Klebert MK, Suessen T, Middleton WD, Shi PY, Krammer F, Teefey SA, Diamond MS, Presti RM, Ellebedy AH. SARS-CoV-2 mRNA vaccines induce persistent human germinal centre responses. Nature, 2021, 596(7870):109-113. https:\/\/doi.org\/10.1038\/s41586-021-03738-2","DOI":"10.1038\/s41586-021-03738-2"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"[13] Kim W. Germinal center response to mRNA vaccination and impact of immunological imprinting on subsequent vaccination. Immune Netw, 2024, 24(4):e28. https:\/\/doi.org\/10.4110\/in.2024.24.e28","DOI":"10.4110\/in.2024.24.e28"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"[14] Gelmez MY, Oktelik FB, Tahrali I, Yilmaz V, Kucuksezer UC, Akdeniz N, Cetin EA, Kose M, Cinar C, Oguz FS, Besisik S, Koksalan K, Ozdemir O, Senkal N, Gul A, Tuzun E, Deniz G. Immune modulation as a consequence of SARS-CoV-2 infection. Front Immunol, 2022, 13:954391. https:\/\/doi.org\/10.3389\/fimmu.2022.954391","DOI":"10.3389\/fimmu.2022.954391"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"[15] Eskandarian Boroujeni M, Sekrecka A, Antonczyk A, Hassani S, Sekrecki M, Nowicka H, Lopacinska N, Olya A, Kluzek K, Wesoly J, Bluyssen HAR. Dysregulated interferon response and immune hyperactivation in severe COVID-19: targeting STATs as a novel therapeutic strategy. Front Immunol, 2022, 13:888897. https:\/\/doi.org\/10.3389\/fimmu.2022.888897","DOI":"10.3389\/fimmu.2022.888897"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"[16] Sara M, Minelli C, Broccia G, Vineis P, Cocco P. COVID-19 and non-Hodgkin's lymphoma: a common susceptibility pattern? PLoS One, 2023, 18(3):e0277588. https:\/\/doi.org\/10.1371\/journal.pone.0277588","DOI":"10.1371\/journal.pone.0277588"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"[17] Claa\u00df LV, Mayr P, Paschold L, Weber T, Terziev D, Jehs B, Brill R, Dober J, M\u00e4rkl B, Wickenhauser C, Czapiewski P, Trepel M, Claus R, Binder M. No association of malignant B-cell non-Hodgkin lymphomas with ipsilateral SARS-CoV-2 vaccination. Cancer Med, 2023, 12(8):9313-9321. https:\/\/doi.org\/10.1002\/cam4.5687","DOI":"10.1002\/cam4.5687"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"[18] Chen C, Guo W, Zhao Y, Wang X, Li J, Zhang Y, Li Z, Wang H, Bai O. Autoimmune disease-associated lymphomas: research progress and review. Front Immunol, 2026, 16:1719391. https:\/\/doi.org\/10.3389\/fimmu.2025.1719391","DOI":"10.3389\/fimmu.2025.1719391"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"[19] Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tun\u00e7alp \u00d6, Straus SE. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med, 2018, 169(7):467-473. https:\/\/doi.org\/10.7326\/M18-0850","DOI":"10.7326\/M18-0850"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"[20] Apollonio B, Ioannou N, Papazoglou D, Ramsay AG. Understanding the immune-stroma microenvironment in B-cell malignancies for effective immunotherapy. Front Oncol, 2021, 11:626818. https:\/\/doi.org\/10.3389\/fonc.2021.626818","DOI":"10.3389\/fonc.2021.626818"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"[21] Verdi\u00e8re L, Mourcin F, Tarte K. Microenvironment signaling driving lymphomagenesis. Curr Opin Hematol, 2018, 25(4):335-345. https:\/\/doi.org\/10.1097\/moh.0000000000000440","DOI":"10.1097\/MOH.0000000000000440"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"[22] Sausen DG, Poirier MC, Spiers LM, Smith EN. Mechanisms of T-cell evasion by Epstein-Barr virus and implications for tumor survival. Front Immunol, 2023, 14:1289313. https:\/\/doi.org\/10.3389\/fimmu.2023.1289313","DOI":"10.3389\/fimmu.2023.1289313"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"[23] Luxenburger H, Thimme R, Hofmann M. T cell adaptation in chronic infections and tumors. Cell Mol Immunol, 2026, 23(5):440-456. https:\/\/doi.org\/10.1038\/s41423-026-01405-y","DOI":"10.1038\/s41423-026-01405-y"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"[24] Chahwan R, Edelmann W, Scharff MD, Roa S. AIDing antibody diversity by error-prone mismatch repair. Semin Immunol, 2012, 24(4):293-300. https:\/\/doi.org\/10.1016\/j.smim.2012.05.005","DOI":"10.1016\/j.smim.2012.05.005"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"[25] Victora GD, Nussenzweig MC. Germinal centers. Annu Rev Immunol, 2012, 30:429-457. https:\/\/doi.org\/10.1146\/annurev-immunol-020711-075032","DOI":"10.1146\/annurev-immunol-020711-075032"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"[26] von Beck K, von Beck T, Ferrell PB Jr, Bick AG, Kishtagari A. Lymphoid clonal hematopoiesis: implications for malignancy, immunity, and treatment. Blood Cancer J, 2023, 13(1):5. https:\/\/doi.org\/10.1038\/s41408-022-00773-8","DOI":"10.1038\/s41408-022-00773-8"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"[27] L\u00fctge M, De Martin A, Gil-Cruz C, Perez-Shibayama C, Stanossek Y, Onder L, Cheng HW, Kurz L, Cadosch N, Soneson C, Robinson MD, Stoeckli SJ, Ludewig B, Pikor NB. Conserved stromal-immune cell circuits secure B cell homeostasis and function. Nat Immunol, 2023, 24(7):1149-1160. https:\/\/doi.org\/10.1038\/s41590-023-01503-3","DOI":"10.1038\/s41590-023-01503-3"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"[28] Ng WL, Ansell SM, Mondello P. Insights into the tumor microenvironment of B cell lymphoma. J Exp Clin Cancer Res, 2022, 41(1):362. https:\/\/doi.org\/10.1186\/s13046-022-02579-9","DOI":"10.1186\/s13046-022-02579-9"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"[29] Seliger B, Massa C. Modulation of lymphocyte functions in the microenvironment by tumor oncogenic pathways. Front Immunol, 2022, 13:883639. https:\/\/doi.org\/10.3389\/fimmu.2022.883639","DOI":"10.3389\/fimmu.2022.883639"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"[30] Velmurugu Y, Rahimic AHF, Curtin R, Hao Y, Nyovanie S, Langton J, Mishra P, Voloshyna I, Koide A, Koide S, Silverman GJ, Herati RS, Patskovsky Y, Diefenbach C, Krogsgaard M. SARS-CoV-2 vaccination unmasks distinct immune dysfunctions across lymphoma subtypes and therapies. Res Sq [Preprint], 2025, Jul 4:rs.3.rs-7016519. https:\/\/doi.org\/10.21203\/rs.3.rs-7016519\/v1","DOI":"10.21203\/rs.3.rs-7016519\/v1"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"[31] Rose-John S. Interleukin-6 family cytokines. Cold Spring Harb Perspect Biol, 2018, 10(2):a028415. https:\/\/doi.org\/10.1101\/cshperspect.a028415","DOI":"10.1101\/cshperspect.a028415"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"[32] Yu L, Li L, Medeiros LJ, Young KH. NF-\u03baB signaling pathway and its potential as a target for therapy in lymphoid neoplasms. Blood Rev, 2017, 31(2):77-92. https:\/\/doi.org\/10.1016\/j.blre.2016.10.001","DOI":"10.1016\/j.blre.2016.10.001"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"[33] Vronsky D, Hershkowitz S, Hershko A, Eliakim-Raz N. A transient inflammatory reaction with a B-cell lymphoid infiltrate and dysplastic bone marrow changes associated with the BNT162b2 COVID-19 vaccine. Eur J Case Rep Intern Med, 2022, 9(6):003381. https:\/\/doi.org\/10.12890\/2022_003381","DOI":"10.12890\/2022_003381"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"[34] Patil A, Swerdlow SH, Lossos IS, Chapman JR. Atypical follicular hyperplasia with light chain-restricted germinal centers after COVID-19 booster: a diagnostic pitfall. Virchows Arch, 2023, 482(5):905-910. https:\/\/doi.org\/10.1007\/s00428-022-03400-w","DOI":"10.1007\/s00428-022-03400-w"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"[35] Yamanaka S, Tanaka K, Miyagawa M, Kido T, Hasebe S, Yamamoto S, Fujii T, Takeuchi K, Yakushijin Y. Distinguishing axillary lymphadenopathy after COVID-19 vaccination from malignant lymphadenopathy. J Clin Med, 2024, 13(12):3387. https:\/\/doi.org\/10.3390\/jcm13123387","DOI":"10.3390\/jcm13123387"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"[36] Tsai HF, Hsu PN. Cancer immunotherapy by targeting immune checkpoints: mechanism of T cell dysfunction in cancer immunity and new therapeutic targets. J Biomed Sci, 2017, 24(1):35. https:\/\/doi.org\/10.1186\/s12929-017-0341-0","DOI":"10.1186\/s12929-017-0341-0"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"[37] Seo W, Jerin C, Nishikawa H. Transcriptional regulatory network for the establishment of CD8+ T cell exhaustion. Exp Mol Med, 2021, 53(2):202-209. https:\/\/doi.org\/10.1038\/s12276-021-00568-0","DOI":"10.1038\/s12276-021-00568-0"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"[38] Pauken KE, Wherry EJ. Overcoming T cell exhaustion in infection and cancer. Trends Immunol, 2015, 36(4):265-276. https:\/\/doi.org\/10.1016\/j.it.2015.02.008","DOI":"10.1016\/j.it.2015.02.008"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"[39] Trombetta AC, Farias GB, Gomes AMC, Godinho-Santos A, Rosmaninho P, Concei\u00e7\u00e3o CM, Laia J, Santos DF, Almeida ARM, Mota C, Gomes A, Serrano M, Veldhoen M, Sousa AE, Fernandes SM. Severe COVID-19 recovery is associated with timely acquisition of a myeloid cell immune-regulatory phenotype. Front Immunol, 2021, 12:691725. https:\/\/doi.org\/10.3389\/fimmu.2021.691725","DOI":"10.3389\/fimmu.2021.691725"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"[40] Vincent-Fabert C, Roland L, Zimber-Strobl U, Feuillard J, Faumont N. Preclinical blocking of PD-L1 molecule, which expression is down regulated by NF-\u03baB, JAK1\/JAK2 and BTK inhibitors, induces regression of activated B-cell lymphoma. Cell Commun Signal, 2019, 17(1):89. https:\/\/doi.org\/10.1186\/s12964-019-0391-x","DOI":"10.1186\/s12964-019-0391-x"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"[41] Ma C, Horlad H, Pan C, Yano H, Ohnishi K, Fujiwara Y, Matsuoka M, Lee A, Niidome T, Yamanaka R, Takeya M, Komohara Y. Stat3 inhibitor abrogates the expression of PD-1 ligands on lymphoma cell lines. J Clin Exp Hematop, 2017, 57(1):21-25. https:\/\/doi.org\/10.3960\/jslrt.17006","DOI":"10.3960\/jslrt.17006"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"[42] Ma J, Pang X, Li J, Zhang W, Cui W. The immune checkpoint expression in the tumor immune microenvironment of DLBCL: clinicopathologic features and prognosis. Front Oncol, 2022, 12:1069378. https:\/\/doi.org\/10.3389\/fonc.2022.1069378","DOI":"10.3389\/fonc.2022.1069378"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"[43] Samkowski J, Sklinda K, Walecki JM. Lymphadenopathy in the era of COVID-19 vaccination - an oncological dilemma in diagnostic imaging. Pol J Radiol, 2022, 87:e304-e310. https:\/\/doi.org\/10.5114\/pjr.2022.117560","DOI":"10.5114\/pjr.2022.117560"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"[44] Hagen C, Nowack M, Messerli M, Saro F, Mangold F, Bode PK. Fine needle aspiration in COVID-19 vaccine-associated lymphadenopathy. Swiss Med Wkly, 2021, 151:w20557. https:\/\/doi.org\/10.4414\/smw.2021.20557","DOI":"10.4414\/smw.2021.20557"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"[45] Zhang Y, Guo W, Zhan Z, Bai O. Carcinogenic mechanisms of virus-associated lymphoma. Front Immunol, 2024, 15:1361009. https:\/\/doi.org\/10.3389\/fimmu.2024.1361009","DOI":"10.3389\/fimmu.2024.1361009"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"[46] Pol\u010dic P, Mentel M, Gavurn\u00edkov\u00e1 G, Bhatia-Ki\u0161\u0161ov\u00e1 I. To keep the host alive - the role of viral Bcl-2 proteins. Acta Virol, 2017, 61(3):240-251. https:\/\/doi.org\/10.4149\/av_2017_302","DOI":"10.4149\/av_2017_302"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"[47] Shafiee A, Amini MJ, Arabzadeh Bahri R, Jafarabady K, Salehi SA, Hajishah H, Mozhgani SH. Herpesviruses reactivation following COVID-19 vaccination: a systematic review and meta-analysis. Eur J Med Res, 2023, 28(1):278. https:\/\/doi.org\/10.1186\/s40001-023-01238-9","DOI":"10.1186\/s40001-023-01238-9"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"[48] H\u00fcbschmann D, Kleinheinz K, Wagener R, Bernhart SH, L\u00f3pez C, Toprak UH, Sungalee S, Ishaque N, Kretzmer H, Kreuz M, Waszak SM, Paramasivam N, Ammerpohl O, Aukema SM, Beekman R, Bergmann AK, Bieg M, Binder H, Borkhardt A, Borst C, Brors B, Bruns P, Carrillo de Santa Pau E, Claviez A, Doose G, Haake A, Karsch D, Haas S, Hansmann ML, Hoell JI, Hovestadt V, Huang B, Hummel M, J\u00e4ger-Schmidt C, Kerssemakers JNA, Korbel JO, Kube D, Lawerenz C, Lenze D, Martens JHA, Ott G, Radlwimmer B, Reisinger E, Richter J, Rico D, Rosenstiel P, Rosenwald A, Schillhabel M, Stilgen-bauer S, Stadler PF, Mart\u00edn-Subero JI, Szczepanowski M, Warsow G, Weniger MA, Zapatka M, Valencia A, Stunnenberg HG, Lichter P, M\u00f6ller P, Loeffler M, Eils R, Klapper W, Hoffmann S, Tr\u00fcmper L; ICGC MMML-Seq consortium; ICGC DE-Mining consortium; BLUEPRINT consortium; K\u00fcppers R, Schlesner M, Siebert R. Mutational mechanisms shaping the coding and noncoding genome of germinal center derived B-cell lymphomas. Leukemia, 2021, 35(7):2002-2016. https:\/\/doi.org\/10.1038\/s41375-021-01251-z","DOI":"10.1038\/s41375-021-01251-z"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"[49] Basso K, Dalla-Favera R. Germinal centres and B cell lymphomagenesis. Nat Rev Immunol, 2015, 15(3):172-184. https:\/\/doi.org\/10.1038\/nri3814","DOI":"10.1038\/nri3814"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"[50] Laidlaw BJ, Ellebedy AH. The germinal centre B cell response to SARS-CoV-2. Nat Rev Immunol, 2022, 22(1):7-18. https:\/\/doi.org\/10.1038\/s41577-021-00657-1","DOI":"10.1038\/s41577-021-00657-1"},{"key":"ref50","doi-asserted-by":"publisher","unstructured":"[51] Jiao J, Lv Z, Wang Y, Fan L, Yang A. The off-target effects of AID in carcinogenesis. Front Immunol, 2023, 14:1221528. https:\/\/doi.org\/10.3389\/fimmu.2023.1221528","DOI":"10.3389\/fimmu.2023.1221528"},{"key":"ref51","doi-asserted-by":"publisher","unstructured":"[52] Pjanova D, Rafeeque A. SARS-CoV-2 infection and vaccination, immune dysregulation, and cancer. Vaccines (Basel), 2026, 14(3):255. https:\/\/doi.org\/10.3390\/vaccines14030255","DOI":"10.3390\/vaccines14030255"},{"key":"ref52","doi-asserted-by":"publisher","unstructured":"[53] Ager A. High endothelial venules and other blood vessels: critical regulators of lymphoid organ development and function. Front Immunol, 2017, 8:45. https:\/\/doi.org\/10.3389\/fimmu.2017.00045","DOI":"10.3389\/fimmu.2017.00045"},{"key":"ref53","doi-asserted-by":"publisher","unstructured":"[54] Blanchard L, Girard JP. High endothelial venules (HEVs) in immunity, inflammation and cancer. Angiogenesis, 2021, 24(4):719-753. https:\/\/doi.org\/10.1007\/s10456-021-09792-8","DOI":"10.1007\/s10456-021-09792-8"},{"key":"ref54","doi-asserted-by":"publisher","unstructured":"[55] Menzel L, H\u00f6pken UE, Rehm A. Angiogenesis in lymph nodes is a critical regulator of immune response and lymphoma growth. Front Immunol, 2020, 11:591741. https:\/\/doi.org\/10.3389\/fimmu.2020.591741","DOI":"10.3389\/fimmu.2020.591741"},{"key":"ref55","doi-asserted-by":"publisher","unstructured":"[56] Tomi\u0107 S, Joksimovi\u0107 B, Beki\u0107 M, Vasiljevi\u0107 M, Milanovi\u0107 M, \u010coli\u0107 M, Vu\u010devi\u0107 D. Prostaglandin-E2 potentiates the suppressive functions of human mononuclear myeloid-derived suppressor cells and increases their capacity to expand IL-10-producing regulatory T cell subsets. Front Immunol, 2019, 10:475. https:\/\/doi.org\/10.3389\/fimmu.2019.00475","DOI":"10.3389\/fimmu.2019.00475"},{"key":"ref56","doi-asserted-by":"publisher","unstructured":"[57] Veglia F, Sanseviero E, Gabrilovich DI. Myeloid-derived suppressor cells in the era of increasing myeloid cell diversity. Nat Rev Immunol, 2021, 21(8):485-498. https:\/\/doi.org\/10.1038\/s41577-020-00490-y","DOI":"10.1038\/s41577-020-00490-y"},{"key":"ref57","doi-asserted-by":"publisher","unstructured":"[58] Wong TN, Miller CA, Jotte MRM, Bagegni N, Baty JD, Schmidt AP, Cashen AF, Duncavage EJ, Helton NM, Fiala M, Fulton RS, Heath SE, Janke M, Luber K, Westervelt P, Vij R, DiPersio JF, Welch JS, Graubert TA, Walter MJ, Ley TJ, Link DC. Cellular stressors contribute to the expansion of hematopoietic clones of varying leukemic potential. Nat Commun, 2018, 9(1):455. https:\/\/doi.org\/10.1038\/s41467-018-02858-0","DOI":"10.1038\/s41467-018-02858-0"},{"key":"ref58","doi-asserted-by":"publisher","unstructured":"[59] Bakhshi TJ, Georgel PT. Genetic and epigenetic determinants of diffuse large B-cell lymphoma. Blood Cancer J, 2020, 10(12):123. https:\/\/doi.org\/10.1038\/s41408-020-00389-w","DOI":"10.1038\/s41408-020-00389-w"},{"key":"ref59","doi-asserted-by":"publisher","unstructured":"[60] Wilpert C, Wenkel E, Baltzer PAT, Fallenberg EM, Preibsch H, Sauer ST, Siegmann-Luz K, Weigel S, Wunderlich P, Wessling D. Vaccine-associated axillary lymphadenopathy with a focus on COVID-19 vaccines. Rofo, 2025, 197(3):288-297. https:\/\/doi.org\/10.1055\/a-2328-7536","DOI":"10.1055\/a-2328-7536"},{"key":"ref60","doi-asserted-by":"publisher","unstructured":"[61] Khatri JK, Tahboub I, Anwar K, Masoudi M, Graffeo V, Jamil MO. Diagnosis of angioimmunoblastic T cell lymphoma after receiving first dose of Pfizer\/BioNTech (BNT162b2) vaccine: a case report. J Investig Med High Impact Case Rep, 2024, 12:23247096241231645. https:\/\/doi.org\/10.1177\/23247096241231645","DOI":"10.1177\/23247096241231645"},{"key":"ref61","doi-asserted-by":"publisher","unstructured":"[62] Cavanna L, Grassi SO, Ruffini L, Michieletti E, Carella E, Palli D, Zangrandi A, Inzerilli N, Bernuzzi P, Di Nunzio C, Citterio C. Non-Hodgkin lymphoma developed shortly after mRNA COVID-19 vaccination: report of a case and review of the literature. Medicina (Kaunas), 2023, 59(1):157. https:\/\/doi.org\/10.3390\/medicina59010157","DOI":"10.3390\/medicina59010157"},{"key":"ref62","doi-asserted-by":"publisher","unstructured":"[63] Cromer D, Juno JA, Khoury D, Reynaldi A, Wheatley AK, Kent SJ, Davenport MP. Prospects for durable immune control of SARS-CoV-2 and prevention of reinfection. Nat Rev Immunol, 2021, 21(6):395-404. https:\/\/doi.org\/10.1038\/s41577-021-00550-x","DOI":"10.1038\/s41577-021-00550-x"},{"key":"ref63","doi-asserted-by":"publisher","unstructured":"[64] Wang J, Li K, Mei X, Cao J, Zhong J, Huang P, Luo Q, Li G, Wei R, Zhong N, Zhao Z, Wang Z. SARS-CoV-2 vaccination-infection pattern imprints and diversifies T cell differentiation and neutralizing response against Omicron subvariants. Cell Discov, 2022, 8(1):136. https:\/\/doi.org\/10.1038\/s41421-022-00501-3\"","DOI":"10.1038\/s41421-022-00501-3"}],"container-title":["Romanian Journal of Morphology and Embryology"],"original-title":[],"link":[{"URL":"https:\/\/rjme.ro\/RJME\/resources\/files\/670226213224.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:42:28Z","timestamp":1789537348000},"score":1,"resource":{"primary":{"URL":"https:\/\/rjme.ro\/archive\/67\/2\/2\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":64,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,9,12]]},"published-print":{"date-parts":[[2026,9,12]]}},"URL":"https:\/\/doi.org\/10.47162\/rjme.67.2.02","relation":{},"ISSN":["1220-0522","2066-8279"],"issn-type":[{"value":"1220-0522","type":"print"},{"value":"2066-8279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]}}}