Objective: We studied detection of human epidermal growth factor receptor 2 (HER 2) protein in imprint cytology of invasive breast cancer and assessed the need for epitope retrieval and criteria for interpreting staining results.
Study Design: In 35 cases of invasive breast cancer, HER2 protein status was assessed in imprinted cytology specimens (alcohol-fixed) and corresponding tissue sections (formalinfixed and paraffin-embedded). Immunohistochemistry assay for HER2 protein expression was done based on the Hercep Test protocol. Cytology specimens pretreated with and without heatinduced epitope retrieval were evaluated based on Hercep Test criteria (quality-based) and modified Hercep Test criteria (quantity-based), and results were compared to those for tissue sections.
Results: A significant relationship was seen between HER2 status assessment in cytology specimens and tissue sections, without regard to heat-induced epitope retrieval or interpretation criteria for staining results. Quantity-based assessment of cytology specimens with no epitope retrieval approximates to that of tissue sections.
Conclusion: The detection of HER2 protein in cytology specimens from breast cancer is possible, and quantity-based assessment of cytology specimens with no epitope retrieval is appropriate.

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Objective: We clarifited the usefulness of intraoperative imprint cytology combined with immunocytochemistry (ICC) in detecting cancer cells metastasizing to sentinel lymph nodes (SLNs) in patients with breast cancer.
Study Design: We analyzed 134 patients who underwent surgical resection for breast cancer. SLNs obtained from patients during surgery were sectioned at 2 mm intervals and imprinted onto glass slides, followed by Papanicolaou and immunocytochemical staining using anticytokeratin antibody.
Results: Permanent sections combined with immunohistochemical analysis using anticytokeratin antibody demonstrated cancer metastasis to SLNs in 37 patients. The sensitivity of imprint cytology was 78.4%, imprint cytology combined with ICC 89.2%, and frozen section 75.7%. Specificity of frozen section evaluated as 100% became 96.9% for the other two methods. Accuracy for imprint cytology was 91.7%, imprint cytology combined with ICC 94.8%, and frozen section and 93.3%. Four false negative and false positive cases evaluated by imprint cytology combined with ICC were present. False negatives and probably false positives were generated by micrometastasis.
Conclusion: Sensitivity is significant improved when ICC is added. Imprint cytology combined with ICC is useful for intraoperatively evaluating metastasis to SLNs in patients with breast cancer.

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Background: We report 2 cases of neuroendocrine carcinoma of the prostate, in which tumor cells appeared in the urine.
Cases: 1) A 70-year-old-man diagnosed with poorly differentiated adenocarcinoma by prostate needle biopsy (stage B2), underwent endohormone therapy, after which his serum PSA decreased to the normal range. Two months later, he reported dysuria, and urinary cytology showed a presence of cancer cells, and neuroendocrine carcinoma was detected by prostate needle biopsy. CT and MRI showed invasion of the bladder wall and seminal vesicle. Despite radiotherapy, the patient died of widespread metastasis after a total course of approximately one year. 2) A 74-year-old-man with high PSA was found by biopsy to have moderately differentiated adenocarcinoma, with the tumor was estimated to be stage D1. Endocrine therapy was so effective that the tumor regressed and serum PSA was normalized. Four years later, however, the tumor recurred and urinary cytology was positive for malignant cells. Neuroendocrine carcinoma was detected by prostate needle biopsy. Chemotherapy was administrated combined with radiotherapy, and the tumor responded completely. The man remains recurrencefree in the 5 years since. The same cytological features seen in 2 cases, i. e., high N/ C ratio, naked and hyperchromatic nuclei with finely or coarse granular chromatin, and peculiar cellular arrangement, thus do not necessarily have the same outcome.
Conclusion: It is important to keep in mind that small undifferentiated cells in urinary cytology during follow-up after pros tate cancer suggest an appearance of neuroendocrine carcinoma by the neurodifferentiation of adenocarcinoma cells. It is also important to note the characteristics of nuclei and cellular arrangements.

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Background: Clear cell meningioma is a rare form occurring in younger patients and at infratentorial sites. Its recurrence rate is higher than that of conventional meningiomas.
Case: A 17-year-old woman presenting with left hip pain was found in magnetic resonance imaging (MRI) to have an intradural, extramedullary tumor 2 cm in diameter at L5. The tumor was removed and intraoperative cytology yielded a diagnosis of meningioma.
Histologically, the tumor showed sheets of cells with small round nuclei and abundant clear glycogen-rich polygonal cytoplasm, and had a vague whorling pattern, and deposits of hyalinized blocky collagen. The final histological diagnosis was clear cell meningioma.
Conclusion: We report a case of clear cell meningioma. Intraoperative cytology was useful for diagnosis.

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Background: Central neurocytoma (CN) is a relatively new tumor concept, and few cases on its cytology have been reported. We report a case of CN arising in the right lateral ventricle, focusing on cytological features of intraoperative imprint and squash preparations.
Case: A 28 year-old man seen at the emergency department for a blow to the head was found in head computed tomography to have a tumor accompanying calcification in the right lateral ventricle. Magnetic resonance imaging showed cysts inside the tumor. In the intraoperative imprint cytology preparations, tumor cells were observed singly or in loose clusters, some forming rosettes, against a background of a finely fibrillated substance palely staining light green. In some areas, cells with perinuclear halos and clearly defined cell membranes were observed. Intraoperative histological examination showed tumor cells with round to oval nuclei, poorly defined cell membranes, and cytoplasm palely stained by eosin. Intraoperative cytological and histological findings suggested CN. Postoperative immunostaining and electron microscopy confirmed this diagnosis.
Conclusion: To rapidly diagnose CN, intraoperative cytology in combination provides findings not demonstrated in frozen sections. By evaluating cytological and histological findings together and considering clinical findings, CN can be rapidly diagnosed.

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Background: Since breast carcinomas with neuroendocrine differentiation include carcinomas of different histologic types, their cytological features have not been fully established. We report cytological findings of neuroendocrine carcinoma of the breast with carcinoid-like structures.
Case: A 64-year-old woman was admitted for a right breast mass. A fine needle aspiration cytology specimen revealed many cell clusters of varying sizes and scattered isolated cells. Tumor cells were columnar or spindle-shaped and had spindleshaped or elliptical nuclei, granular chromatin, and small to moderate amounts of cytoplasm. Palisading and streaming arrangements of tumor cells were characteristic. Histologically, tumor cells proliferated with nesting, ribbon-like, trabecular, and tubular patterns, resembling a carcinoid tumor. Tumor cells showed argyrophilia with the Grimelius technique. Immunohistochemically, tumor cells were positive for chromogranin A and synaptophysin.
Conclusion: When clusters with palisading or streaming arrangement of columnar or spindle-shaped cells with spindleshaped or elliptical nuclei are observed on an aspiration cytology specimen of the breast, neuroendocrine carcinoma with carcinoid-like structures should be considered in the differential diagnosis.

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Background: Malignant melanoma of the uterine cervix is rare. We report such a case that mimicked leiomyosarcoma cytologically and histologically, with little melanin pigmentation at the initial manifestation.
Case: A 66-year-old woman suspected of carcinoma in situ or microinvasive carcinoma based on a cancer screening cervical smear evidenced no abnormality histologically or in further cytology smears. One year later, cytological reexamination showed malignant cells suggesting leiomyosarcoma. Although colposcopically directed biopsy was normal, malignant melanoma was detected in endocervical curettage necesitating total abdominal hysterectomy and bilateral salpingo-oophorectomy with intrapelvic lymphadenectomy. Pathological examination showed malignant melanoma of the uterine cervix with lymph node metastasis. Immunohistochemically, the tumor aberrantly expressed both muscle and melanoma markers. Despite systemic chemotherapy, the patient died one year and 8 months after surgery.
Conclusion: Malignant melanoma of the uterine cervix is rare. The few melanin granules evidenced may be confused with leiomyosarcomas, either morphologically or immunophenotypically.

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Background: Renal cell carcinoma metastasis to the uterus is extremely rare, and must be differentially diagnosed from primary endometrial clear cell cartinoma. We report a case of renal cell cartinoma metastasizing to the uterus.
Case: A 62-year-old woman, 1G1P, who underwent surgery for renal cell carcinoma composed of clear cell carcinoma and granular cell carcinoma 11 months earlier, reported atypical genital bleeding. Endometrial cytology showed (1) clear hemorrhagic background, (2) normal atrophic endometrial cells, (3) atypical cells scattered or with irregular aggregation, (4) atypicalcells with abundant and granular cytoplasm and apparent cellularborder, and (5) enlarged nuclei with fine granular chromatinand 1 or 2 apparent nucleoli. Based on these findings, including granular cytoplasm and clear back ground, and a history of renal cell carcinoma, this case was diagnosed cytologically as metastatic renal cell carcinoma. In the resected uterus, granular cell carcinoma widely invaded the myometrium and the endometrium was normal atrophic. Tumor cells were immunohistochemically positive for CD10. These findings proved renal cell carcinoma metastatic to the uterus.
Conclusion: For differential diagnosis of metastatic renal cell carcinoma and primary clear cell carcinoma of the uterusmimicking clear cell carcinoma, cytoplasmic findings of malignant cells must be considered in addition to clinical history. Immunohistochemical examination of CD10 is also useful.

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In Japan, the history of cytotechnologists' training dates back to 1962, when the late Dr. K. Masubuchi and the late Dr. J. Mizuno took the initiative of holding meetings of the Societyof Cytotechnology, an organization composed primarily of gynecologists that was in existence before the Japanese Society of Clinical Cytology (JSCC) came to be established. In 1965, the Japanese Association for Maternal Welfare (JAMW) shifted the theme of its campaign from “Protect Women from the Hazards of Artifical Abortion”, to “Protect Women from Cancer”. As an activity to promote this new campaign, the association began group checks for uterine cancer using cytodiagnosis. Under these circumstances, it became an urgent need to cultivate an adequate number of cytodiagnostic technologists (cytotechnologists) capable of performing accurate screening. In 1966, a cytotechnologists' training course (3 weeks) was sponsored jointly by the Japanese Society of Clinical Pathology and the JSCC. In 1968, six-month cytotechnologists' training courses began to be offered at the Cancer Institute Hospital of Japanese Foundation for Cancer Research (JFCR Hospital) and at the Osaka Medical Center for Cancer and Cardiovascular Diseases. Later, in 1978, the Tokyo Metropolitan Cancer Detection Center (currently known as the Tokyo Metropolitan Tama Cancer Detection Center) adopted the training program started by the JFCR Hospital. The training program sponsored by the JFCR Hospital and Tokyo Metropolitan Tama Cancer Detection Center was initially called “Cytodiagnostic Screener Training School”, to be later renamed as “Cytotechnologist Training School”. The program offered by the Osaka Medical Center for Cancer and Cardiovascular Diseases was initially called “Cytodiagnostic Screener Training Course”, to be later renamed in 1997 as “Cytotechnologist Training Course”. In 1982, a 4-year university course of cytotechnology was offered for the first time by Kyorin University School of Health Science. From 1985 through 1992, cytotechnology taining was offered at Fujita Health University College, within the framework of the hygiene technology course. In 1994, the cytotechnology course began to be offered at Kitasato University School of Allied Health Sciences. In 1999, Gunma University Faculty of Medicine opened a cytotechnology course in its School of Health Science for the first time among national universities. In 2001, another national university bagan to offer a similar course in Facalty of Health Science, Yamaguchi University School of Medicine. More 4-year university training courses for cytotechnologists are expected to be offered in the near future.

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The university educational program for cytotechnologist (CT) in Japan was established at Kyorin Univ. in 1982 and at Kitasato Univ. in 1994. After CT qualification testing and acquisition of Medical techonologist (MT) certification, the program was launched. Examinations in graduation prospect changes were made possible in the fourth year of qualification tests in 1997. CT played an active part, improving the rate of success, and since employment eligibility was put into practice, it also became possible to pursue pathology and cytology. The effect of a consistent university education is considered high-priority. It became a motivating force as CT education shifted to the 4-year university system in national junior colleges. In 1999, Gunma Univ. and in 2002, Yamaguchi Univ. started CT education. We provide a consistent education starting in the Pt year. In one-onone education, importance is attached to acquisition of the knowledge and skills needed for success and to a sense of mission as a CT. We instill responsibility and pride while creating a person who can step in and be effective immediately. An enormous enormous amount of time is spent on MT education and there is no room for CT education, but the demand for CT will increase exponentially. While establishment of a more effective education is desired, CT as a profession must be socially recognized as independent of MT.

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Cytotechnology education in the United States is at a crossroads. Today's technology presents us with important and potentially profession-altering decisions. Will we continue to follow traditional models of cytology practice and educational policy, or, is it now time to reexamine our role as microscopists? We will soon have to decide whether Cytotechnologists will continue doing what they have been trained to do for over 50 years-to be cell morphologists and screeners, or whether they will evolve to become Cell Scientists, using all the diagnostic technologies available today and in the future.
To predict what cytotechnology eduation in the United States should be in the future, it's helpful to look at current models of program structure, student demographics, and practice opportunities.

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The Japanese Society of Clinical Cytology (JSCC) certifies cytopathology instructors (including cytopathologists). Cytology has unquestionably become accepted as a very useful tool in medical practice, but cytology has not been adequately recognized as a speciality by the public. The purpose of this presentation is to describe the actual state of affairs regarding cytopathology in clinical practice including the active numbers of cytopathology instructors in Japan, the medical subspecialties of them, the changes in the number of examinees and the success rate of the cytopathologist board examination, eligibility for taking the examination, and problems concerning use of the examination. Advisable and more realistic use of the examination was also discussed. As of April 2003 there were 1840 cytology instructors and 5479 cytotechnologists in Japan, and the ratio of cytology instructors to cytotechnologists was roughly 1: 3. The distribution of cytopathology instructors according to age showed a regular distribution with a peak at 45-49 years. Female cytopathology instructors increased in their 30s to 40s. Nearly 90% of cytopathology instructors are qualified in pathology or gynecology as their medical subspeciality. The average success rate for the cytopathologist board examination was 80.4%. Cytopathology instructors certified by the JSCC are responsible for preparing and transmitting highly specialized and qualified medical information obtained by cytological examinations. For this reason, the JSCC should promptly establish a continuing education system and a more realistic examination for cytopathology instructors.

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