Objective : The purpose of this study was to examine the impact of coronavirus disease 2019 (COVID-19) on various aspects of cytology practice in Japan.

Study Design : We distributed an online questionnaire to members of the Japanese Society of Cytotechnologists to investigate the changes in cytology workflow and workload. The survey was conducted in May 2020 and May 2021.

Results : A total of 293 cytotechnologists responded to the survey in 2020 and 397 responded in 2021. The survey results demonstrated that the number of cytology specimens examined decreased significantly during the COVID-19 pandemic. The impact of the first emergency declaration on the cytology workload continued in many facilities in 2021. Many cytotechnologists reported that their work environment had changed, and that they had begun to implement new work arrangements. In some facilities, the number of cytology specimens decreased by more than 40% per year. The number of cancer screenings offered at the municipality level fell in 36% of facilities, while that offered at the workplace level fell in 18% of facilities. Some facilities had infection control challenges in their cytology practice.

Conclusion : Some facilities did not take sufficient infection control measures for cytology specimen processing. Furthermore, new cancer screening methods need to be devised.

Background : Angiosarcoma is a rare disease, and diagnosis of this tumor by cytopathology alone is challenging. We report a case of synchronous primary cardiac angiosarcoma and primary left breast invasive ductal carcinoma. The angiosarcoma was diagnosed by cytology, and immunohistochemistry using cells blocks prepared from the bloody pleural fluid confirmed invasion of the pleura by the cardiac angiosarcoma, contributing to appropriate treatment selection.

Case : A 40-year-old woman presented to a previous hospital with dyspnea and generalized anasarca. Clinical examination showed a mass surrounding the aorta and right atrium, a left breast mass, and pericardial and pleural effusions. Findings of pericardial fluid cytology led to the suspicion of adenocarcinoma. The breast mass was diagnosed as invasive ductal carcinoma by biopsy. The patient was transferred to our hospital for further diagnostic evaluation of the cardiac mass. Biopsy of the cardiac tumor revealed the diagnosis of angiosarcoma. Cytopathology of the pleural fluid showed aggregated and individual atypical cells with abundant pale cytoplasm and hyperchromatic nuclei, suggestive of malignancy, but differential diagnosis between a primary cardiac neoplasm and metastatic breast cancer was difficult. Immunohistochemistry performed on a cell block prepared from the pleural fluid showed features of angiosarcoma, suggesting infiltration of the pleura by the cardiac angiosarcoma.

Conclusion : We encountered a case in which preparation of cell blocks for immunohistochemistry was useful for determining the origin of the atypical cells observed on pleural fluid cytology in a patient with synchronous double cancers. Molecular analysis is useful for the definitive diagnosis in cases in which morphological diagnosis is difficult.

Background : Cytological and immunohistochemical evaluation are necessary for accurate diagnosis of pancreatic neuroendocrine neoplasms (NENs), as diagnosis by endocrine tests or imaging examinations alone is difficult. A recently developed technique, endoscopic ultrasonography guided-fine needle aspiration (EUS-FNA), enables the diagnosis of pancreatic NENs. Herein, we present a case in which cytology and immunohistopathology of specimens obtained by EUS-FNA confirmed the diagnosis of insulinoma in a suspected case of pancreatic NEN.

Case : A 47-year-old woman presented with a 5-year history of weight gain and 1-year history of incoherent speech. She was transported by ambulance to a nearby hospital, and thence to our hospital, when she experienced a tonic seizure. The results of laboratory examination were as follows : blood glucose, 58 mg/dl ; plasma insulin, 8.6 μU/l ; plasma C-peptide, 0.46 ng/ml ; plasma insulin/C-peptide ratio, 0.34. Abdominal computed tomography revealed a solid tumor on the pancreatic head with a positive result of somatostatin receptor scintigraphy. Pancreatic NEN was suspected, and EUS-FNA was performed. Cytology revealed polygonal cells with light-green cytoplasm, and round nuclei with a “salt and pepper” like chromatin structure. Immunohistochemistry showed positive staining for chromogranin A, synaptophysin, CD56, NSE, and insulin, and the Ki-67 index was 1%. Based on these findings, the tumor was diagnosed as an insulinoma, and the patient was referred to another hospital for pancreatectomy and splenectomy.

Conclusion : EUS-FNA was useful for the accurate diagnosis of insulinoma in a case with suspected pancreatic NEN.

Background : Mucoepidermoid carcinoma (MEC) of the salivary glands is the most commonly encountered primary salivary gland malignancy, and the tumor cells harbor MAML2 rearrangements. Herein, we report a case in which a definitive diagnosis of MEC was made preoperatively by MAML2 FISH of liquid-based cytology (LBC) samples prepared from specimens obtained by fine-needle aspiration (FNA).

Case : The patient, in his 10 s, presented to us with a left parotid mass. Neck ultrasonography revealed a mass with multiple cysts in the left parotid gland, and FNA cytology was performed. The FNA smears showed mild-to-moderate cellularity with epithelial clusters, including bland mucous and intermediate cells, in a background of mucin and lymphocytes. Based on the cytomorphology, a diagnosis of low-grade MEC was suspected, and an ancillary MAML2 FISH test was performed using a cell block specimen prepared from residual LBC samples. Break-apart FISH analysis for MAML2 identified a split signal (48%) in the tumor cells. The final preoperative diagnosis was malignant, low-grade MEC. The resected histological specimens confirmed the diagnosis of MEC.

Conclusions : Ancillary studies help to fine-tune the histological typing of salivary gland tumors, thereby increasing the accuracy of the Milan system for reporting salivary gland cytology.

Background : Large cell neuroendocrine carcinoma (LCNEC) of the uterine cervix is rare, accounting for about 0.5% of all cervical tumors, and it carries a poor prognosis. The rate of positive ascitic fluid cytology in cases of cervical cancer reportedly ranges from 2.7% to 15.0%. Herein, we report a case of LCNEC of the uterine cervix in which a specimen could not be obtained from the uterine cervix, but neuroendocrine tumor cells were detected in the ascitic fluid.

Case : A 41-year-old nulliparous woman presented with abdominal distention and leg edema. Clinical examination revealed a tumor originating from the posterior wall of the lower uterine body and occupying the pelvis, and the uterine cervix was deviated toward the pubic bone. The patient also had a mental developmental disorder and schizophrenia. Cell and tissue specimens were obtained transvaginally. Cytology of the ascitic fluid collected at the time of laparoscopy showed arrangement of closely stacked tumor cells with well-defined nucleoli and fine granular chromatin. Immunohistochemistry of a biopsy specimen showed positive staining for INSM-1, p53, synaptophysin, and chromogranin A.

Conclusion : Although transvaginal specimen collection from the uterine cervix was not possible, cytology of the ascitic fluid and immunohistochemical staining of the tumor tissue proved useful for the diagnosis of uterine cervical LCNEC in our case.