COVID-19 pandemic impact on cytopathology practice in the post-lockdown period: An international, multicenter study

BACKGROUND

In a previous worldwide survey, the authors showed a drastic reduction in the number of cytological specimens processed during the coronavirus disease 2019 "lockdown" period along with an increase in malignancy rates. To assess the continued impact of the pandemic on cytological practices around the world, they undertook a second follow-up worldwide survey collecting data from the post-lockdown period (2020).

METHODS

Participants were asked to provide data regarding their cytopathology activity during the first 12 weeks of their respective national post-lockdown period (2020), which ranged from April 4 to October 31. Differences between the post-lockdown period and the corresponding 2019 period were evaluated, and the authors specifically focused on rates of malignant diagnoses.

RESULTS

A total of 29 respondents from 17 countries worldwide joined the survey. Overall, a lower number of cytological specimens (n = 236,352) were processed in comparison with the same period in 2019 (n = 321,466) for a relative reduction of 26.5%. The overall malignancy rate showed a statistically significant increase (12,442 [5.26%] vs 12,882 [4.01%]; P < .001) during the same time period. Similar results were obtained if both malignancy and suspicious for malignancy rates were considered together (15,759 [6.58%] vs 16,011 [4.98%]; P < .001).

CONCLUSIONS

The data showed a persistent reduction in the cytological specimen volume during the post-lockdown period (2020). However, the relative increase in the cytological workload in the late part of the post-lockdown is a promising finding of a slow return to normality.

Horseshoe Kidney Complicated by Xanthogranulomatous Pyelonephritis in a Young Girl: A Case Report and Review of the Literature

The cases of horseshoe kidney presented by xanthogranulomatous pyelonephritis are very rare. In this study, the case of XGP developing in HSK in a young female patient was presented due to its rare incidence and the previously reported cases were reviewed, as well. The patient, who has end-stage renal disease and was under treatment, admitted to the clinic for preemptive kidney transplantation. Bilateral open en bloc nephrectomy was performed before the kidney transplantation. The histopathological examination of the specimen was reported as XGP. Eight months later, living-donor organ transplantation was performed to the patient with the kidney obtained from her father. XGP can present as a complication of HSK. Moreover, HSK may rarely be manifested by end-stage renal disease in young patients. In such cases, who would undergo kidney transplantation, it is important to examine the HSK in detail and perform bilateral nephrectomy to prevent complications after transplantation.

Global impact of the COVID-19 pandemic on cytopathology practice: Results from an international survey of laboratories in 23 countries

BACKGROUND

To the authors' knowledge, the impact of the coronavirus disease 2019 (COVID-19) pandemic on cytopathology practices worldwide has not been investigated formally. In the current study, data from 41 respondents from 23 countries were reported.

METHODS

Data regarding the activity of each cytopathology laboratory during 4 weeks of COVID-19 lockdown were collected and compared with those obtained during the corresponding period in 2019. The overall number and percentage of exfoliative and fine-needle aspiration cytology samples from each anatomic site were recorded. Differences in the malignancy and suspicious rates between the 2 periods were analyzed using a meta-analytical approach.

RESULTS

Overall, the sample volume was lower compared with 2019 (104,319 samples vs 190,225 samples), with an average volume reduction of 45.3% (range, 0.1%-98.0%). The percentage of samples from the cervicovaginal tract, thyroid, and anorectal region was significantly reduced (P < .05). Conversely, the percentage of samples from the urinary tract, serous cavities, breast, lymph nodes, respiratory tract, salivary glands, central nervous system, gastrointestinal tract, pancreas, liver, and biliary tract increased (P < .05). An overall increase of 5.56% (95% CI, 3.77%-7.35%) in the malignancy rate in nongynecological samples during the COVID-19 pandemic was observed. When the suspicious category was included, the overall increase was 6.95% (95% CI, 4.63%-9.27%).

CONCLUSIONS

The COVID-19 pandemic resulted in a drastic reduction in the total number of cytology specimens regardless of anatomic site or specimen type. The rate of malignancy increased, reflecting the prioritization of patients with cancer who were considered to be at high risk. Prospective monitoring of the effect of delays in access to health services during the lockdown period is warranted.

Fine-needle aspiration washout in the diagnosis of cystic parathyroid adenoma

Cystic parathyroid adenomas are one of the rare causes of neck masses. Due to its rarity, it causes misdiagnosis and wrong treatments and has undesirable consequences. The measurement of parathyroid hormone in fine-needle aspiration washout fluid is a minimally invasive, safe method for the diagnosis of parathyroid cysts and seems to be more useful than Tc-99m sestamibi (MIBI) parathyroid single photon emission computed tomography (SPECT)/CT.

Tubulopapillary adenoma of the common bile duct presenting with jaundice

In this report, an adult patient with tubulopapillary adenoma of the common bile duct that manifested with jaundice is presented. Diagnostic challenges were analyzed. Although adenomas of the common bile duct are rare, they should be kept in mind in the differentiation of lesions of this region. It should be remembered that these lesions radiologically could mimic carcinoma and choledocholithiasis. Endoscopic resection should be considered as the primary method for treatment. Histopathology is the gold standard in diagnosis.

Spontaneous rupture of the kidney in the patients with synchronous renal hemangioma and nephrogenic hypertension

Most renal neoplasms in adults are epithelial in origin and mesenchymal tumors are rarely encountered. Vascular tumors and tumor-like lesions account for a very small subset. Hemangioma of the kidney is a rarely seen benign vascular neoplasm that probably arises from angioblastic cells. Its general sign is macroscopic hematuria with or without pain. Preoperative diagnosis is difficult or impossible. Previously, spontaneous rupture of the kidney caused by renal hemangioma was not reported in the English literature. In this study, two cases with a history of nephrogenic hypertension who presented with spontaneous renal rupture are presented. There wasn't any trauma history in the background of our patients. A long-standing nephrogenic hypertension was present in both patients. Patients underwent radical nephrectomy due to rupture of the renal tumor. In histopathological examination, capillary hemangioma was detected in the renal medulla in both cases. Patients didn't need antihypertensive therapy during the postoperative period.

Lipomatous pleomorphic adenoma in the hard palate: Report of a rare case with cyto-histo correlation and review

Pleomorphic adenoma is the most common benign tumor of the salivary glands. They are usually composed of epithelial/myoepithelial cells and chondromyxoid stroma. Extensive lipomatous differentiation is very rare. We report a case of lipomatous pleomorphic adenoma (LPA) that presented with a mass in the hard palate of a 32-year-old woman. The fine-needle aspiration cytology material was reported as benign cytology consistent with adenoma with major adipocytic component. Histopathological examination of the excision material displayed that more than 90% of the tumor was adipocytic in texture, containing scant epithelial and myoepithelial cells and chondromyxoid stromal fragments. Preoperative cytodiagnosis of lipomatous pleomorphic adenoma on FNA is based on cytomorphology intimately associated pleomorphic adenomatous and lipomatous tissue elements. LPA should be on the mental list of the (cyto)pathologist in differential diagnosis of lipomatous tumors or non-tumorous lipomatosis or carcinoma invasion in the adipose tissue of the minor salivary gland of the hard palate.

Endovesical leiomyoma of bladder: a case report

Benign mesenchymal tumors cover 0,04-0,5% of all bladder tumors and their major part consists of leiomyomas. Having the smooth muscle tissue origin, these tumors can exhibit intramural, endovesical and extravesical localization in the bladder. Clinically, the irritative and obstructive symptoms, hematuria accompany endovesical leiomyomas. Along side being asymptomatic, intramural and extravesical leiomyomas can sometimes be characterized by mass formation, hematuria, and irritative symptoms, rarely by obstructive symptoms. In the diagnostic process histopathology is of great importance, especially in exclusion of radiologically and cystoscopically indistinguishable lesions. A case of endovesical leiomyoma of bladder in 49 year-old male patient admitted to the hospital with a complaint of hematuria and irritative symptoms is presented. Transurethral resection is performed for the patient with the purpose of treatment and diagnosis, and follow-up with ultrasonography was deemed appropriate once every three months. In the macroscopic examination of the material 4,0 cc of white-and-pink-colored, soft tissue fragments from 0,5 to 1,8 cm in diameter were observed. A well-vascularized tumor tissue composed of spindle cells with uniform and elongated nucleuses and normal urothelial epithelium with no specific features on its surface was observed in the microscopic examination. Recurrence wasn`t observed during 32-month follow-up. As bladder leiomyoma is a rare pathology, generally accepted follow-up scheme for this disease after the treatment isn't reported. For this reason, we did the follow-up of the patient in a minimally invasive way that doesn't comply with the EAU guidelines - ultrasonography of urinary tract was performed on the patient on quarterly basis. After the 32 month-follow-up, no recurrence was seen. As a result, the bladder leiomyoma is a rare, and it requires careful pathological examination. Due to the lack of knowledge about this tumor large scale of studies.

Gingival granular cell tumor of the newborn: a case report and review of literature

The etiology and histogenesis of granular cell tumor are still debated. Granular cell tumor of the newborn is considered to be a different entity than the adult form of this lesion with different immunohistochemical features. We present a case of a rare gingival granular cell tumor in a newborn and review the literature. Gingival granular cell tumor must be clinically differentiated from teratoma, congenital dermoid cyst, congenital fibrosarcoma, hemangioma, lymphangioma, leiomyoma, rhabdomyoma, heterotopic gastrointestinal cyst, congenital cystic choristoma and congenital lipoma. Surface ulceration or pseudoepitheliomatous hyperplasia may lead to confusion with malignancy.