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Solid Tumor Rules/Histology--Lung: How is histology coded and which H Rule applies for a lung adenocarcinoma when the greatest percentage of the adenocarcinoma is stated to be, "solid; complex glands (cribriform and fused glands) (50%)"? See Discussion.
In 01/2023, right lower lobectomy final diagnosis proved
a single adenocarcinoma tumor with the histological patterns described as
acinar (20%), papillary (30%) and solid; complex glands (cribriform and fused
glands) (50%). There is no H Rule applicable to a complex glandular pattern
adenocarcinoma. Is this equivalent to a solid predominant adenocarcinoma (8230)
per Rule H7? Or is the predominant adenocarcinoma a mixed subtype coded as 8255
per Rule H9?
Histology code 8255/3 best identifies this histology. Complex glands in lung tumors are often associated with a poor prognosis and represent a high-grade pattern in lung cancer grading systems. This histology is not currently recognized as a variant by WHO.
Reportability--Liver: Is a 2023 cholangiocarcinoma case
with Liver Imaging Reporting And Data System (LI-RADS) M (LR-M) lesion on
imaging reportable?
Report LR-M unless there is information to the contrary.
The American College of Radiology defines LR-M as "probably or definitely
malignant, not necessarily hepatocellular carcinoma (HCC)."
Immunotherapy/Other
Therapy--Heme & Lymphoid Neoplasms: Is the elimination of immunosuppression
treatment coded as other treatment? An example is when a post-transplant
patient develops a malignant myeloproliferative neoplasm that subsides when
immunosuppression drugs are stopped.
Do not code as a treatment. Record the cessation of
immunosuppressive drug treatment in text to explain the patient’s change in
disease status.
Sequence Number--Central/Reportability--Heme &
Lymphoid Neoplasms: Is a hematolymphoid disease included in the sequencing if it
was not reportable at the time of diagnosis?
Do not include the disease in the sequencing if the
original hematolymphoid disease was not reportable at time of diagnosis.
The 2025 SEER Manual Sequence Number--Central
Coding Instruction 1.a advises: A ‘reportable’ primary refers to the
site/histology/behavior of the tumor and the years when reporting was required.
Review of the reportability requirements in effect during the diagnosis year
will be needed.
Diagnostic Confirmation--Heme & Lymphoid Neoplasms: How
is Diagnostic Confirmation coded for hematopoietic and lymphoid neoplasms (heme)
when immunophenotyping, genetics, etc. confirm the diagnosis.
Assign Code 3 (Positive histology PLUS positive immunophenotyping or genetic testing) for
1. Cases with positive histology for the neoplasm being abstracted (including acceptable ambiguous terminology and provisional diagnosis), AND
Immunophenotyping, genetic testing, or JAK2 is listed in the Definitive Diagnosis in the Heme Database, AND
Testing
Confirms
the neoplasm OR
Identifies a more specific histology (not preceded by ambiguous terminology)
Peripheral blood smear followed by flow cytometry (most commonly done with CLL/SLL, 9823/3)
2. A not otherwise specified (NOS) histology diagnosed and not a provisional diagnosis, AND genetic/immunophenotyping was performed and positive
Refer to the current version of the Heme Manual for specific notes and examples when coding Diagnostic Confirmation.
Reportability/Behavior:
Our registry collects some borderline (behavior /1) cases that are not
reportable to SEER or any other standard setters. Can we assign a behavior code
of /2 to these cases?
Do not assign a behavior code of /2 to these cases unless you
have a way to flag them so that they are not reported to the standard setters
as in situ cases. Work with your state central registry to ensure that these cases are not unintentionally included in state case submission.
Reportability/Behavior--Ovary: Is ovarian mucinous
borderline tumor with foci of multifocal intraepithelial carcinoma reportable?
Report ovarian mucinous borderline tumor with foci of
multifocal intraepithelial carcinoma. The foci of intraepithelial carcinoma
makes this reportable. See the list of synonyms for in situ in the SEER Manual,
Behavior Code data item.
Reportability/Histology--Heme
& Lymphoid Neoplasms: Is a diagnosis of myeloid stem cell disorder or
myeloid stem cell neoplasm reportable when the differential diagnosis includes
only reportable neoplasms? If so, how should histology be coded? See Discussion.
Pathologists are increasingly using the terms "myeloid stem cell disorder" and "myeloid stem cell neoplasm" to describe reportable myeloid neoplasms. If the pathologist uses these terms and indicates the differential diagnosis includes only reportable neoplasms such as myelodysplastic syndrome, myeloproliferative neoplasm, and acute myeloid leukemia (AML), should this be accessioned as a reportable primary?
Example: The 01/2023 peripheral blood shows high grade myeloid stem cell disorder, and the differential diagnosis includes chronic
myelomonocytic leukemia(CMML) and AML. The patient refused further work-up and expired several days later. No additional information is available.
Report the case when the differential diagnosis includes only reportable neoplasms
in the absence of additional information. We are unable to provide
general instructions for provisional diagnoses as each situation will need to be
reviewed and assessed individually when no further work-up information is available.
Assign myeloid
leukemia, NOS (9860/3) to the case described in the example. Assign a generic histology code because a specific
histology code cannot be assigned when there are several differential diagnoses. Since the differential
diagnoses include a chronic and an acute leukemia, code as myeloid leukemia, NOS since it is not clear if this is chronic or acute.
Solid Tumor Rules/Histology--Fallopian Tube: How is histology coded for a high-grade serous carcinoma with admixed yolk sac tumor of the right fallopian tube? See Discussion.
There was a single right fallopian tube tumor with two distinct morphologies. The diagnosis comment states, “The combined morphologic and immunohistochemical features are best classified as primary fallopian tube high grade serous carcinoma with a somatically derived yolk sac tumor.”
Assign high-grade serous carcinoma of the fallopian tube (8461/3). There is currently no code to capture this rare mixed histology. Yolk sac tumors rarely occur in the fallopian tubes of postmenopausal patients and are associated with poor outcome. It is important to document the findings in the appropriate text field.
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