MP/H Rules/Histology--Lung: How many primaries should be abstracted when a patient has an adenocarcinoma with bronchioalveolar-like features in the right upper lobe, adenocarcinoma in the right middle lobe and non-small cell carcinoma with clear cell features in the right lower lobe? See Discussion.
A RUL lung wedge resection and RML and RLL lobectomies were performed. The RUL resection showed invasive adenocarcinoma with bronchioalveolar-like features. Tumor size 9x.9x.8cm. The RLL lobectomy showed invasive non-small cell carcinoma with clear cell features. Tumor size 4.1x2.5x1.8cm. The RML lobectomy showed invasive adenocarcinoma. Tumor size 3.0x1.6x2.2cm.
Comment: Essentially three invasive tumors and a focus of bronchioalveolar carcinoma were identified in 3 specimens. All of the tumors appear somewhat histologically different. The larger tumors in the right upper and middle lobe were somewhat similar but still appear histologically different and therefore the pathologic staging is done based on all tumors being separate. The pathologic staging for this case is pT2(4) pN0 pMX.
What histology code and what site code are to be used on each abstract?
For cases diagnosed 2007 or later:
Abstract two primaries:
C349 with histology coded to 8140 - invasive adenocarcinoma (RUL and RML)
C343 with histology coded to 8310 - invasive non-small cell carcinoma with clear cell features (RLL)
First, determine the number of tumors. There are three separate tumors in right lung in the example above:
RUL: invasive adenocarcinoma, bronchioalveolar-like features (8140, "-like" is not on the list of ambiguous terms used to code histology)
RLL: invasive non-small cell carcinoma with clear cell features (8310)
RML: invasive adenocarcinoma (8140)
Because there are three tumors, begin with rule M3 in the Multiple Tumors module. Stop at rule M11, multiple primaries for the tumor in the RLL (8310) compared to the tumors in the RUL and RML (8140 and 8140).
Now evaluate the tumors in the RUL and RML using the multiple primary rules. Start at rule M3 and stop at rule M12, single primary.
Grade, Differentiation--Bladder: Can grade be coded from the pathology report for a recurrent bladder cancer specimen? See Discussion.
In 2006 a TURB was done for bladder carcinoma diagnosed 10 years ago. Is grade always coded 9 on class 3 cases unless the original slides were reviewed?
Code grade from the original tumor; do not code grade from recurrence.
If the grade of the original primary tumor is specified, code it, regardless of class of case.
Reportability--Brain and CNS: In addition to Schwannoma, are there additional types of benign tumors that arise in peripheral nerves along the spinal cord that are not reportable? See Discussion.
Are neuroepitheliomatous neoplasms such as ganglioneuroma, gangliocytoma, ganglioglioma occurring along the spinal cord reportable? Are nerve sheath tumors such as neuroma occurring along the spinal cord reportable? Angioma?
Reference: SINQ 20051071; Primary Central Nervous System Tumors, NPCR Training Materials 2004
Reportability depends on the location of the tumor. Tumors in the following sites are reportable:
C700 - C709
C710 - C719
C720 - C729
C751 - C753
Benign and borderline tumors of the peripheral nerves (C47_), including peripheral nerves along the spinal cord, are not reportable.
Please note: spinal schwannomas arising in the nerve root or spinal dura are reportable.
Histology--Lymphoma: How is a "lymphocytic lymphoma of follicular center cell origin" coded?
For cases diagnosed prior to 1/1/2010:Assign code 9690 [Follicular lymphoma, NOS]. According to the WHO Classification of Lymphoid tumors, follicular lymphoma is a neoplasm of follicle center B cells which has at least a partially follicular pattern.
Assign code 9695 for follicular lymphoma grade 1, 9691 for follicular lymphoma grade 2, and 9698 for follicular lymphoma grade 3.
For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
MP/H Rules/Histology--Thyroid: Is a "papillary carcinoma of the thyroid" coded to 8260/3 [Papillary adenocarcinoma] per the ICD-O-3 because it lists "papillary carcinoma of the thyroid" as a synonym for that code or should it be coded to 8050 [Papillary carcinoma, NOS]?
For cases diagnosed 2007 or later, assign code 8260 [papilary carcinoma of the thyroid].
Ambiguous Terminology/Date of Conclusive Terminology: If there is an unknown date of diagnosis, should the Ambiguous Terminology field always be coded to 9 and the Date of Conclusive Terminology be coded to 99999999? See Discussion.
Scenario: Mammogram is suspicious for carcinoma, unknown date in 2007. A biopsy prior to admission to reporting facility is positive for carcinoma. Patient seen at reporting facility in June 2007 for treatment.
The purpose of the data item "Ambiguous Terminology" is to flag cases entered into the registry based on a diagnosis with ambiguous terminology. Because the case above was entered into the registry based on conclusive terminology, code Ambiguous Terminology to 0 [Conclusive term] and code Date of Conclusive Terminology to 88888888 [not applicable].
Primary Site: For malignant gastrointestinal tumors (GISTs), how should the primary site be coded and which Collaborative Stage and TNM staging schemes should be used for disease found in the stomach, small intestine or other locations?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code the primary site to the location where the GIST originated. If the primary site cannot be determined, assign code C809 [Unknown primary site].
GIST of gastrointestinal hollow viscera cannot be staged in TNM.
In Collaborative Staging, use the stomach scheme for GIST of the stomach. Use the small intestine scheme for GIST of the small intestine. For GIST of other primary sites, use the CS scheme for the specific site.
MP/H Rules/Multiple Primaries--Bladder/Renal Pelvis: Is a non-invasive papillary transitional cell carcinoma of the bladder diagnosed one year after the occurrence of an invasive papillary transitional cell carcinoma of the renal pelvis reported as one or two primaries?
For cases diagnosed 2007 or later:
This is a single primary with renal pelvis as primary site.
Use the 2007 MP/H rules to determine if the 2007 diagnosis is a new primary. Use the Urinary rules, multiple tumors module. Start with rule M3. Follow the rules down to Rule M8 and stop. This is an example of implantation effect.
Reportability--Breast: Is a final path diagnosis of "phyllodes tumor, borderline (malignant, low grade)" reportable if the comment states "Features favor the diagnosis of a borderline phyllodes tumor (or also called malignant phyllodes tumor of low grade)"?
No, borderline phyllodes tumors (PT) are not reportable. The ICD-O-3 code is 9020/1. According to the WHO Classification of Tumours of the Breast and Female Genital Organs, borderline PT's are also called low grade malignant PT's.
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