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Assign code 17 for irreversible electroporation ablation of the prostate when there is no tissue submitted to pathology for a 2021 or 2022 case.

Assign code A170 for a 2023 case.

Assign 000 for EOD Regional Nodes when you have a pathology only report with a localized tumor based on Breslow’s depth and/or Clark’s Level (per EOD and/or Summary Stage) and no information on regional lymph nodes or mets. When the tumor is noted to be regional or distant based on Breslow’s Depth and/or Clark’s based on the definitions in EOD and/or Summary Stage, do not assume that the nodes are negative and assign 999. Clarification will be added to the EOD manual.

NTRK-rearranged spindle cell neoplasm is a newly identified variant of sarcoma; however, WHO has not yet proposed a specific ICD-O code for this rare neoplasm. Code to spindle cell sarcoma (8801/3).

WHO defines NTRK-rearranged spindle cell neoplasm as an emerging group of molecularly defined rare soft tissue tumors that span a wide group of morphologies and histological grades, and are most often characterized by a spindle cell phenotype among other characteristics.

Abstract two primaries using the 2023 Solid Tumor Rules, Other Sites, Rule M19, as adenocarcinoma and pancreatic neuroendocrine tumors are two distinct histologies.  The WHO Classification of Digestive Tumors, 5th ed., Chapter 10-Tumors of the Pancreas, lists both epithelial tumors and neuroendocrine neoplasm as separate entities.  The Solid Tumor Rules histology-specific tables contain histologies that commonly occur in the 19 site-specific histology tables; therefore, not all histologies are listed in the rules. Further, the adenocarcinoma would be staged in the Pancreas Schema, while the neuroendocrine tumor would be staged in the NET Pancreas schema.

We will consider adding PanNETs to Table 11 in a future release of the Solid Tumor Rules.

Assign code 40, Pull through WITH sphincter preservation (colo-anal anastomosis).  The National Cancer Institute Dictionary of Cancer Terms defines coloanal anastomosis as a surgical procedure in which the colon is attached to the anus after the rectum has been removed. It is also called coloanal pull-through.

Abstract a single primary using Breast Solid Tumor Rules, Rule M18, as none of the previous rules apply.

Undifferentiated carcinoma is a malignant epithelial tumour lacking overt evidence of a specific line of differentiation. Dedifferentiated carcinoma is composed of an undifferentiated carcinoma and a differentiated component. Dedifferentiated carcinoma (8020/3) as a morphology is associated with cancer of the endometrium and ovary rather than the breast.  Breast cancer shows a broad spectrum of morphology with extensive variation in histological type and grade, related to the complexity of carcinogenesis.  This includes initial genetic changes in the cell of origin, subsequent genetic and epigenetic alterations, and reprogramming that occur at various stages of development along with interaction of other factors that influence the process of differentiation.  This scenario likely represents the process of phenotypic change of a carcinoma at a later stage, better known as transdifferentiation.

Report intracholecystic papillary neoplasm (ICPN) with high-grade dysplasia (8503/2) of the gallbladder.

Code AML with monocytic differentiation as acute myeloid leukemia, NOS (9861/3) per consultation with our expert hematopathologist.

Acute monoblastic and monocytic leukemia (9891/3) and acute myelomonocytic leukemia (9867/3) are distinct entities according to the WHO. "AML with monocytic differentiation" is a descriptive diagnosis, whereas, "Acute monoblastic and monocytic leukemia" are specific diagnoses. In the WHO Classification of Tumours, Central nervous system tumours (4th Ed) in 2016, WHO began integrating information on molecular alterations that provide significant prognostic implications and/or a therapeutic target into the histology code/term itself. As a result it is also important to look at the molecular testing because acute myeloid leukemias can have different molecular mutations that could result in coding to a different histology code. In this case, there was no other information regarding additional immunophenotyping, so that is why AML, NOS was assigned.  Acute myeloid leukemia with monocytic differentiation has been added to the Hematopoietic and Lymphoid Neoplasm Database as an alternate name for 9861/3.

Use the ambiguous terminology list as a guide in the absence of additional information after reviewing all available information and consulting the physician who diagnosed and/or staged the tumor. 

Equivalent to "Diagnostic for" malignancy or reportable diagnosis

• most certainly carcinoma
• malignant until proven otherwise

Not Equivalent to "Diagnostic for" malignancy or reportable diagnosis

• almost certainly ("almost" conveys uncertainty in comparison to "most" as in "most certainly")

We will update SINQ 20180104.

Assign code 500 for EOD Primary Tumor and code 30 for EOD Mets. This will correctly derive the T4aM1b stage based on AJCC 8th edition.

Abstraction of peritoneal metastasis changed from the T category in the AJCC 7th edition to the M category in the 8th and 9th AJCC editions. As a result, for cases diagnosed in 2018 and later, peritoneal deposits in the right lower quadrant should be abstracted as EOD Primary Tumor code 500 and EOD Mets code 30. However, the EOD Primary Tumor code of 600 has not yet been updated to align with the 8th and 9th AJCC editions. The 2025 updates will correct for this via a conversion for cases diagnosed in 2018 and forward where EOD Primary Tumor = 600 and EOD Mets = 00 or 10 to EOD Primary Tumor = 500 and EOD Mets = 30. Effective immediately, abstract peritoneal deposits in the right lower quadrant as EOD Primary Tumor code 500 and EOD Mets code 30, even though you will still have the ability to assign EOD Primary Tumor code 600 in your abstraction software until the 2025 updates are deployed.