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20160031 | MP/H Rules/Histology--Brain and CNS: What is the code for Rosette-forming glioneural tumor from a pathology report of a brain tumor biopsy for a date of diagnosis in 2015? See Discussion. |
This diagnosis is not listed in the ICD-O-3 though it is listed as code 9509/1 for this specific tumor in the 2007 WHO classification of Tumours of Central Nervous System. (See link: http://link.springer.com/article/10.1007/s00401-007-0243-4/fulltext.html.) |
Assign 9505/1 for Rosette-forming glioneuronal tumor. The new code, 9509/1, has not been implemented in the United States. 9505/1 is to be used until the new code is implemented. See page 7 of the NAACCR Guidelines for ICD-O-D Implementation, effective January 1, 2014, http://www.naaccr.org/LinkClick.aspx?fileticket=u7d3sB71t5w%3d&tabid=126&mid=466. |
2016 |
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20160024 | Reportability--Melanoma: Please explain how a CTR is to interpret the guideline in the MP/H rules (Cutaneous Melanoma): Evolving melanoma (borderline evolving melanoma): Evolving melanoma are tumors of uncertain biologic behavior. Histological changes of borderline evolving melanoma are too subtle for a definitive diagnosis of melanoma in situ. Is this to mean that evolving melanoma in situ is not reportable? Or should we follow the guidelines in SEER Question 20130022 that states the reportability terms for melanoma and melanoma in situ. |
Follow the guidelines in SINQ 20130022 for now. When the MP/H rules are revised, new instructions will be implemented.
See also SINQ 200120078 and 20110069. |
2016 | |
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20160054 | MP/H Rules/Multiple primaries--Melanoma: How many melanoma primaries should be abstracted if, during the workup for a metastatic melanoma of an unknown cutaneous site, an in situ melanoma is also discovered? See Discussion. |
Patient has diagnosis of melanoma with spindle cell features found in a right lower lobectomy specimen. Chart notes indicate this is metastatic from a cutaneous primary of unknown site. Further work up includes a biopsy of the tip of the nose, which is diagnostic for in situ melanoma. Should this be abstracted as two separate primaries, one for an invasive melanoma of unknown primary site and the other for an in situ melanoma of the skin on the tip of the nose? Which MP/H Rule would apply? |
Yes, abstract this as two separate primaries, an invasive melanoma of unknown primary site and an in situ melanoma of the skin on the tip of the nose. Rule M3 applies. |
2016 |
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20160065 | MP/H Rules/Histology--Lung: What histology code and MP/H Rule applies to the Histologic Type described as adenocarcinoma, mixed invasive mucinous and non-mucinous which involves multiple lung tumors present in a single lobe? See Discussion. |
The patient had a lower lobectomy with final diagnosis of adenocarcinoma with the following features: Tumor Focality: Multiple separate tumor nodules in same lobe; Tumor Size: 2.6 cm, 0.7 cm, 0.3 cm and 0.1 cm in greatest dimension; Histologic Type: Adenocarcinoma, mixed invasive mucinous and non-mucinous adenocarcinoma; Histologic Grade: Moderately differentiated. |
Assign histology code 8254/3.
The 2007 MP/H Lung rules do not include coding guidelines for mixed mucinous and non-mucinous tumors. Lung Table 1 (in the Terms and Definitions, pages 37-38, http://seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf ) is very specific about which histologies can be coded to mixed adenocarcinoma (8255/3). Mucinous is not included per the note at the end of Table 1. Per WHO 3rd and 4th Ed Tumors of the Lung, mixed mucinous and non-mucinous tumors of the lung are classified as 8254/3. Mixed invasive mucinous and non-mucinous adenocarcinoma is a synonym for BAC, mucinous and non-mucinous. |
2016 |
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20160073 | MP/H Rules/Multiple primaries/Histology: What histology and how many primaries are coded for a mixed germ cell tumor with a somatic type malignancy (rhabdomysarcoma) if the patient was diagnosed with seminoma of the testis in 2009 followed by a 2015 metastatic germ cell tumor in a retroperitoneal lymph node, stated to be a recurrence of the testicular cancer? See Discussion. |
In September 2009 the patient was diagnosed with seminoma, classical type, following an orchiectomy. Testicular mass recurrence in 2014 was treated with chemotherapy. Then in April 2015 a retroperitoneal dissection of a peri-aortic LN was positive for mixed germ cell tumor with somatic type malignancy (rhabdomyosarcoma) involving 1/11 nodes. Path Comment: major component of tumor is teratoma, rhabdomyosarcoma represents <5% of mass. Now in October 2016, the patient has a retroperitoneal mass biopsy positive for spindle cell sarcoma with rhabdomyosarcomatous differentiation. The comment section of the pathology report states, "Given the history of a germ cell tumor w/ rhadbomosarcomatous component, the findings are consistent with a recurrence of rhabdomyosarcomatous component of germ cell tumor." Can a seminoma transform to a mixed germ cell tumor with a somatic type malignancy (see SINQ 20140082 - testicular teratoma with somatic type malignancy)? |
According to our expert pathologist consultant, yes, seminoma could transform to a mixed germ cell tumor with a somatic type malignancy. He advises us to code this case as 9061/3. From our expert pathologist consultant: This occurs as "reprogramming" of the initial germ cell tumor/seminoma cell. The process is not understood, but genetic studies support this progression concept. Most often the next step is teratoma. It is out of the teratoma that the somatic malignancy usually comes. I do wonder about the possibility that this was really an embryonal carcinoma which resembles a seminoma - occasionally this can be a difficult separation. I wonder if they radiated the scrotum following the orchiectomy, also, given the scrotal recurrence. |
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20160012 | Reportability--Brain and CNS: Is a thalamic amyloidoma reportable if so what histology code is used? |
Thalamic amyloidoma is not reportable. Amyloidoma (tumoral amyloidosis, amyloid tumor) is a tumor-like deposit of amyloid. It is not neoplastic. Amyloid is a protein derived substance deposited in various clinical settings. |
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20160064 | Behavior--Prostate: What is the correct behavior of intraductal carcinoma from a prostate biopsy with a Gleason score 4+4=8. While highly aggressive, but not suggestive of invasion, coding behavior as /2 seems inappropriate. |
WHO classifies intraductal carcinoma of the prostate 8500/2. According to WHO, "the hallmark of intraductal carcinoma of the prostate is a proliferation of prostate carcinoma cells that is within and may significantly expand the native prostatic ducts and acini, with the basal cell layer at least partially preserved." Further, differentiation between intraductal carcinoma and infiltrating high-grade carcinoma of the prostate may require basal cell stains. Under Prognosis, WHO states: " intraductal carcinoma of the prostate on prostate biopsies is often associated with high-grade cancer (with a mean Gleason score of 8) ." So while it may seem counter-intuitive, assign behavior code /2 when the diagnosis is intraductal carcinoma of the prostate. |
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20160050 | Reportability--Appendix: Is a mucinous cystic neoplasm with high grade dysplasia of the appendix reportable? See discussion. |
The language appears similar to the mucinous cystic neoplasm of the pancreas with high grade dysplasia (8470/2), which was clarified to be reportable in 2014. |
WHO does not list MCN as a histology for the appendix. This case should be clarified with the pathologist.
For pancreas specifically, the term "mucinous cystic neoplasm (MCN) with high grade dysplasia" replaced the term "mucinous cystadenocarcinoma, noninvasive" according to WHO. MCN with high grade dysplasia of the pancreas is reportable because it is used in place of the now obsolete terminology. If we did not make the new terminology reportable, trends over time could be affected.
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20160015 | Multiple primaries--Heme & Lymphoid Neoplasms: Could you please clarify Note 2 found in Rule M10, which is " 'Transformations to' (acute neoplasms) and 'Transformations from' (chronic neoplasms) are defined for each applicable histology in the database." Do the neoplasms being considered have to contain the words 'chronic' and/or 'acute'? |
Hematopoietic neoplasms that transform generally don't have 'chronic' or 'acute' as part of their preferred name. The 'chronic' and 'acute' designations are determined by the usual course of the neoplasm. Chronic neoplasms are generally slow growing while acute neoplasms grow fast and are more widespread. Not all Hematopoietic neoplasms transform. Each neoplasm that has the ability to transform has the transformations listed under the 'Transformations to' and/or 'Transformation from' sections in the Hematopoietic database.
For example, Diffuse large B-cell lymphoma (histology code 9680/3) has no histologies/neoplasms listed under 'transformations to.' This means that this neoplasm does not transform to any other neoplasm. There are multiple histologies/neoplasms listed under 'Transformations from' indicating the neoplasms listed under the Transformations from are the chronic neoplasms, and DLBCL is the acute neoplasm. If DLBCL (9680/3) occurs at the same time, within 21 days, or greater than 21 days of any of the histologies listed under 'Transformations From,' rules M8-M13 apply. If DLBCL (9680/3) occurred at the same time as a neoplasm not listed in the Transformations sections, the acute and chronic rules do not apply. |
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20160001 | MP/H Rules/Multiple primaries/Histology--Rectum: How many primaries does this person have and what is the correct histology? See discussion. |
Rectal polyp excised in June, 2012, found to have adenocarcinoma in situ in a tubulovillous adenoma. Additional colorectal biopsies in November; all were negative. Another rectal polyp removed in December 2012 showing a tubulovillous adenoma with focal carcinoma in situ. Then, in February, 2013 another rectal polyp removed. This was diagnosed as mod. diff. adenocarcinoma with mucinous features, infiltrating into submucosa, seen in a background of tubulovillous adenoma. Surgical margins free (mucin %=40%). Finally, in May, 2013, a low anterior resection with no residual adenocarcinoma.
This appears to be adenocarcinoma in multiple adenomatous polyps (8221/3), although the final path from May 2013 described one benign polyp and said, 'no other masses, suspicious lesions or polyps are identified.' Going through the MP/H rules, both M13 and M14 result in this being a single primary, and come before the rule about an invasive tumor following an in situ tumor more than 60 days later is a new primary. The original abstract was coded C209 and 8263/2. If this is a single primary, should it be changed to 8221 with a behavior code of 3? Is this scenario another example of when to change the original diagnosis based on subsequent information? |
Abstract a single primary and code as 8263/3. Other Sites rule M14 applies. The histology code is 8263/3 based on rules H28 and H12. Apply H28 first, make a second pass through the H rules and apply H12. See slide 18 in the "Beyond the Basics" presentation for applicable instructions on a similar situation, http://seer.cancer.gov/tools/mphrules/training_adv/SEER_MPH_Gen_Instruc_06152007.pdf
This case is an example of the need to update the original abstract based on more complete, subsequent, information. |
2016 |
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