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Report Produced: 02/25/2026 12:29 PM

Report Question ID Question Discussion Answer Year
20170037

Primary site--Other and Unspecified Urinary Organs: What is the topography code for a Skene's gland adenocarcinoma?

The most appropriate available topography code is C681, paraurethral gland. Skene's gland is also referred to as paraurethral gland.

 2017
20170076

MP/H Rules/Histology--Brain and CNS: Is meningioma with atypical features coded as meningioma (9530/0) or atypical meningioma (9539/1)? See Discussion.

Pathology report microscopic description: The tumor is a meningothelial neoplasm (EMA+; BCL-2 and CD34 negative) with prominent collagen deposition. Necrosis and prominent nucleoli are present; no other atypical features are seen. Mitoses are present, up to 2 per 10 high-powered fields. Final Diagnosis: Dura, bicoronal craniotomy (specimen A): Meningioma with atypical features.

There is no rule in benign brain and CNS section of Multiple Primary/Histology (MP/H) Rules stating to code the most specific histologic term when the diagnosis is (something less specific, i.e., adenocarcinoma). This rule is in other site chapters of MP/H but appears missing in the benign brain and CNS section.

Code as meningioma, NOS (9530/0). This lesion has some of the features of an atypical meningioma (necrosis and prominent nucleoli), but it does not fit the definition of atypical meningioma in WHO Classification of Tumors of the Central Nervous System. Use text fields to document the details.

 2017
20170006

Diagnostic confirmation--Heme & Lymphoid Neoplasms (Lymphoma): To code "3" in Diagnostic Confirmation, does the genetic testing need to confirm a specific histology or is it enough that is simply rules out others? See Discussion.

For example, pathology states: Right axillary lymph node, excision: Diffuse large B-cell lymphoma (DLBCL) (see note). COMMENT: FISH studies were performed that were negative for BCL-6, c-Myc/IgH, CCND1/IgH and IgH/BCl-2 gene rearrangement, ruling out the most common forms of double-hit lymphoma. Flow cytometry studies demonstrated positivity for CD45, CD20, HLA-Dr, CD19, CD11c, CD22, CD30, CD38, CD79b, and FMC7. Low positivity was seen for CD5. No reactivity was seen for CD10, CD23, CD25, CD103 or CD123.

Both histologic plus immunophenotyping or genetic testing should be positive to assign code 3 for Diagnostic Confirmation. The Hematopoietic and Lymphoid Neoplasm Coding Manual Diagnostic Confirmation instructions state, assign 3 for

Cases positive for 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 DB AND a.) Confirms the neoplasm OR b.) Identifies a more specific histology (not preceded by ambiguous terminology).

Because the patient was diagnosed with DLBCL by histology, and flow cytometry was positive for CD antigens (immunophenotyping) 20, 22, and 30 for DLBCL, code 3 is appropriate.

 2017
20170073

Histology/Behavior--Brain and CNS: How are histology and behavior coded for a diagnosis of pineal anlage tumor in an infant? See Discussion.

Patient is an 11 month old with brain biopsy showing final diagnosis of pineal anlage tumor. How are behavior and histology coded for this rare tumor?

Assign 9362/3 for pineal anlage tumors. According to the WHO Classification of Tumors of the Central Nervous System, 4th edition, pineal anlage tumors, while extremely rare, share features with pineoblastoma. Although they have a distinct morphology, there is no other ICD-O-3 code for pineal anlage tumors.

 2017
20170017

MP/H Rules/Multiple primaries--Liver: How many primaries of the same site and histology are reported if tumors appear years apart but neither is surgically removed? See Discussion.

Patient has an April 2009 biopsy proven diagnosis of cholangiocarcinoma with a single liver mass in segment 4 that was treated with TACE and systemic chemotherapy. The treated lesion was stated to be stable in subsequent scans performed between 2010 and late 2015.

December 2015 imaging identified a new mass in the left hepatic lobe consistent with cholangiocarcinoma. Is the 2015 tumor a new primary?

In auditing files for expected (but not received) abstracts due from facilities, we've observed these types of cases not being consistently reported as multiple primaries.

Abstract as a single primary. The 2009 liver tumor remained "stable" following treatment and the patient was never disease free.

 2017
20170064

Grade/Histology--Rectum: How should histology and grade be coded for high grade neuroendocrine tumor (NET) (WHO Grade 3) of the rectum? See Discussion.

Rectal mass biopsy final diagnosis: High grade neuroendocrine tumor (WHO Grade 3). Neither SINQ 20170033 nor 20160023 address coding histology or grade for neuroendocrine tumors that are designated as high grade and/or WHO grade 3.

Assign histology code 8246/3. Assign grade code 4 based on the description "high grade." A high-grade neuroendocrine "tumor" is actually a neuroendocrine "carcinoma" (NEC) according to WHO Classification of Tumors of the Digestive System. If possible, verify this interpretation with the diagnosing pathologist. Use text fields to document the details of this case.

 2017
20170078

Scope of Regional Lymph Node Surgery--Lung: How do you code Regional Nodes Positive, Regional Nodes Examined, and Scope of Regional Lymph Node Surgery when a fine needle aspirate (FNA) or biopsy of supraclavicular lymph nodes is positive for a lung cancer primary? Supraclavicular lymph nodes are distant in SEER Summary Stage and regional by AJCC. See Discussion.

There is a discrepancy in regional lymph nodes for lung between SEER and AJCC. Supraclavicular lymph nodes/cervical lymph nodes are distant for SEER but regional for AJCC. For SEER states, when there is an FNA or biopsy of a supraclavicular lymph node performed and it is positive for a lung primary and no other lymph nodes are examined, do you code 95 in Regional Nodes Positive/Regional Nodes Examined and code "1" for Scope of Regional Lymph Node Surgery or do you not count the FNA/biopsy of the supraclavicular lymph node since it is distant?

For cases diagnosed through 2017, use the Collaborative Staging (CS) system to determine regional versus distant lymph nodes. Supraclavicular lymph nodes are regional for lung in CS.

Please note that Summary Stage is not the same as EOD, CS, or AJCC staging. Registrars should not use Summary Stage definitions for anything other than directly assigning the Summary Stage field.

 2017
20170029

Reportability--Bone: Are giant cell tumors (GCT) of the bone that metastasize to the lung reportable? See Discussion.

Patient had radical resection of pelvic giant cell tumor of bone in August 2012. Final diagnosis clarified that no features to suggest a frankly malignant giant cell tumor were identified.

July 2013 left upper lobe nodules were removed and found to be consistent with multifocal metastatic lung involvement with a previous pelvic giant cell tumor of bone. However, the pathology report comment specifies there are no histological high-grade features to suggest a malignancy:

While SINQ 20091087 may apply, these metastases clearly arrived in the lung by hematogenous spread. The previous SINQ note refers to a case where the implants/metastases can seed the surrounding pelvic and abdominal structures by rupture of the tumor or intraoperative tumor spillage. That type of spread is not quite the same as the current case showing tumor cells leaving the primary tumor/site and travelling through the blood to implant in the lungs.

This case is not reportable. According to the WHO Classification of Bone Tumors, pulmonary metastases from GCTs are "very slow-growing and are thought to represent pulmonary implants that result from embolization of intravascular growths of GCT. Some of these benign pulmonary implants can regress spontaneously. A small number, however, exhibit progressive enlargement and can lead to the death of the patient." The pathologist for this case is very clear that no malignancy was found in the lung or in the bone.

 2017
20170025

MP/H Rules/Multiple primaries--Breast: Is this the same primary per MP/H Rule M10? Ductal carcinoma of the left breast in 2013, treated with a lumpectomy. New tumor with ductal and lobular carcinoma in the same breast in 2016.

The 2016 diagnosis is the same primary. MP/H Rule M10 for breast cancer applies. Do not change the original histology code. Use text fields to document the later histologic type -- duct and lobular.

 2017
20170040

MP/H Rules/Histology--Lung: What is the histology code for lung cancer case identified pathologically from a metastatic site that differs from the histology stated by the physician? See Discussion.

Bronchial washings were negative. Four lymph nodes were biopsied and found to have metastatic poorly differentiated neuroendocrine carcinoma. The treating oncologist calls it small cell carcinoma, extensive stage, and treats patient with carboplatin and VP-16 (etoposide) The MP/H rule says to take path/cyto from a metastatic site if no pathology/cytology available from the primary site. Is the physician's statement and treatment taken into consideration here?

Code the histology based on the pathology report from the lymph node biopsy for this case. Pathology has higher priority than a physician's statement for assigning histology code. Use text fields to document the physician's statement.

 2017