MP/H Rules/Histology--Peritoneal primary: Can the cell types from the primary site and a metastatic site be combined to code histology? See Discussion.
Patient has vaginal mass biopsy diagnosed as 'papillary carcinoma with psammoma bodies.' Two weeks later the patient has laparoscopy with multiple peritoneal biopsies, diagnosed as 'well differentiated serous adenocarcinoma'. Patient stated to have peritoneal primary with mets to vagina and was treated with chemotherapy. Do we code the histology to 8441/31 from the primary site biopsies, or can we use 8460/3, combining the cell types from the primary and metastatic sites? Please see SINQ 20041062 for a similar question before the 2007 MP/H rules.
For cases diagnosed 2007 or later, assign code 8441 [serous adenocarcinoma, NOS].
Code the histology from the primary site when available. Do not combine histologies from primary and metastatic sites.
In this primary peritoneal case, the diagnosis from the peritoneal biopsies was serous adenocarcinoma.
Multiplicity Counter--Ovary: Given the diffuse nature of ovarian cancer, should we count bilateral parenchymal involvment of ovaries as two tumors? See Discussion.
Are peritoneal implants mets and not counted as separate tumors, even though they're not stated to be metastatic in the path report, and are not coded as distant mets?
Code Multiplicity Counter to 02 [Two tumors present] for an epithelial ovarian primary involving both ovaries. Do not count the peritoneal implants; they are regional metastasis and not included in the multiplicity counter. An example like this will be added to the manual in the next revision.
CS Lymph Nodes/CS Mets at DX--Ovary: Are lymph nodes in the pericolic mesentery of the sigmoid that are removed during ovarian cancer debulking surgery, coded as regional or distant? See Discussion.
Debulking surgery found tumor in both ovaries and in lymph nodes of pericolic mesentery, which was removed en bloc with a segment of sigmoid colon (colon had tumor implants involving serosa). Pericolic nodes are not listed as regional for ovary. However Note 2 in the CS manual for Extension states "sigmoid mesentery" is a regional pelvic organ, and that metastatic deposits here should be coded in the extension field, not as distant mets. Should lymph nodes from this same area be coded as regional or distant?
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.
Lymph nodes in the mesentery of the sigmoid colon are regional for an ovarian primary. Code involved sigmoid mesenteric nodes under CS Lymph Nodes.
MP/H Rules--Lung: How do we interpret 'spiculated opacities?' How many primaries do we abstract for this patient? See Discussion.
Patient admitted for CT scan of chest. Impression: A small subpleural spiculated opacity is noted in the left upper lobe measuring 9.7x7.7mm. Right upper lobe spiculated nodular opacity measures 13.9x5.9mm. Right lower lobe scattered faint alveolar nodular opacities are noted. The lungs are otherwise clear. Abnormal soft tissue density mass is noted of the right hilum surrounding the distal main right pulmonary artery. Bronchoscopy/mediastinoscopy done: rare malignant cells present consistent with small cell carcinoma, specimen submitted as brushing of right bronchus intermedius. The tumor in the lymph node is metastatic small cell carcinoma. Patient discharged to hospice; died 5 weeks later.
Do the MP/H rules pertain only to the measured opacities in each lung and not to the RLL scattered faint alveolar nodular opacities? The right side was cytologically confirmed. But if we abstract the left lung, what is the histology...8041 or 8000?
For cases diagnosed 2007 or later:
Because there was cytologic confirmation of cancer, for this case only count the spiculated opacities as tumors. Abstract as a single primary using Rule M1. Note 2 under lung rule M1 applies to this case.
Code the histology as 8041 [small cell carcinoma] per rule H10.
Date Multiple Tumors--Prostate: For a prostate biopsy done 10/20/08, both lobes involved with tumor, unknown how many tumors, what would be coded in date of multiple tumors?
In this case, code the date of the biopsy in Date of Multiple Tumors [10202008]. When the number of tumors is unknown, code the date of diagnosis as the Date of Multiple Tumors. This is the date on which it was determined that there were an unknown number of tumors. This instruction will be added to next edition of the MP/H manual.
MP/H Rules/Histology--Lung: What is the correct histology code for a neuroendocrine neoplasm described as a carcinoid and also referred to as oncocytic? See Discussion.
Left mainstem bronchus mass excised: metaplastic endobronchial mucosa with submucosa containing an infiltrating poorly diff malignant tumor. Origin of tumor is not identified in overlying mucosa. IHC stains will be performed.
Addendum #1. IHC stains show well diff neuroendocrine neoplasm, favor carcinoid. Recommend sending this to expert in lung neoplastic pathologist.
For cases diagnosed 2007 or later, code as 8246 [Neuroendocrine carcinoma, NOS]. According to our pathologist consultant, the neuroendocrine description is more specific than the oncocytic description in this case.
CS Extension--Corpus uteri: Can a suspicious cytology be used to code extension? See Discussion.
Endometrial primary confirmed by biopsy on 10/26/06. Pelvic washing on 11/14/06 was 'suspicious for malignancy.' Resection path the same day stated the primary tumor invades the inner 1/3 of the myometrium.
Can we use the pelvic washing cytology & code CS extension 61 or should CS extension be coded 12?
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.Assign extension code 61 [cancer cells in peritoneal washings] for the case described above.
"Suspicious" is listed as a term indicating involvement. There is no exception noted for cytology reports. See page 122 of the 2007 SEER manual.
MP/H Rules--Lung: Per rule M8, tumors of the same site (left lung), same histology (NSCC), greater than 3 yrs apart are separate primaries.
However, there was a recurrence to mediastinal LNs after 2 years. Would that make a difference as to whether the 2008 left lung carcinoma is reportable as a new primary or not? See Discussion.
Scenario: NSCC 2004 LLL with positive hilar/mediastinal LNs treated with LLL lobectomy, chemo and rad. 2006 per CT/PET recurrence in mediastinal LNs treated with chemoradiation. 2008 left lung nodule positive for NSCC stated by MD to be recurrence from 2004 (2008 path not compared to 2004 path).
For cases diagnosed 2007 or later:
The 2008 lung carcinoma is a separate primary according to rule M8. The 2006 diagnosis is metastases to the lymph nodes. Do not apply the MP/H rules to metastases.
MP/H Rules--Breast: For tubulolobular carcinoma, do we use 8522? See Discussion.
Path comment: This mixed variant of ductal and lobular carcinoma has been called in the past tubulolobular carcinoma, however, more recently is a mixed pattern of ductal and lobular carcinoma and not a variant of lobular carcinoma.
For cases diagnosed 2007 or later, use rule H18 and assign code 8524 [lobular mixed with other types of carcinoma]. According to the MP/H rules, tubular is not a specific type of duct or lobular. This is based on the latest WHO classification of breast tumors.
The combination histology of tubular and lobular will be reviewed during the upcoming revision of the MP/H rules.
MP/H Rules--Breast: What histology code is used for lobular carcinoma, pleomorphic type?
For cases diagnosed 2007 or later, use rule H14 and code the histology 8520 [lobular carcinoma]. 8520 is the only ICD-O-3 code for lobular carcinoma. There are no codes for specific lobular types.
An official website of the United States government
Home