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20180100 | Reportability/Primary Site--Skin: Is vulvar intraepithelial neoplasia III (VIN III) or associated invasive squamous cell carcinoma reportable when stated to be of the or or ? See Discussion. |
Example: Operative report states, partial simple vulvectomy, anoscopy with normal-appearing clitoris, clitoral prepuce, bilateral labia majora, and labia minora. There is a 1.5 x 1 cm raised, hyperpigmented lesion which appears consistent with VIN 3 on the perineal body, just to the right of midline, and not touching the midline. It goes quite close to the anus but is not touching the anus. Final diagnosis on resection is, Invasive squamous cell carcinoma arising in a background of high-grade squamous intraepithelial neoplasia (VIN III) with the following features: Location: perineum. Focal invasion arising in setting of 1 cm area of VIN III. |
Squamous carcinoma and squamous intraepithelial neoplasia III arising in the skin of the perineum (C445) are not reportable. Even though the abreviation "VIN III" is used in this example, this lesion does not involve the vulva. Since it involves the perineum, and skin of perineum is coded to C445, it is not reportable. Neoplasms arising in skin (C44) with the following histologies are not reportable. --Malignant neoplasm (8000-8005) --Epithelial carcinoma (8010-8046) --Papillary and squamous cell carcinoma (8050-8084) --Squamous intraepithelial neoplasia III (8077) arising in perianal skin (C445) --Basal cell carcinoma (8090-8110) |
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20180098 | Solid Tumor Rules (2018)/Histology: Please provide further explanation for prioritizing biomarkers in the histology coding rules. See Discussion. |
The 2018 Solid Tumor (ST) Rules General Rules state: For those sites/histologies which have recognized biomarkers, the biomarkers frequently identify the histologic type. Currently there are clinical trials being conducted to determine whether these biomarkers can be used to identify multiple primaries. Follow the Multiple Primary Rules; do not code multiple primaries based on biomarkers. Additionally, Biomarkers is at the top of the priority order to identify histology in several sections (it appears to be excluded from only Colon, Melanoma and Other sections). In the sections that include this rule, there is not much additional information on using biomarkers. Can you please provide further explanation for prioritizing biomarkers in the histology coding rules? For example, will the ST manual be updated when we need to look for specific biomarkers in a diagnosis? |
Instructions for biomarkers will be added to other site rules when applicable. The use of biomarkers to determine a specific histologic type is not yet a standard of care in the majority of cases. |
2018 |
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20180097 | Reportability/Histology--Liver: Are primary hepatic neuroendocrine neoplasm and primary hepatic neuroendocrine tumor (PHNET) reportable? What are the specific histology codes? |
Primary hepatic neuroendocrine tumor (PHNET) is reportable as are other digestive system NETs. There is no specific histology code for PHNET. We suggest you assign 8240/3. Use text fields to document the details. Unless you can obtain clarification, do not report primary hepatic neuroendocrine neoplasm with no further information. If this term is being used as a synonym for PHNET, document this in the registry's policies and procedures, and report these cases. |
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20180096 | Reportability/Histology--Small intestine: Is a neuroendocrine microtumor of the duodenum a reportable tumor? See Discussion. |
This comment was added to the pathology report by the pathologist: A focus of neuroendocrine microtumor measured 350 micrometers, qualifying as a neuroendocrine microtumor. Focus was immunohistochemically positive for chromogranin and synaptophysin and negative for gastrin. The Ki-67/CD45 immunostain showed <1% positivity in microtumor. |
Neuroendocrine microtumor of the duodenum is reportable as 8240/3. "Microtumor" pertains to the size/amount of NET and not to a histologic type. |
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20180095 | Solid Tumor Rules (2018)/Histology--Lung: How is histology coded when the term "predominant" is used to describe solid adenocarcinoma, acinar adenocarcinoma, etc.? Pathology reports often say "See Synoptic" (also known as the College of American Pathologists (CAP) protocol) included in the Final Diagnosis rather than including all the detail. Based upon the new Solid Tumor Rules for lung, predominant/predominantly is no longer a subtype/variant and should not be coded unless there is a specific code/subtype-variant for the NOS in Table 3, e.g., adenocarcinoma, lepidic predominant. See Discussion. |
Examples Example #1: CAP histology type: Adenocarcinoma, solid predominant, Final diagnosis states that Adenocarcinoma, poorly differentiated, solid predominant (80%) and cribriform (20%) subtype (see lung carcinoma synoptic report) Example #2: CAP histology type : Invasive adenocarcinoma, solid predominant, Other Subtypes Present (specify subtype(s), may also include percentages): acinar (45%) and micropapillary (5%) Final diagnosis : adenocarcinoma of the lung, please see Synoptic Report Example #3: CAP histology type: Adenocarcinoma, acinar predominant , Adenocarcinoma, solid predominant Final diagnosis: Adenocarcinoma, poorly differentiated, solid predominant (60%), papillary (30%) and acinar (10%) subtype (see lung carcinoma synoptic report) |
The lung H rules and tables have been updated to include histologies that CAP identifies using the term "predominant" in the diagnosis. Example: Code adenocarcinoma, lepidic predominant, to 8250/3 rather than 8140/3. When the final pathology diagnosis includes more than one "predominant" adenocarcinoma subtype such as acinar, solid, or lepidic, then code the type with the greatest percentage according to Lung Solid Tumor Rule H7. |
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20180094 | Reportability--Prostate: According to the 2018 SEER Program Manual, a prostatic intraepithelial neoplasia (PIN) III is not reportable, but is an atypical small acinar proliferation (ASAP) PIN 4 reportable? |
ASAP is not reportable. Patients with ASAP found on needle biopsy will likely undergo another biopsy. |
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20180093 | 2018 Solid Tumor Rules/Multiple primaries--Lung: What is the histology and number of primaries for a lung case diagnosed in 2018 with adenocarcinoma with acinar predominant pattern on biopsy, and subsequent lobectomy showing adenocarcinoma with solid growth pattern and separate adenocarcinoma with lepidic predominant pattern? Should this be coded as one primary with an adenocarcinoma, NOS (8140/3) histology since we cannot use pattern or predominant, based on the histologic type listed in the synoptic report, and the fact it states synchronous primary tumors in the same lobe. See Discussion. |
02/18 RUL biopsy: Moderatley differentiated adenocacarcinoma with acinar predominant pattern 04/18 RUL lobectomy: 6.5cm poorly differentiated adenocarcinoma with solid growth pattern and 1.1 cm separate adenocarcinoma with lepidic predominant pattern Synoptic report: Procedure: Lobectomy Specimen Laterality: Right Tumor Tumor Site: Upper lobe Histologic Type: Invasive adenocarcinoma, solid predominant Tumor Size: 6.5 Centimeters (cm) Tumor Focality: Synchronous primary tumors in same lobe Lymph Nodes Number of Lymph Nodes Involved: 0 Number of Lymph Nodes Examined: 12 Nodal Stations Examined: 4R: Lower paratracheal; 8R: Para-esophageal (below carina); 10R: Hilar; 7: Subcarinal Pathologic Stage Classification (pTNM, AJCC 8th Edition) Primary Tumor (pT): pT3 Regional Lymph Nodes (pN): pN0 |
This is a single primary per Lung rule M7. First determine the histology for each tumor. Both tumors are coded 8140/3 because the histologies are a PATTERN. Reference: Coding Multiple Histologies (precedes histology rules) Instruction 2 says do not code pattern . If the word pattern was not in the diagnosis, you would code the specific histology. |
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20180092 | Reportability/Histology--Brain and CNS: Is diffuse intrinsic pontine glioma is reportable? If yes, what is the correct histology code? |
Diffuse intrinsic pontine glioma is reportable. For cases diagnosed in 2018, assign 9385/3. |
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20180090 | Reportability--Ovary: Is an ovarian serous borderline tumor with microinvasion with serous tumor aggregates (3 mm in greatest dimension) in 2 of 10 pelvic lymph nodes reportable? See Discussion. |
SINQ 20170043 is a similar question about an ovarian mucinous borderline tumor with microinvasion, but the answer seems to be specifically referencing mucinous tumors only. It is unclear if that SINQ could be applied to this case. In addition, we were not sure how to interpret the nodal involvement. The physician assessment after surgery was low grade serous carcinoma, chemo not recommended and letrozole started. |
Ovarian serous borderline tumor with node implants is not reportable; it is a borderline neoplasm. However, if the oncologist believes he or she is dealing with a low grade serous carcinoma rather than a borderline tumor, this case is reportable. We recommend that you determine whether the diagnosis of low grade serous carcinoma, chemotherapy not recommended, is based on the pathological findings or on something else before reporting this case. |
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20180089 | Reportability--Appendix: Is disseminated peritoneal adenomucinosis (DPAM) reportable when it is being referred to as if the primary tumor is a low-grade appendiceal mucinous neoplasm (LAMN)? See Discussion. |
Example 1: 8/23/2017 debulking path diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) with involvement of intrapelvic mucin, left ovarian mass, uterine serosa and pelvic tumor, consistent with disseminated peritoneal adenomucinosis, that may also be called low-grade mucinous carcinoma peritonei. 8/8/2018 resection of sigmoid and rectum, path diagnosis of peri-colorectal fibroadipose issue with low-grade mucinous carcinoma compatible with the prior diagnosis of pseumomyxoma peritonei with low-grade mucinous carcinoma histology. Example 2: Path diagnosis of low-grade appendiceal mucinous neoplasm in association with low grade mucinous carcinoma peritonei involving the serosa of the small intestine and mesentery. Also, there is involvement of serosal lined soft tissue of peritoneum, omentum, stomach, falciform ligament, gallbladder, diaphragm and spleen. Some pathologists in our area are referring to DPAM as mucinous carcinoma peritonei, which is causing confusion because the term carcinoma is being used. One would assume that because the pseudomyxoma peritonei/underlying tumor itself is low-grade (LAMN), then the case is not reportable, but we would like clarification. |
For cases diagnosed prior to 1/1/2022 Disseminated peritoneal adenomucinosis (DPAM) is not reportable when the primary tumor is a low-grade appendiceal mucinous neoplasm (LAMN). The term disseminated peritoneal adenomucinosis (DPAM) is discouraged by the WHO Digestive System monograph (page 123, section on pseudomyxoma peritonei (mucinous carcinoma peritonei)), since it does not clarify whether the process is low grade or high grade carcinoma. When used, the term should be referring back to the histology of the defining process and in both of these examples this appears to be LAMN, and therefore not reportable. The only exception to this might be if the peritoneal implants were invasive; that is, they contained adenocarcinoma invading into the underlying peritoneum, bowel serosa, etc., rather than simply being present within the surface mucinous material. The pathologist would make this clear if this was, in fact, believed to be invasive carcinoma. |
2018 |
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