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20190073 | Solid Tumor Rules (2018)/Multiple primaries--Lung: How many primaries should be reported for a patient with a March 2018 diagnosis of non-small cell carcinoma with neuroendocrine differentiation on lung biopsy (single left upper lobe tumor only) who also has a prior history of left lung squamous cell carcinoma in 2016 (treated with chemotherapy/radiation)? See Discussion. |
The Solid Tumor Rules instruct us not to use differentiation for coding histology unless it is specifically listed in the table. The terminology non-small cell carcinoma with neuroendocrine differentiation is not in lung histology Table 2. However, SINQ 20150033, prior to Solid Tumor rules, indicates this diagnosis should be coded to 8574 (adenocarcinoma/carcinoma with neuroendocrine differentiation). This presentation appears to represent distinctly different histologies. However, because the 2018 histology diagnosis is not in the table and the prior SINQ appears to disagree with current instruction, it is not clear how to apply the M rules to this case. The outcome of the histology coding will affect the number of primaries reported in this case. |
Abstract separate primaries according to the 2018 Lung Solid Tumor Rules. Lung Table 3 is not an exhaustive list of lung histologies and the H rules instruct you to use the tables, ICD-O and/or ICD-O updates. Per ICD-O-3, carcinoma with neuroendocrine differentiation is coded to 8574/3; whereas, squamous cell carcinoma is coded to 8070/3. These represent distinct histologies on different rows in Table 3. |
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20190070 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded for a when the pathologist notes the low grade B-cell lymphoma raises the possibilities of extranodal marginal zone lymphoma of mucosa associated tissue (MALT lymphoma) and lymphoplasmacytic lymphoma (LPL)? See Discussion. |
Rule PH28 confirms the more specific histologies are ignored if this is truly a low grade B-cell lymphoma (i.e., non-Hodgkin lymphoma, NOS) since both MALT lymphoma and LPL are more specific types of low grade B-cell lymphomas. This leaves only a diagnosis of low grade B-cell lymphoma with plasmacytic differentiation to consider. SINQ 20130033 states a low grade B-cell lymphoma with plasmacytic differentiation should be coded as 9680/3 (diffuse large B-cell lymphoma (DLBCL)). However, DLBCL is a high grade B-cell lymphoma, not a low grade B-cell lymphoma. If the pathologist classifies this as a non-specific low grade B-cell lymphoma, and clarifies that this may represent a more specific type of low grade B-cell lymphoma (MALT lymphoma or LPL), should the histology be coded to a high-grade lymphoma (DLBCL) or non-Hodgkin lymphoma, NOS? |
Code low grade B-cell lymphoma with plasmacytic differentiation as 9591/3 (Non-Hodgkin lymphoma, NOS). Plasmacytic differentiation is commonly seen with B-cell neoplasms. If further information identifies a more specific histology, the abstract can be updated to reflect the more specific histology. In the latest WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues, 4th ed., there is confirmation that DLBCL is a high grade B-cell neoplasm. We will update the SINQ question. |
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20190085 | Primary site/Histology: Are the 2018 ICD-O Histology Update topography codes intended to specify the most common sites for these new codes and can the histology be coded if they occur in other sites? See Discussion. |
Example 1: Endometrial biopsy final diagnosis is high-grade serous adenocarcinoma. Should we code this endometrial primary with histology 8441 (serous adenocarcinoma) because C54.X topography code is not listed in the applicable 2018 ICD-O-3 codes Histology Update for the new morphology, or should we apply the new histology code 8461 (high-grade serous carcinoma)? The NAACCR implementation guideline section 2.3 includes an important reminder that: Many of the new codes, terms, and behaviors listed in this update are site-specific and do not apply to all sites. Applicable C codes will be noted next to the term in bold font. However, this is followed by the more ambiguous instruction for edits that appear to imply the combination with non-listed sites is possible: These site- and histology-specific combinations will not be added to the Impossible combination edit. However, if a site other than the one listed with the morphology code is assigned, the result will be an edit requiring review. This is Interfield Edit 25. |
The NAACCR Guidelines for ICD-O-3 Histology Code and Behavior Update Implementation, effective January 1, 2018, state: Currently in ICD-O-3, when a topography (C code) is listed in parentheses next to the morphology term, it indicates morphology is most common to that site. It may occur in other sites as well. Many of the new codes, terms, and behaviors listed in this update are site-specific and do not apply to all sites. Please review the Comments to determine which histology codes are specific to sites. You may use sites not listed as the suggested site; however, it will generate an edit error for review and verification of the appropriate site. |
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20190066 | Solid Tumor Rules (2018)/Histology--Breast: How is the histology coded for a metastatic carcinoma, consistent with primary breast carcinoma, when no other pathology information is available? See Discussion. |
The 2018 Breast Solid Tumor Rules Equivalent Terms and Definitions - Changes from 2007 Multiple Primaries/Histology Rules states: Mammary carcinoma is a synonym for carcinoma no special type (NST)/duct carcinoma not otherwise specified (NOS) 8500. It will no longer be coded as carcinoma NOS 8010. Should metastatic carcinomas of breast origin be 8500, or is code 8010 (carcinoma NOS) more applicable because histology coding from metastatic sites is not as reliable? |
Code as 8500/3 as it is the only tissue available for this carcinoma associated with a breast primary. Breast carcinoma NST/NOS is now coded as 8500. |
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20190056 | Behavior--Breast: What is the behavior of a solid papillary carcinoma when a pathologist does not indicate it in the pathology report and follow-up with the pathologist to obtain clarification regarding the behavior is not possible? See Discussion. |
Example: Mastectomy specimen final diagnosis shows two foci of invasive ductal carcinoma including: Invasive ductal carcinoma, no special type, in association with solid papillary carcinoma (tumor #1, 1 cm, slices 6 and 7) and invasive ductal carcinoma, no special type (tumor #2, 1.2 cm, slices 9 and 10). Summary Staging outlines, Tumor #1: Histologic Type: Invasive ductal carcinoma, no special type, in association with solid papillary carcinoma. As well as, Tumor #2: Histologic type: Invasive ductal carcinoma, no special type. Additional findings include ductal carcinoma in situ (DCIS): presently approximately 3.3 cm, spanning slices 10-13. The behavior of the solid papillary carcinoma component will affect the provisional histology of the first tumor (8523/3) per Rule H17 vs. 8500/3 per Rule H7). Based on the response, we can determine whether this represents a single or multiple primaries (single primary per M13 vs. multiple primaries per M14). |
Review all sections of the pathology report carefully for any mention of invasion, or lack of invasion, pertaining to the solid papillary carcinoma. Per WHO 4th Ed Breast: If there is uncertainty that there is invasion, these lesions should be regarded as in situ. The distinction between in situ and invasive disease in solid papillary carcinoma is difficult. |
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20190025 | 2018 Solid Tumor Rules/Histology--Colon: What is the histology code of a diagnosis of well differentiated neuroendocrine tumor (NET), grade 2 of the appendix? See Discussion. |
SINQ 20160023 and the Solid Tumor Rules indicate NET G1 (or well differentiated NET) is coded as 8240 and NET G2 is coded as 8249. Clarification regarding grade coding in the CAnswer Forum indicates well differentiated neuroendocrine tumor refers to the histologic type, and not the grade. Therefore, the term well differentiated is ignored for the purpose of grade coding. Neither of these sources clarifies how to code histology for a tumor diagnosed as well differentiated neuroendocrine tumor, grade 2. |
Assign histology code 8249 for histology described as well differentiated NET G2. A synonym for NET of the appendix includes well-differentiated endocrine tumor/carcinoma according to WHO Classification of Tumors of the Digestive System, 4th edition. "Well differentiated" could apply to either NET G1 or NET G2. |
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20190046 | Tumor Size/Bladder: The 2018 SEER Coding and Staging Manual says to use imaging over physical exam as priority for determining tumor size. If a bladder tumor is 4 cm visualized on cystoscopy, and is 2.8 cm on CT scan, which should be used as the clinical size? Is cystoscopy (endoscopy) a clinical exam or imaging? |
For the case described here, use the size from the CT scan. Physical exam includes what can be seen by a clinician either directly or through a scope. A tumor size obtained visually via cystoscopy is part of a physical exam. Therefore, the imaging (CT) tumor size is preferred. Use text fields to describe the details. |
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20190077 | Summary Stage 2018/EOD 2018--Thymus: How should SEER Summary Stage 2018 be coded for a 2018 thymus primary which has mediastinal fat invasion without mediastinal pleural involvement? See Discussion. |
The Extent of Disease (EOD) manual states that "Confined to thymus WITH mediastinal or pleural involvement" should be coded as regional by direct extension. I have EOD primary tumor coded as 200 and based on SEER*RSA, this is localized. |
Code 200 derives Regional Extension (RE) for Summary Stage; however, based on the information you provided, thymus primary with mediastinal fat invasion without mediastinal pleural involvement, EOD Primary Tumor would be coded to 100: Confined to thymus (encapsulated tumor), which includes extension into the mediastinal fat; No mediastinal or pleura involvement. This derives "Localized" for Summary Stage. Per AJCC T1, extension into the mediastinal fat is separate from involvement of the mediastinal pleura. For Summary Stage 2018, this would be code 1, Localized only (localized, NOS): Confined to thymus, NOS; No mediastinal or pleura involvement or UNKNOWN if involved. We will note that "extension into the mediastinal fat" is included in code 100 for the next release (September 2020). |
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20190037 | Solid Tumor Rules/Multiple Primaries--Breast: How many primaries should be abstracted for simultaneously diagnosed non-contiguous invasive duct carcinoma and mucinous carcinoma? Does rule M12 apply since the two histologies are on different rows of Table 3 of the Breast Solid Tumor Rules? See Discussion. |
Core biopsy of left breast at 2:00: Invasive ductal carcinoma, Nottingham score 6/9. Core biopsy of left breast at 4:00: Invasive mucinous carcinoma (variant of ductal carcinoma), Nottingham score 5/9. Post neo-adjuvant mastectomy: Main (largest tumor): Invasive ductal carcinoma, upper outer quadrant grade 2. Secondary tumor: mucinous carcinoma, grade 1 at 4:00. |
Abstract multiple primaries when separate, non-contiguous tumors are on different rows in Table 3 of the Breast Solid Tumor Rules. Use Rule M14 as each row in the table reflects a distinctly different histology, in this case, invasive ductal carcinoma (8500) and mucinous carcinoma (8480). |
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20190011 | Reportability--Skin: Is an atypical smooth muscle cell proliferation of the skin reportable? See Discussion. |
Example: Patient has left thigh skin excision with final diagnosis of atypical smooth muscle cell proliferation, inked peripheral margin is involved and inked deep margin is free of disease in the sections examined. See Comment. Diagnosis comment states: The terminology regarding this lesion is controversial. Lesions with identical features are designated as leiomyosarcoma in the dermatopathology literature, whereas, the preferred classification in the soft tissue pathology is atypical intradermal smooth muscle neoplasm. Although the lesion appears predominantly dermal based, since the margin is involved, the lesion cannot be entirely evaluated, and therefore the final designation is deferred to the findings in the excisional specimen. (This slide was read by bone and soft tissue pathologist.) There has been no excision of this tumor and, as a central registry, we have no access to the pathologist for clarification. Is this skin case reportable based on the dermatopathology interpretation when further documentation is not available? |
Since you do not have the option of checking with the pathologist and no further information is available, do not report this case. The diagnosis is atypical smooth muscle cell proliferation of the skin, which is not reportable. Registrars with access to the pathologist should querry the pathologist for clarification in this situation. |
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