| Report | Question ID | Question | Discussion | Answer | Year |
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20120051 | MP/H Rules/Histology--Breast: What histology code for a diagnosis of pleomorphic lobular carcinoma in situ? | For cases diagnosed 2007 or later, code the histology as lobular carcinoma, in situ [8520/2].
The steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Breast Histo rules because site specific rules exist for this primary.
Start at the SINGLE TUMOR: IN SITU CARCINOMA ONLY module, Rule H1. The rules are intended to be reviewed in consecutive order. Stop at the first rule that applies to the case you are processing. Code the histology to lobular carcinoma in situ [8520/2] because this is the only histologic type identified.
Pleomorphic lobular carcinoma is a variant of lobular carcinoma which does not have an ICD-O-3 code. It is still a lobular carcinoma. The identification of the variants of lobular carcinoma was a relatively recent discovery and the information was not available when the 2007 MP/H Rules were written. All of the lobular variants will be included in the next revision of the MP/H Rules. |
2012 | |
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20120067 | MP/H Rules/Histology--Thyroid: How is the histology coded for a poorly differentiated thyroid carcinoma with rhabdoid phenotype arising in a papillary carcinoma? | For cases diagnosed 2007 or later, code the histology as papillary carcinoma, poorly differentiated [8260/33].
The WHO classification lists grade III papillary carcinoma as one of the synonyms for poorly differentiated thyroid carcinoma.
The steps used to arrive at this decision are: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Other Sites Histo rules because site specific rules have not been developed for this primary. Start with the SINGLE TUMOR: INVASIVE ONLY module, rule H8. The rules are intended to be reviewed in consecutive order within a module. Per rule H13 "phenotype" is not a term used to code a more specific histology. Moving to Rule H14 the histology is coded 8260/3 [papillary adenocarcinoma]. |
2012 | |
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20071007 | MP/H Rules/Histology: In the absence of a tissue diagnosis, should the histology field be coded based on the findings of a suspicious cytology or a CT scan that clinically confirmed the diagnosis? See Discussion. | Cytology (brushings at ERCP) which are highly suspicious of adenocarcinoma. A CT of the abdomen performed the next day shows a mass, most likely Klatskin tumor. Can the histology be coded to Klatskin tumor [8162/3] based on the CT findings? | For cases diagnosed 2007 or later, code the histology to 8162/3 [Klatskin tumor] using the histology from the CT. This case is confirmed clinically based on the CT. It cannot be accessioned based on suspicious cytology.
Rule H8 in the 2007 Histology Coding Rules for Other Sites provides instructions for coding histology when the pathology report and cytology report are not available. |
2007 |
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20120065 | MP/H Rules/Primary site: What is the primary site and histology for a focus of papillary thyroid cancinoma, follicular variant, arising in thyroid tissue of mature cystic teratoma of the ovary? | For cases diagnosed 2007 or later, code the primary site to ovary [C56.9] and the histology to papillary carcinoma, follicular variant [8340/3].
The steps used to arrive at this decision are:
Refer to the 2012 SEER Manual for help to determine the primary site. This neoplasm is arising in a teratoma of the ovary. Per the 2012 SEER Manual, in this case the site is coded to ovary [56.9] because that is where the tumor originated. Although the teratoma contains thyroid tissue, it arose in the ovary. Teratomas are unusual in that they contain all three germ cell layers from which an embryo forms. It is not unusual to have malignancies that are usually primary to the thyroid, liver, brain, lung, etc., originate in a teratoma.
Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Other Sites Histology rules because site specific rules have not been developed for this primary.
Start with the SINGLE TUMOR: INVASIVE ONLY module, rule H8. The rules are intended to be reviewed in consecutive order within a module. Code the histology as papillary carcinoma, follicular variant [8340/3]. |
2012 | |
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20081111 | MP/H Rules/Histology--Breast: If an in situ carcinoma diagnosed in 2007 demonstrates comedo necrosis, should the histology be coded to comedocarcinoma in situ? See Discussion. |
According to the new MP/H rules, we code descriptive features. There is no coding guidance or reference to "necrosis" within the breast MP/H rules. Based on SEER SINQ 20021002, the "comedo necrosis" would not be coded at all for pre-2007 cases. Does this still hold true for cases diagnosed after January 1, 2007? |
For cases diagnosed 2007 or later, comedo necrosis is not synonymous with comedocarcinoma. If no further information is available for this case, code as carcinoma in situ. |
2008 |
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20091120 | MP/H Rules/Histology--Esophagus: Should the modifying expression "with areas of" be used to code histology? See Discussion. |
Patient was found to have two tumors in the esophagus. The large tumor was diagnosed as adenocarcinoma with areas of neuroendocrine differentiation (small cell carcinoma). The smaller tumor was diagnosed as small cell carcinoma. If we accept the "areas of" to be part of the diagnosis, rule H16 indicates that histology for the large tumor would be coded 8045 (combined small cell and adenocarcinoma). If we ignore the "areas of," then histology for the large tumor would be coded to 8140 (adenocarcinoma). Either way, when counting primaries, rule M17 would be applied and the two tumors would be classified as separate primaries. However, it seems that the two tumors are probably the same disease process since they both show small cell carcinoma. |
For cases diagnosed 2007 or later, do not use the modifying expression "with areas of" to determine a more specific histology per rule H13 in the MP/H rules. |
2009 |
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20110057 | MP/H Rules/Behavior--Appendix: How do you code mucinous cancers of the appendix? Is a "low grade mucinous appendix tumor/neoplasm" with peritoneal spread reportable? See Discussion. |
Low grade mucinous neoplasms can spread to the peritoneal cavity and in that sense are metastatic but histologically have bland/benign features (may be a benign cystadenoma that ruptured and spread by rupturing) are not a carcinoma. Thus, some have termed this group as DPAM (diseminated peritoneal adenomucinous) and not a true carcinoma. Others indicate that if you have metastasis the tumor is a carcinoma. |
For cases diagnosed 2007 or later, low-grade mucinous tumors of the appendix are a /1, borderline/uncertain behavior, and not reportable. These tumors do spread to the peritoneal cavity (pseudomyxoma peritonei). This spread, or deposits, or implants are also borderline/uncertain behavior and do not make the appendiceal tumor reportable. By contrast, a high-grade mucinous tumor of the appendix may produce malignant/invasive pseudomyxoma peritonei. When the pseudomyxoma peritonei are diagnosed as invasive or malignant, the mucinous tumor in the appendix is reportable as a /3. |
2011 |
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20071040 | MP/H Rules/Multiple Primaries--Melanoma: Is there a difference between multiple primary rules M6 and M7 because both rules state that tumors occurring more than 60 days apart are to be reported as multiple primaries? See Discussion. | Rule M6 clearly states that an invasive melanoma occurring more than 60 days after an in situ melanoma is a multiple primary. However M7 states that any melanomas diagnosed more than 60 days apart are multiple primaries. Since M7 does not state malignant melanomas diagnosed more than 60 days apart, this implies that any scenario: in situ following an invasive, invasive following an in situ, in situ following an in situ, or invasive following an invasive are all multiple primaries if more than 60 days apart. If that is the intent of M7, then M6 is totally unnecessary. If the intent of M7 is only for an invasive following an invasive, then the word malignant needs to be inserted as the first word of rule M7. |
For cases diagnosed 2007 or later, M7 is intended to apply to in situ and invasive melanomas. Therefore, M6 and M7 are repetitive. This will be corrected when revisions are made to the MP/H rules. In the meantime, both M6 and M7 result in multiple primaries so it does not matter which rule is used. |
2007 |
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20091119 | MP/H Rules/Multiple primaries--Lung: How many primaries are to be reported for an adenocarcinoma of the lung in the right middle lobe of the lung and bronchioalveolar carcinoma, non-mucinous type in the right upper lobe? See Discussion. |
Bilobectomy revealed two tumors, adenocarcinoma in the right middle lobe and bronchioalveoar carcinoma non-mucinous type in the right upper lobe. MP/H rule M10 states that tumors with non-small cell carcinoma (8046) and a more specific non-small cell type (chart 1) are a single primary. Does rule M10 apply to only those cases for which one tumor is stated to be non-small cell, NOS? Or do we use chart 1 to identify specific subtypes? For this case, using chart 1, would we note that bronchioalveolar is a subtype of adenocarcinoma and count this case as a single primary? Most of the MP/H rules schemas have a rule making an adenocarcinoma and a more specific type of adenocarcinoma a single primary. Would we apply rule M10 to this case and count it as a single primary? Or would we move on to rule M11 and count the case as two primaries? |
For cases diagnosed 2007 or later, Rule M11 applies. Accession two primaries. Rule M10 applies only to cases for which one tumor is stated to be "non-small cell carcinoma." |
2009 |
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20081064 | MP/H Rules--Bladder: Is a TURBT in 4/07 that demonstrates papillary carcinoma (8130/3) followed two weeks later with biopsies that demonstrate high grade flat dysplasia/carcinoma in situ (8010/2) two primaries? |
For cases diagnosed 2007 or later, rule M6 applies and this is a single primary. Flat transitional cell carcinoma and carcinoma in situ of the bladder are synonymous. See the definition of "Flat Tumor (bladder)/Noninvasive flat TCC" in the Urinary Terms and Definitions section of the 2007 MP/H manual. |
2008 |
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