Reportability/Histology: Would a histology reading "Well-differentiated neuroendocrine neoplasm" of the appendix be reportable? Since the word "tumor NOS" and "neoplasm NOS" both code to 8000, I would assume they would be interchangeable but just wanted to verify.
According to SINQ 20130027 & 20140002 a "Well-differentiated neuroendocrine tumor" of the appendix IS reportable.
"Well-differentiated neuroendocrine neoplasm" of the appendix is reportable. According to the WHO classification of Digestive System Tumors, "Well-differentiated neuroendocrine neoplasm" of the appendix is synonymous with NET. WHO states on page 13 "The term 'neuroendocrine neoplasm' can be used synonymously with 'neuroendocrine tumor.'"
Neuroendocrine "tumor," or NET G1, is listed in the WHO classification as one of the malignant neoplasms of the appendix.
MP/H Rules/Multiple Primaries: Is this counted as one or two primaries?
Patient is diagnosed with SCC esophageal cancer. Work-up reveals a lung nodule. Lung FNA (cytology) is read by the pathologist as SCC, favor metastatic esophageal SCC. However, the managing physicians are treating the patient as two separate primaries.
If the patient is being managed and treated as a case of primary lung cancer, report the lung diagnosis as a separate primary.
Multiple Primaries/Histology--Colon: What is the correct histology code and MP/H Rule when a colectomy final diagnosis is adenocarcinoma with colloid and signet ring cell features? See discussion.
The MP/H Equivalent Terms and Definitions for Colon indicate that type, subtype, predominantly, with features of, major, or with ___ differentiation are all equivalent in terms of coding histology. However, this is not indicated in the General Instructions (e.g., Histologic Type ICD-O-3 or General Instructions Histology Coding Rules). It also is not included as a Note under the Rules where one would expect to use these terms, for example, Rule H7. Is this an oversight or error in the Manual?
In this case, Rule H7 seems to be the first (and most appropriate) rule that applies to this mixed histology tumor. However, the specific histology terms that an invasive tumor may be identified as, are only listed under Rule H13. Can these same terms be used when applying rules for which they are not specifically noted? It would seem logical to use the equivalent histology terms to code a mixed histology tumor identified as a subtype or with features, etc., despite the fact that the specific terms are not listed under Rule H7.
Rule H7 applies. Assign code 8255. H13 does not apply as mucinous/colloid/signet are not NOS histologies. They are specific histologies. This will be addressed in the upcoming revisions to the rules.
Reportability--Brain and CNS: Is "Lhermitte-Duclos disease" is reportable? See discussion.
The MRI states "Lhermitte-Duclos disease" but does not include "dysplastic gangliocytoma of cerebellum"; is this the same as "Lhermitte-Duclos dysplastic gangliocytoma of cerebellum (C716)"?
"Lhermitte-Duclos disease" alone can be interpreted as "Lhermitte-Duclos dysplastic gangliocytoma of cerebellum (C716)" and reportable. The WHO classification for CNS tumors lists this entity as "Dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease)" signifying that the terms are used synonymously.
Primary Site--Testis: What is the prmary site for a 38 y/o male diagnosed with testicular cancer in a formerly undescended testis that was treated with orchiopexy at age 10-11? See discussion.
Should it be coded to where the testis was physically at the time of diagnosis (C621), or should it be coded to C620 to reflect the increased risk for developing malignancy in an undescended testis?
Code the primary site C621 (descended testis). The primary site of this neoplasm is a scrotal (descended) testis. The history of orchiopexy can be noted in a text field, but does not change the primary site in this case.
Grade--Bladder: How is Grade coded for the following cases diagnosed 1/1/2014 and later? See Discussion.
1) Low grade urothelial carcinoma, invasive carcinoma not identified (8120/2)
2) Papillary urothelial carcinoma, high grade, no evidence of invasion (8130/2)
The rules for coding Bladder Grade appear to have changed over time. SPCM 2013 Appendix C instructions state that Grade should be coded to 9 for urothelial carcinoma in situ (8120/2) and to 1 or 3 for non-invasive papillary urothelial carcinoma (8130/2).
When the grade instructions were removed from Appendix C in 2014, these site specific instructions for in situ bladder cases were no longer included. Thus the two grade system, found in SPCSM 2014+ Grade/Differentiation Coding Instructions for Solid Tumors, is being used to code grade for both the in situ and invasive urothelial malignancies stated to be "low grade" (code 2) or "high grade" (code 4). See also, SINQ 20150022. Please clarify the current grade instructions for in situ and invasive urothelial carcinomas of the bladder.
Follow the instructions in the 2014+ Grade Coding Instructions to code grade for cases diagnosed 2014 and later, http://seer.cancer.gov/tools/grade/ Instruction #4.a. states to code grade for in situ tumors when grade is specified. This instruction applies to bladder cases, as well as other in situ tumors.
Grade--Bladder: Do you use the grade stated on the pathology report for coding the grade/differentiation field for bladder and renal pelvis field? See discussion.
Please confirm correct coding for grade for papillary urothelial carcinoma of the bladder/renal pelvis and urothelial carcinoma of the bladder/renal pelvis. SEER Manual 2014 and 2015 state: "Do not use these tables to code grade for any other groups including WHO (CNS tumors), WHO/ISUP (bladder, renal pelvis), or FIGO (female gynecologic sites) grades." They also state "In transitional cell carcinoma for bladder, the terminology high grade TCC and low grade TCC are coded in the two-grade system" in the Grade section. These statements are not included in SEER Manuals prior to 2014.
Use the grade stated on the pathology report to code grade/differentiation for bladder and renal pelvis field unless the grade is stated to be WHO/ISUP grade.
Primary Site--Sarcoma: What is the best primary site code for an undifferentiated sarcoma of the pulmonary artery? See discussion.
Consolidation of the case: The operating hospital stated: SOFT TISSUE: Resection: Procedure: Radical resection Other: Pneumonectomy Tumor Site: Right pulmonary artery - They used code C383 (mediastinum NOS). The consulting hospital stated: Lung, right, pneumonectomy: High grade sarcoma consistent with intimal sarcoma; tumor involves pulmonary artery. They used code C449 (other soft tissue NOS). Would C493 (soft tissue thorax) be correct?
Code the primary site to pulmonary artery, C493. According to the WHO classification of tumors, intimal sarcomas are malignant mesenchymal tumors arising in large blood vessels. They show mostly intraluminal growth with obstruction of the vessel. They may occur in the pulmonary vessels or, less often, in the aorta.
Primary site--Anus/Anal Canal: What site do you code squamous cell carcinoma of the anal verge?
Assign C211 for anal verge. Anal verge is defined as the lower (distal) end of the anal canal, junction between the skin of the anal canal and the perianal skin, http://www.seer.cancer.gov/manuals/2015/AppendixC/rectosigmoid/coding_guidelines.pdf
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