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Report Produced: 02/25/2026 20:38 PM

Report Question ID Question Discussion Answer Year
20180106

First Course Treatment--Other Therapy: Please explain how to code this new therapy, peptide receptor radionuclide therapy (PRRT) for rare neuroendocrine tumors. See Discussion.

According to this article, PRRT treatment lutetium Lu 177 dotatate was approved earlier this year by the United States Food and Drug Administration for adult use. PRRT is a nuclear medicine therapy that travels throughout the body looking for a certain receptor within neuroendocrine tumors. These include pancreatic and small neuroendocrine tumors in the gastrointestinal tract. Once absorbed into the tumor, the radioactive material starts to break down tumor cells, killing them. It is the first radioactive drug approved for the targeted treatment of gastroenteropancreatic neuroendocrine tumors.

(http://cinj.org/rutgers-cancer-institute-new-jersey-and-robert-wood-johnson-university-hospital-are-first-state ).

For cases diagnosed prior to 2023: Code Peptide Receptor Radionuclide Therapy (PRRT) in the data item Other Therapy, code 1, Other.

See SINQ 20220042 and 20230005 for information pertaining to cases diagnosed in 2023 or later.

 2018
20180021

Solid Tumor Rules (2018)/Histology--Corpus uteri: What is the correct histology code for "Mesophrenic-like adenocarcinoma" of the corpus uteri?" See Discussion.

The article I read (https://www.ncbi.nlm.nih.gov/pubmed/?term=28984674) makes the distinction between mesophrenic adenocarcinoma and mesophrenic-like adenocarcinoma. The authors propose the term mesonephric-like Mullerian adenocarcinoma. So would this be coded as Mullerian adenocarcinoma?

Assign code 9110/3, mesonephric adenocarcinoma. These tumors commonly arise in the cervical wall and more commonly involve the lower uterine segment than do other cervical adenocarcinomas.

 2018
20180045

Solid Tumor Rules (2018)/Histology--Breast: The Histology Coding Instructions for breast cancer indicate the term type is not used to code histology unless documented to be greater than or equal to 90% of the tumor. Does this also apply if the format of pathology reports submitted in the College of American Pathologists (CAP) protocol from a specific facility always describes the histology under the heading, Histologic type: ___? See Discussion.

For certain facilities in our area, the breast pathology reports using a CAP protocol format are formatted as follows; the Final Diagnosis will state Infiltrating carcinoma with the following features. The features list the specific tumor characteristics required in the CAP protocol formatting. The histology is always displayed in the list form and specified as Histologic type: (for example, Histologic type: Ductal carcinoma). Is this specific histology really to be ignored because it is preceded by the word type even if this is just a consequence of the pathology report formatting?

In the CAP protocol, the term Histologic Type is a label where the histology that corresponds to the largest carcinoma is collected. According to the CAP protocol for invasive breast cancer, the histologic type corresponds to the largest carcinoma. If there are smaller carcinomas of a different type, this information should be included under "Additional Pathologic Findings." The findings noted in the Final Diagnosis, Histologic Type, and Additional Path Findings of the protocol should be used to determine the histology.

When there are multiple histologies and

1) the subtype or variant is listed as 90% when there is a Not Otherwise Specified/No Specific Type (NOS/NST) and a subtype, or

2) the subtype/variant histology reflects the majority of the tumor when there are two or more different histologies (two or more distinct subtypes)

Code the subtype/variant; otherwise, use the Specific and Not Otherwise Specified/No Specific Type (NOS/NST) Terms and Code listed in Table 2 (columns 1 and 2) of the 2018 Solid Tumor Rules for Breast Cancer.

 2018
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.

 2019
20190075

Sex: How should the sex field be coded for the newly allowable non-binary gender designation ? See Discussion.

Washington State added to birth certificates, which allows people to have their certificates changed to this non-binary gender designation. Gender X is defined as a gender that is not exclusively male or female, including, but not limited to: intersex, agender, amalgagender, androgynous, bigender, demigender, female-to-male, genderfluid, genderqueer, male-to-female, neutrois, nonbinary, pangender, third sex, transgender, transsexual, Two Spirit, and unspecified.

Code Gender X as 9 when that is the only information available. Use text fields to document the details.

Also refer to coding instruction #7.

When gender is not known

Assign code 1 when the primary site is C600 'C639

Assign code 2 when the primary site is C510 'C589

Assign code 9 for primary sites not included above

 2019
20190022

Solid Tumor Rules (2018)/Histology--Lung: Is histology code or the number of primaries assigned differently in SINQ 20180093 if the word "pattern' was omitted? See Discussion.

Regarding the answer to SINQ 20180093: This is a single primary; coded 8140/3 adenocarcinoma. In the biopsy and the two tumors found on lobectomy, the specific adenocarcinoma histologies are described as acinar predominant pattern, solid growth pattern and lepidic predominant pattern. You do not code a pattern, so rule M7 above applies and this is a single primary.

My question is based on Note 2 in Coding Multiple Histologies for lung cancers that says: Predominantly describes the greater amount of tumor. Predominant and majority are synonyms. Per the CAP protocol, the term predominant is acceptable for the following specific subtypes of adenocarcinoma. For these subtypes only, the word predominant is used to describe both the subtype and the grade of the tumor.

If the word "pattern' was omitted, you would abstract multiple primaries per the Lung Solid Tumor Rule M6 and code histology to adenocarcinoma, acinar predominant (8551/3) and adenocarcinoma, lepidic predominant (8250/3) per Rule H4 as the word "pattern' is not included in each histology.

 2019
20190086

EOD 2018/EOD Primary Tumor--Melanoma: The code and level translations in the Note 4 of Extent of Disease (EOD) Primary Tumor for Melanoma Skin seem incorrect. Please advise.

* Code 000: In situ

* Code 100: Level I (should be level II) (< 0.75 mm Breslow's Depth)

* Code 200: Level II (should be level III) (0.76 mm to 1.50 mm Breslow's Depth)

* Code 300: Level III (should be level IV) (> 1.50 mm Breslow's Depth)

Please see the corrected levels below for the note. Note 4: If a Breslow's depth is given in the pathology report and there is no other indication of involvement, the following guidelines may be used (Note: If a physician documents a different Clark's Level than provided by these guidelines, go with the physician's Clark Level)

Code 000: Level I (In situ)

Code 100: Level II (< 0.75 mm Breslow's Depth)

Code 200: Level III (0.76 mm to 1.50 mm Breslow's Depth)

Code 300: Level IV (> 1.50 mm Breslow's Depth)

Thank you for bringing this to our attention.

 2019
20190044

Solid Tumor Rules (2018)/Histology--Colon: Is the term phenotype equivalent to type, subtype, variant for the purpose of coding histology? See Discussion.

In our region, pathologists often describe histology using the term phenotype. However, the use of the term phenotype is not discussed in the Solid Tumor Manual.

Example: Final Diagnosis of a colon tumor is invasive adenocarcinoma with a mixed phenotype, and the Diagnosis Comment states: The majority of the disease is poorly differentiated/signet ring cell phenotype.

Would the histology be coded to 8490 (signet ring cell carcinoma), if the majority of the tumor is a more specific histology described by the term phenotype?

While variant, type, and subtype can be used interchangeably according to the Solid Tumor Rules, SINQ 20170058 states that the Multiple Primaries/Histology (now Solid Tumor) Rules do not include coding phenotype. Code as invasive adenocarcinoma NOS (8140).

 2019
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.

 2019
20190047

Reportability/Liver: If on imaging, there is no statement of the Liver Imaging Reporting and Data System (LI-RADS) score but there is reference that a lesion is in the Organ Procurement and Transplantation Network (OPTN) 5 category, is hepatocellular carcinoma (HCC) reportable based on the OPTN 5 classification? See Discussion.

SINQ 20160008 discusses the reportabilty and diagnosis date for liver primaries where imaging references the LI-RADS category as LR-5 or LR-5V. The 2018 SEER Coding and Staging Manual, Appendix E Reportable Example #16, demonstrates this concept. According to the LI-RADS categories a value of 5 is "definitely HCC" and is concordant with OPTN 5. Often we see only the OPTN categorization.

Report HCC based on the OPTN class of 5. OPTN class 5 indicates that a nodule meets radiologic criteria for HCC. Be sure to document in text fields.

 2019