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| Report | Question ID | Question | Discussion | Answer | Year |
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20170044 | Histology--Sarcoma: What is the histology code for epithelioid angiosarcoma? |
Assign 9120/3 for epithelioid angiosarcoma. |
2017 | |
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20160056 | MP/H Rules/Histology--Testis: How should histology be coded for a testicular primary with a combination of teratoma, yolk sac tumor and embryonal carcinoma? See discussion.
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Patient had a radical orchiectomy with the final diagnosis of "Mixed germ cell tumor with the following features -- histologic type: Mixed germ cell tumor (teratoma 50%, yolk sac tumor 25%, and embryonal 25%)." |
Assign 9085/3. Code this combination of teratoma, yolk sac tumor, and embryonal tumor in the testis to mixed germ cell tumor (9085/3) based on the WHO Classification of Tumors of the Male Genital Organs. |
2016 |
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20160044 | MP/H Rules/Histology--Sarcoma: What is the appropriate histology code for a final diagnosis of undifferentiated pleomorphic sarcoma and/or pleomorphic sarcoma, undifferentiated? See Discussion. |
Does the Other Sites MP/H Rule H17 apply in this case, which results in coding the higher histology 8805/3 (undifferentiated sarcoma)? Or does the "undifferentiated" statement only refer to grade, which results in coding histology to 8802/3 (pleomorphic sarcoma)? |
Assign 8802/34 to pleomorphic cell sarcoma/undifferentiated pleomorphic sarcoma. Pleomorphic is more important than undifferentiated when choosing the histology code in this case. Undifferentiated can be captured in the grade code. |
2016 |
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20160067 | MP/H Rules/Histology--Skin: What histology code and MP/H Rule apply to a skin primary with the final diagnosis, ? See Discussion. |
The patient had an upper arm shave biopsy with final diagnosis of basaloid carcinoma with squamous and neuroendocrine differentiation. The pathologist also comments: Further resection was negative for residual malignancy.
Would SINQ 20150033 apply, thus resulting in final histology of carcinoma with neuroendocrine carcinoma (8574/3)? |
Assign 8574/3 according to Other Sites rule H17 for basaloid carcinoma with squamous and neuroendocrine differentiation.
There is no combination code that includes basal cell, squamous, and neuroendocrine. We can combine basal cell with squamous, 8094/3, or carcinoma with neuoendocrine differentiation, 8574/3. Rule H17 directs us to assign the higher code, 8574/3. |
2016 |
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20140090 | MP/H Rules/Histology--Endometrium: What is the correct histology code for an endometrial cancer described as "Adenocarcinoma with areas of squamous differentiation?" |
Assign 8570/3 to adenocarcinoma with squamous differentiation of the endometrium. The most recent WHO classification does not list "adenocarcinoma" for tumors of the uterine corpus. WHO does state that "endometroid carcinoma of the usual type is a glandular neoplasm..." Further, WHO states "Endometroid carcinoma typically displays a glandular or villoglandular architecture..." Based on the WHO classification, the use of the term "adenocarcinoma" in this context can be interpreted as endometroid carcinoma. |
2014 | |
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20160057 | MP/H Rules/Histology--Prostate: What is the histology code for a prostate case whose histology reads “adenoca with mixed ductal and acinar variants? |
Assign 8523/3.
The 2013 revision to ICD-O-3 has a new code for mixed acinar ductal carcinoma; however, this new code will not be implemented in the U.S. until 2018 or later. Page 7 of the Guidelines for ICD-O-3 Update Implementation document released by NAACCR 1/1/2014 instructs us to use 8523/3 in the meantime. |
2016 | |
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20170049 | MP/H Rules/Histology--Pancreas: What is the histology code of invasive adenocarcinoma, non-mucinous with intraductal tubulopapillary features, moderately differentiated, from the pathology report final diagnosis of the pancreas? Does 'intraductal" refer to a non-invasive/in-situ component or describe the pattern of growth? |
Assign 8503/3, intraductal papillary adenocarcinoma with invasion, to capture the more specific features of the adenocarcinoma. Histology Rule H13 for Other Sites states to code the most specific histologic term. Examples include Adenocarcinoma and a more specific adenocarcinoma. Note: The specific histology may be identified as type, subtype, predominantly, with features of, major, or with ___ differentiation. |
2017 | |
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20160053 | MP/H Rules/Histology: How is the histology coded for an invasive adenocarcinoma arising in a papilloma with high-grade dysplasia? See Discussion. |
Patient has a perihilar bile duct primary with a microscopic focus of invasive moderately differentiated adenocarcinoma arising in a large papilloma. The MP/H Rules do not address adenocarcinomas arising in a papilloma, only adenocarcinomas arising in an adenoma (or polyp). Should the histology be coded as 8140 for the invasive adenocarcinoma component? Or should the matrix principle be applied and the histology coded as a malignant glandular papilloma (8260/3)? |
Assign 8503/3 for invasive adenocarcinoma arising in a papilloma with high-grade dysplasia, perihilar bile duct primary. Neither ICD-O-3 nor the WHO classification have a code for this specific histology; however, our expert pathologist consultant states 8503/3 is the best available choice based on pages 264 and 273 in the WHO Digestive system classification. |
2016 |
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20190020 | Solid Tumor Rules (2018)/Histology--Head & Neck: What table in the Head and Neck Solid Tumor Rules applies to tumors of the lip (C000-C009)? The rules apply to all tumors in sites C000-C148, C300-C339, C410, C411, C442 and C479, but none of the histology tables include the lip. See Discussion. |
Example: Patient has a secretory carcinoma of minor salivary gland tissue (mammary analogue secretory carcinoma [MASC]) of the mucosal lower lip; it is unclear which table to use and how to arrive at the correct histology using the H Rules. Rule H1 (code the histology when only one histology is present) states, Note 1: Use Tables 1-9 to code histology. There is no table that includes the lip. The correct histology should be 8502 which is listed in Table 6 (Tumors of Salivary Glands) however this does not correspond to minor salivary glands of the mucosal lip (site C003 per ICD-O-3 coding instruction). The 2018 ICD-O-3 Update table does not include this histology, however Table 6 indicates code 8502 (secretory carcinoma) is a new code that was approved by IARC/WHO. The ICD-O-3 only includes this histology as secretory carcinoma of breast. Therefore, in order to arrive at the correct histology, one must be aware of previous SINQ entries 20160036 and 20130003 that indicate secretory carcinoma (or MASC) is histology 8502. However, these are related to MP/H Rules, so registrars may be hesitant to apply this guideline to cases coded using Solid Tumor Rules. |
Assign 8502/3 using Table 6 of 2018 Solid Tumor Rules for Head and Neck. Table 4 notes that there is no ICD-O site code for minor salivary glands. Many minor salivary glands are located in the lips, inner cheek (buccal mucosa), and there are extensive minor salivary glands in the linings of the mouth and throat. Code to the site in which the salivary gland is located. Mammary analog secretory carcinoma (MASC), also called secretory carcinoma, is a rare, generally low-grade salivary gland carcinoma characterized by morphological resemblance to mammary secretory carcinoma and ETV6-NTRK3 gene fusion. Common sites are of the parotid gland, oral cavity, submandibular gland, and the axilla with rare sites being the face including the lips, trunk, and limbs according to WHO Classification of Head and Neck Tumors, 4th edition and WHO Classification of Skin Tumors, 4th edition. This histology is usually associated with primary site of breast and you may get an edit that you can override. |
2019 |
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20150021 | MP/H Rules/Histology--Skin: How is histology coded for an "endocrine mucin-producing sweat gland carcinoma with transformation to mucinous carcinoma"? See Discussion. |
Endocrine mucin-producing sweat gland carcinoma (EMPSCG) is a rare type of low-grade sweat gland carcinoma. Some journal articles indicate that most patients with EMPSCG have coexisting mucinous carcinomas, suggesting that EMPSCG is a precursor to invasive mucinous carcinoma of the skin. Sweat gland carcinoma has its own histology code per the ICD-O-3 (8400/3); should an endocrine mucin-producing sweat gland carcinoma also be coded as 8400/3? If so, would the correct histology for the skin case above be mucinous carcinoma (8480/3) per Rule H17? Conversely, if the terms "mucin-producing" are referring to mucin-producing carcinoma, and not referring to the sweat gland carcinoma, would the histology be coded 8481/3 (mucin-producing carcinoma)? |
Assign 8480/3.
There is no mixed ICD-O-3 code for EMPSCG. Both histologies are in the mucinous family: mucinous adenocarcinoma (8480/3) and sweat gland carcinoma (8400/3). Apply Other sites rule H17 and code the numerically higher ICD-O-3 code (8480/3).
Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare low-grade sweat gland carcinoma with a strong predilection to the eyelid region. It is histologically analogous to endocrine ductal carcinoma/solid papillary carcinoma of the breast and is characterized by a multinodular solid cystic mucinous tumor with immunoreactivity to neuroendocrine markers. Only 20 cases of this unusual tumor have been reported. |
2015 |
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