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2012 Total abdominal hysterectomy - bilateral salpingo-oophorectomy

Primary Site – Ovary, Right

Histology - Small-Cell Carcinoma (Hypercalcemic Type), Large-Cell Variant

2024 Total abdominal hysterectomy - bilateral salpingo-oophorectomy

Primary Site – Ovary, Left

Histology - Small-Cell Carcinoma (Hypercalcemic Type), Large-Cell Variant

ROS Final Diagnosis: LSO: Ovary with an endometriotic cyst (1.2 cm) and stromal endometriosis with multifocal papillary syncytial eosinophilic, clear cell and tubal metaplasia, no evidence of carcinoma.

COMMENT: There is extensive endometriosis involving the ovarian stroma and the ovarian surface. The ovarian stroma contains multiple cystic endometrial glands and surrounding endometrial type stroma with variable amounts of hemorrhage. There are non-cystic foci of endometriosis comprised of small, irregular glandular structures within the stroma. The lining of larger cyst/cysts is involved by a single layer of cuboidal to columnar cells with markedly eosinophilic cytoplasm in areas of serous (tubal) metaplasia and papillary projections suggestive of papillary syncytial metaplasia. Within these areas there is epithelial tufting and stratification, raising the consideration of proliferative/borderline change (which we cannot entirely exclude), however, given the background of endometriosis and morphologic similarity to papillary syncytial metaplasia in the endometrium, we favor that this is a non-neoplastic reactive change. There is no evidence of carcinoma.

The 2011 pathology report: Spine at L3 biopsy: metastatic adenocarcinoma. Per addendum: Prior total abdominal hysterectomy specimen from 2003 was reviewed and showed an ovarian mucinous cystic tumor of borderline malignancy which has a similar morphology to the invasive adenocarcinoma seen on current specimen.

Abdominal tissue and omental biopsy: invasive and non-invasive glandular implants compatible with origin from ovarian mucinous borderline tumor.

The final diagnosis per radiation oncologist was, "recurrent ovarian cancer."

Serous borderline tumor–micropapillary variant (8460/2, C569) was included in the ICD-O-3 Behavior Code/term updates effective 1/1/2018 but marked as Not Reportable for 2018.

There have been multiple additional updates to the ICD-O but no further clarification as to the reportability of this histology. ICD-O-3.2 currently lists serous borderline tumor, micropapillary variant (C569) as 8460/2 with no mention of reportability and no information provided in Includes/Excludes.

SINQ 20220032 instructs capturing this histology as reportable when diagnosed 1/1/2021 or later and occurring in the testis. The answer indicates this is reportable due to the /2 behavior code in ICD-O-3.2, but it does not specify that it is limited to specific sites.

Is serous borderline tumor, micropapillary variant reportable for ovary? If so, what dates apply? Is serous borderline tumor, micropapillary variant of the testis diagnosed after 1/1/2021 reportable?

Code A280 is defined as a total removal of the ovarian tumor or removal of a single ovary (oophorectomy) WITH a hysterectomy. The unilateral removal of both the fallopian tube and ovary [(salpingo-) oophorectomy] is included in surgery codes A350-A370. However, the SEER Note under code A280 states, "Also use code A280 for current unilateral (salpingo-) oophorectomy with previous history of hysterectomy." Should this SEER Note read, "Also use code A280 for current unilateral oophorectomy with previous history of hysterectomy"?

Patient had bilateral ovarian tumors. The right ovary had serous cystadenocarcinoma and left ovary had clear cell adenocarcinoma. The pathology COMMENT section stated, "Based on the histologic differences of the tumors within each ovary, feel these represent two distinct separate primaries. Lymph node metastases are clearly serous ca." The physician staged the right ovary as T2a N1 M0 and left ovary as T1c N0 M0. Do we accession one primary per rule M7 [Bilateral epithelial tumors (8000-8799) of the ovary within 60 days are a single primary]?

What is intention of Rule M7? If the histology in each ovary is different but within the range (8000-8799), is that supposed to be accessioned as one primary? Or is the intention of Rule M7 that tumors in both ovaries must have the SAME histology within that histology range to be a single primary?