MP/H Rules/Histology--Breast: What histology code is used for a single tumor, micropapillary carcinoma with components of mixed ductal and lobular carcinoma?
For cases diagnosed 2007 or later, use rule H16 and assign code 8522 [Duct and lobular carcinoma].
Micropapillary is specific duct type (see Table 1).
MP/H Rules--Breast: Is inflammatory breast cancer always one primary per lifetime? Or is a subsequent inflammatory breast cancer a second primary if diagnosed more than five years later?
For cases diagnosed 2007 or later, a diagnosis of inflammatory breast cancer more than five years after a previous diagnosis of inflammatory breast cancer is a separate (new) primary. See rule M5 in the Breast Multiple Primary Rules.
EOD-Extension--Breast: If the pathology report states "infiltrating duct carcinoma...measuring 7mm in diameter...focal areas of intraductal carcinoma," do we code this field to 14 [Invasive and in situ components present, size of entire tumor coded in Tumor Size and in situ described as minimal] or to 16 [Invasive and in situ components present, size of entire tumor coded in Tumor Size and proportions of in situ and invasive not known]?
For cases diagnosed 1998-2003: If 7mm is the measurement of the infiltrating duct portion of this cancer, assign extension code 13 [Invasive and in situ components present, size of invasive component stated and coded in Tumor Size].
If 7mm is the size of the whole malignancy and the size of the invasive portion cannot be determined, assign extension code 14 [Invasive and in situ components present, size of entire tumor coded in Tumor Size (size of invasive component not stated) and in situ described as minimal (less than 25%)]. "Focal areas of in situ carcinoma" qualifies as minimal.
Primary Site: How do we code site when endometrioid carcinoma arises in "endometriosis"?
Code the Primary Site to where the endometriosis implanted, which may or may not be the endometrium. Endometrioid carcinoma can arise in the ovary, endometrium and other internal genital sites. The site/histology edit for endometrioid and ovary has been removed from the SEER edit set.
EOD-Extension--Kidney: If a "tumor thrombus" in a renal vein is discontinuous from the primary tumor in the kidney, is it still coded to 60 [Tumor thrombus in a renal vein, NOS], rather than 85 [Metastasis]?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 60 [Tumor thrombus in a renal vein, NOS]. A thrombus can be a bolus of tumor cells within a large vein that may or may not still be connected/contiguous with the primary tumor. However, both a discontinuous and contiguous thrombus are coded to 60.
Immunotherapy/Other
Therapy--Heme & Lymphoid Neoplasms: Is the elimination of immunosuppression
treatment coded as other treatment? An example is when a post-transplant
patient develops a malignant myeloproliferative neoplasm that subsides when
immunosuppression drugs are stopped.
Do not code as a treatment. Record the cessation of
immunosuppressive drug treatment in text to explain the patient’s change in
disease status.
Reportability/Histology--Liver: Are primary hepatic neuroendocrine neoplasm and primary hepatic neuroendocrine tumor (PHNET) reportable? What are the specific histology codes?
Primary hepatic neuroendocrine tumor (PHNET) is reportable as are other digestive system NETs. There is no specific histology code for PHNET. We suggest you assign 8240/3. Use text fields to document the details.
Unless you can obtain clarification, do not report primary hepatic neuroendocrine neoplasm with no further information. If this term is being used as a synonym for PHNET, document this in the registry's policies and procedures, and report these cases.
EOD 2018/EOD Primary Tumor--Cervix: How is Extent of Disease (EOD) Primary Tumor of the cervix coded when it invades into the bladder on surgery and noted as T4. No further information is provided, and it is not possible to contact the physician for clarification. Would you code 550 (Bladder wall; bladder, NOS excluding mucosa), 750 (Bladder mucosa), or 999 Unknown?
Assign code 550 (Bladder, NOS excluding mucosa) to EOD Primary Site based on invasion into the bladder with no mention of mucosa. EOD Primary Tumor for cervix, Note 1, instructions are to use the extension information to code primary tumor in preference to a statement of FIGO stage when both are available. TNM staging is closely related to FIGO stage, and the surgical findings of bladder invasion NOS in this case should be used in preference to the statement of T4.
Grade, Differentiation--Breast: How do we code grade for a breast primary diagnosis of "Low grade invasive duct, modified Bloom-Richardson grade II/III (tubule formation 2, nuclear grade 1, mitotic rate 1)"? This appears to add up to a Bloom-Richardson score of 4, which does not fit with a Bloom-Richardson II/III.
Code the Grade, Differentiation field to 1 [grade I] using the information from the BR score.
For cases diagnosed 1998-2003: Grade or differentiation information from breast pathology reports is used in the following priority order:
1. Terminology (well, moderately, poorly)
2. Histologic grade (grade I, grade II)
3. BR scores
4. BR grade
5. Nuclear grade
On the hierarchical list for coding breast grade, the first two priorities do not apply to this case, but the third (Bloom-Richardson scores) does. Add the BR information (2+1+1) for a total score of 4, which translates to BR low grade (code 1). The statement of "II/III" may be a typo that should state I/III.
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