Reportability/Histology--Tongue: Is high grade squamous dysplasia of the tongue reportable; and is it the same as carcinoma in situ (CIS), code 8077/2?
High grade squamous dysplasia of the tongue is reportable as of 2021 and later as 8077/2.
Diagnostic confirmation: When a CT guided Fine Needle Aspiration is performed and the pathology report indicates smears and cell block were prepared, if the diagnosis is positive for cancer, can you code diagnostic confirmation as 2 (positive cytology) because of the cell block?
Yes, assign diagnostic confirmation code 2 for diagnosis based on smears and cell block from CT guided FNA. This reply pertains to solid tumors.
Reportability/Histology--Head and Neck: Is a right cerebellopontine (CP) angle endolymphatic sac papillary tumor (ELST) reportable? If so, what is the histology code?
Revised December 2015
ELST is reportable. Code histology to adenocarcinoma (8140/3). Code primary site to inner ear (C301).
Endolymphatic sac tumors are rare non-metastasizing adenocarcinomas that originate in the endolymphatic sac of the inner ear (C301). They are slow growing and widely invade, and in later stages often destroy, the petrous bone. The WHO Classification assigns ICD-O-3 code 8140/3.
MP/H Rules/Histology--Breast: How is histology coded for an "infiltrating papillary carcinoma" of the breast when there is no mention of ductal or adenocarcinoma in the pathology report?
For cases diagnosed 2007 or later, assign histology code 8503 [Papillary adenocarcinoma]. Rule H14 applies.
ICD-O-3 code 8050 does not apply in this case. Refer to the numeric listing in ICD-O-3. 8050 is a squamous cell neoplasm. Papillary carcinoma of the breast is NOT a squamous cell neoplasm. It is a neoplasm of the breast parenchyma - ducts, lobules or connective tissue. 8503 is the correct code in this case.
Primary Site/EOD-Size of Primary Tumor--Lung: If the only lung mass described in CXR is a "hilar mass," is the primary site coded to C34.9 [Lung, NOS] or C34.0 [Main Bronchus; incl. Carina]? Also, can the size of the hilar mass be used to code the size of tumor field?
Because the only description available is "hilar mass," code primary site as C34.0.
For cases diagnosed 1998-2003: Use size of mass for EOD-Size of Primary Tumor.
Reportability--Brain and CNS: Does a neurofibroma actually arise in peripheral nerve roots like a schwannoma even if it is referred to as a "C6-T1 intradural spinal cord tumor" and is therefore not reportable?
Schwannomas and neurofibromas of the peripheral nerves are not reportable. Schwannomas of the nerve root or spinal dura are reportable.
First Course Treatment: If an "aromatase inhibitor" used as a complement to Tamoxifen is treatment, how should it be coded?
When an aromatase inhibitor is part of the planned first course of therapy, code it under hormone treatment.
When a change of drug is PLANNED, it is part of the same course even if subcategories change. This is the usual situation with Tamoxifen and aromatase inhibitor (for example: Femara). The switch to Femara is planned, so it is not a new course. When a drug change happens that is not planned, it is still the same course if both drugs are in the same category and subcategory. An unplanned drug change to a different subcategory would be a new course.
Surgery of Primary Site--Brain and CNS: Is "debulking" of a primary brain tumor coded to 21 [subtotal resection of tumor] or 30 [gross resection of tumor]?
Assign code 21 [subtotal resection of tumor, lesion, or mass]. Debulking removes as much of the tumor volume as possible in cases where it is not possible to remove the entire tumor. Debulking should improve the effectiveness of subsequent radiation therapy and/or chemotherapy.
MP/H Rules/Histology--Lung: How is histology coded for a diagnosis of squamous carcinoma and large cell undifferentiated neuroendocrine carcinoma?
For cases diagnosed 2007 or later, apply rule H7 and code the numerically higher ICD-O-3 code, 8070/3 [Squamous cell carcinoma]. See Chart 1, the histology tree in lung equivalent terms. Large cell neuroendocrine carcinoma is histology code 8013/3. The other histology is squamous carcinoma, 8070/3. 8070/3 is higher numerically than 8013/3.
Multiple Primaries (Pre-2007)--Skin: In a patient with Muir Torre syndrome, should each of 12 sebaceous carcinomas diagnosed from 1994-2005 be a new primary or should this process be one primary diagnosed in 1994?
For tumors diagnosed prior to 2007:
Follow the rules in the 2004 manual for determining multiple primaries. When the sebaceous carcinomas are in different sites (topography code difference in the first two numeric digits after the C), they are separate primaries. When the sebaceous carcinomas are more than two months apart, they are separate primaries.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.