Solid Tumor Rules (2018, 2021)/Histology--Kidney: What is the correct histology code for a kidney primary described as clear cell papillary renal cell carcinoma"? Should we use H2 and code 8312/3 or H3 and code 8323/3?
Assign 8323/3, clear cell papillary renal cell carcinoma using the 2018 Kidney Solid Tumor Rules, Rule H1, as this is a single histology, a variant of renal cell carcinoma NOS.
Reportability/Behavior:
Our registry collects some borderline (behavior /1) cases that are not
reportable to SEER or any other standard setters. Can we assign a behavior code
of /2 to these cases?
Do not assign a behavior code of /2 to these cases unless you
have a way to flag them so that they are not reported to the standard setters
as in situ cases. Work with your state central registry to ensure that these cases are not unintentionally included in state case submission.
Surgery of Primary Site/Immunotherapy--Bladder: Is administration of BCG coded as both surgery and immunotherapy?
Yes, code as both surgery and immunotherapy. The CoC included immunotherapy/BCG under surgery and also under immunotherapy by request of the clinical advisor for bladder, reflecting the mixed-modality nature of the treatments. [Answer from CoC I & R]
Histology/Grade, Differentiation--Lymphoma: What code is used to represent the histology "high grade malignant lymphoma with features of so called blastic NK cell cutaneous lymphoma [hematodermic lymphoma]" found on punch biopsy?
For cases diagnosed prior to 1/1/2010:Code the Histology field to 9709/3 [cutaneous lymphoma, NOS]. Code the Grade, Differentiation field to 8 [NK cell].
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
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.
First course treatment--Heme & Lymphoid Neoplasms: Is the use of the corticosteroid, Clobetasol, cancer-directed treatment for mycosis fungoides or is it only used to treat the side effects of that disease?
Clobetasol is not cancer-directed treatment at this time.
Note: Question originally submitted in 2010. During 2014 review, this was checked and Clobetasol is still not cancer directed treatment for Mycosis Fungoides.
Histology (Pre-2007)/Diagnostic Confirmation: Which histology code is preferred if the CBD brushing is positive for malignant cells, cytologically most consistent with ductal adenocarcinoma [8500/3], and the common hepatic artery lymph node biopsy has metastatic adenocarcinoma, consistent with cholangiocarcinoma [8160/3]?
For tumors diagnosed prior to 2007:
Assign histology code 8160 [Cholangiocarcinoma]. Code from the pathology specimen when available. In this case, the only pathology is from the lymph node specimen.
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.
MP/H Rules--Breast: What histology code is used for lobular with focal ductal features? Do we ignore the focal features and code as lobular or do we use the combination code for duct and lobular?
For cases diagnosed 2007 or later, use rule H14 and assign code 8520 [lobular]. Ignore histologies described as "focal," "foci," or "focus." This instruction will be added to the next version of the MP/H manual.
Grade/Histology--Digestive System: What is the grade for neuroendocrine tumor (NET) or neuroendocrine carcinoma (NEC) of gastrointestinal morphologies described as: 1) NET G1 (M8240/3) and NET G2 (M8249/3) or 2) neuroendocrine carcinoma, low grade (M8240/3) and neuroendocrine carcinoma, well differentiation (M8240/3) and neuroendocrine carcinoma, moderate differentiation (M8249/3)? The SEER Instructions for Coding Grade for 2014+, Coding for Solid Tumors section, #3 state: Code the grade shown below (6th digit) for specific histologic terms that imply a grade. NET and NEC are not included in the specific terms.
You may code grade as follows.
Grade 1 – NET G1 (M8240/3)
Grade 2 – NET G2 (M8249/3)
Grade 1 – neuroendocrine carcinoma, low grade (M8240/3) or neuroendocrine carcinoma, well differentiation (M8240/3)
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