Report | Question ID | Question | Discussion | Answer | Year |
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20190047 | Reportability/Liver: If on imaging, there is no statement of the Liver Imaging Reporting and Data System (LI-RADS) score but there is reference that a lesion is in the Organ Procurement and Transplantation Network (OPTN) 5 category, is hepatocellular carcinoma (HCC) reportable based on the OPTN 5 classification? See Discussion. |
SINQ 20160008 discusses the reportabilty and diagnosis date for liver primaries where imaging references the LI-RADS category as LR-5 or LR-5V. The 2018 SEER Coding and Staging Manual, Appendix E Reportable Example #16, demonstrates this concept. According to the LI-RADS categories a value of 5 is "definitely HCC" and is concordant with OPTN 5. Often we see only the OPTN categorization. |
Report HCC based on the OPTN class of 5. OPTN class 5 indicates that a nodule meets radiologic criteria for HCC. Be sure to document in text fields. |
2019 |
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20140034 | Reportability--Ovary: Can you clarify when widely metastatic borderline histologies of the ovary and various other sites are reportable? See discussion. |
SINQ 20130176 states that an adult granulosa cell tumor of the ovary with metastases is malignant. However, SINQ 20091087 states that a borderline tumor of the appendix with metastasis is not reportable.
The first statement of 20130176 “though granulosa cell tumor is coded 8620/1, the presence of peritoneal or lymph node metastases indicate the tumor is malignant and coded as /3” does not coincide with the second statement of “the behavior of borderline/LMP ovarian epithelial tumors is determined by the ovarian primary, even though there may be peritoneal implants or metastatic disease in the lymph nodes”. If the ovarian metastases do make this a reportable malignancy, can this line of thinking be used to determine reportability for borderline histologies for other sites such as the appendix? |
The case in 20130176 is adult granulosa cell tumor. The answer points out an important difference in the way "metastases" from this histology should be interpreted versus low malignant potential ovarian epithelial tumors. Metastases from adult granulosa cell tumor of the ovary indicates a malignant primary. So-called metastases from a LMP epithelial tumor do not indicate a malignant primary when the metastatic deposits are also LMP/borderline in behavior.
Do not apply instructions for ovarian cases to other primary sites including appendix. |
2014 |
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20200027 | Reportability--Ambiguous Terminology: Should either of the terms, strongly characteristic of or most certainly, be used to accession a case as reportable when they are used to describe a malignancy and no other information is available? See Discussion. |
SINQ 20130140 indicates a histologic diagnosis that is characteristic of a specified malignancy is reportable because this is equivalent to the term, diagnostic of. Does the same logic apply to a clinical diagnosis that is strongly characteristic of a malignancy on imaging? SINQ 20180104 indicates the term, almost certainly, is not a reportable ambiguous term. If a radiologist notes a mass was most certainly malignant, is this adequate to accession this as reportable? Is a clinically certain diagnosis equivalent to diagnostic of? Or are the modifiers almost and most irrelevant because the terms certainly and certain are not on the ambiguous terminology list? |
Look for more information. What is the plan for each of these patients? Consult with the physician and search for further information to assist with the decision. If no further information can be obtained, accession both of these cases based on the imaging reports. If more information becomes available later, review and revise as applicable. |
2020 |
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20120060 | Primary Site/Reportability: What is the primary site and reportability status of a "pancreatic endocrine neoplasm" that arises in the heterotopic pancreas of the splenic hilum that is stated to be a "well-differentiated endocrine tumor, uncertain behavior per the WHO classification"? See Discussion. | SINQ 20120035 states that well differentiated pancreatic endocrine neoplasms should be reported with histology code 8240/3. However, the pathology report provides the WHO Classification which states "uncertain behavior." Should this tumor still be reported as 8240/3?
If reportable, how is the primary site coded? The tumor arose in heterotopic pancreas (in the splenic hilum), which is pancreatic tissue found outside the usual anatomical location of the pancreas. Per the pathology report, the tumor did not invade the spleen. Should the primary site be coded to C48.1 [mesentery]? The patient is female and the coding schema for "Peritoneum for Females" would apply to the case. However, none of those CS extension codes seem to apply to this localized case.
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This case is reportable. Code the primary site to C25.9 [pancreas, NOS] and the histology to 8240/3 [neuroendocrine tumor (NET), Grade 1].
Per the 2012 SEER Manual, code the site in which the primary tumor originated. This neoplasm arose in pancreatic tissue and will behave accordingly, even though this pancreatic tissue is not located in the usual place.
Pancreatic endocrine and neuroendocrine neoplasms are essentially the same thing. However, they are described in two different WHO classifications; the endocrine classification and the digestive system classification. The digestive system classification is more recent, and is preferred by our expert pathologist consultant. The term "neuroendocrine" is to be used now, rather than "endocrine." In the pancreas, "well differentiated endocrine tumor" is synonymous with "neuroendocrine tumor (NET) Grade 1" and is coded 8240/3. |
2012 |
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20120017 | Reportability: Is a low-grade neuroendocrine neoplasm with gastrin expression found in a periportal lymph node reportable if the clinical impression is compatible with a gastrinoma? See Discussion. |
SINQ 20110095 states that "low-grade neuroendocrine neoplasm/carcinoid tumor with expression of gastrin" is reportable. However, in this case "carcinoid tumor" is not mentioned. Is this case reportable if the expression "carcinoid tumor" is missing in the diagnosis of the pathology report? Also, does the fact that the gastrinoma was found in a lymph node affect reportability? |
This is a reportable case. Code the histology as malignant gastrinoma [8153/3]. Gastrinomas are usually malignant. This one is apparently present in a metastatic site (periportal lymph node) which confirms the malignancy. |
2012 |
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20160003 | MP/H Rules/Multiple primaries--Thyroid: How many primaries should be reported for a diagnosis of Hurthle cell carcinoma (2.7 cm) and papillary carcinoma (0.3 cm) in the thyroid? See discussion. |
SINQ 20110028 includes a note that states "Hurthle cell carcinoma is a synonym for follicular carcinoma according to the WHO." That case is a little different in that the Hurthle cell carcinoma was stated to be a probable follicular variant of papillary carcinoma. The case above does not include that statement.
Is Hurthle cell carcinoma a type of follicular carcinoma? Does rule M6 (follicular and papillary tumors in the thyroid w/in 60 days) apply, report a single primary? Or does rule M17 (tumors with ICD-O-3 histology codes different at the third digit) apply thus leading to multiple primaries (8290 for Hurthle cell and 8260 for papillary thyroid carcinoma)? |
Apply rule M6 and report a single primary.
Hurthle cell carcinoma is a snynonym for follicular carcinoma of the thyroid. |
2016 |
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20140033 | Reportability/Ambiguous Terminology--Prostate: Can you clarify why a prostate biopsy diagnosis of “highly suspicious for, but not diagnostic of adenocarcinoma, suggest another biopsy” is not reportable while a biopsy diagnosis of “atypical glands suspicious for adenocarcinoma with insufficient atypia to establish a definitive diagnosis of malignancy” is reportable? See discussion. |
SINQ 20091103 states that prostate biopsies showing “highly suspicious for, but not diagnostic of adenocarcinoma, suggest another biopsy” are NOT reportable. However, SINQ 20071056 states that “atypical glands suspicious for adenocarcinoma with insufficient atypia to establish a definitive diagnosis of malignancy” is reportable. This appears to be an issue of semantics with no clearly outlined method to determine reportability of such cases.
We have two recent cases with similar semantic issues and want to know whether they are reportable.
1) Prostate biopsy with “atypical small acinar proliferation, highly suspicious for adenocarcinoma, with quality/quantity insufficient for outright diagnosis of cancer.”
2) Prostate biopsy with “atypical small acinar proliferation highly suspicious for adenocarcinoma but due to the small size of focus, findings are not definitively diagnostic.” |
Both case examples provided are reportable using instructions for ambiguous terminology. The diagnoses are qualified by the words "highly suspicious" because neither diagnosis is definitive ("insufficient for outright diagnosis of cancer" and "not definitively diagnostic."). However, we follow our instructions for interpreting ambiguous terminology and report these cases.
SINQ 20091103 differs slightly. The final diagnosis in 20091103 declares unequivocally "not diagnostic of adenocarcinoma." That phrase in the final diagnosis negates the ambiguous terminology. The situation in 20071056 is similar to the two examples above - the ambiguous terminology instructions apply. |
2014 |
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20160011 | Reportability--Stomach: Are microcarcinoid tumors reportable? See discussion. |
SINQ 20081076 states carcinoid tumorlets of the lung are not reportable and are defined as being less than 5 mm in diameter and benign. Per the WHO Classification of Digestive Tumours, microcarcinoid tumors are precursor lesions/nodules measuring greater than 0.5 mm, but less than 5 mm (0.5 cm). Is the term microcarcinoid tumor equivalent to carcinoid tumorlet, and therefore not reportable? Or is a microcarcinoid tumor a reportable type of neuroendocrine tumor (NET)? |
Microcarcinoid and carcinoid tumors are reportable. The ICD-O-3 histology code is 8240/3. Microcarcinoid is a designation for neuroendocrine tumors of the stomach when they are less than 0.5 cm. in size. Neuroendocrine tumors of the stomach are designated carcinoid when they are 0.5 cm or larger.
The term microcarcinoid tumor is not equivalent to carcinoid tumorlet. |
2016 |
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20130150 | MP/H Rules/Histology--Bladder: What is the histology code histology code for a bladder TUR that demonstrates mixed invasive urothelial and small cell carcinoma? See Discussion. |
SINQ 20041104 (prior to 2007 MP/H rules) states to code histology to 8045. The MP/H rules do not address this combination of urothelial and small cell carcinoma. The current MP/H rule that applies is Rule H8, code the higher histology (8120/3). However, if the histology is coded to 8120/3, the fact that small cell carcinoma exists will be lost. If the small cell carcinoma drives the treatment plan/prognosis, shouldn't this situation be reflected in the rules for coding histology? |
Code the histology to 8045/3 [mixed small cell carcinoma]. The presence of small cell carcinoma drives the treatment decisions for this case.
This issue will be addressed in the next revision of the MP/H rules. |
2013 |
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20240030 | Reportability/Primary Site--Skin: Is squamous cell carcinoma (SCC) that overlaps skin and the vermillion border reportable when the percent of overlap is unknown? See Discussion. |
SINQ 20031110 addresses an overlapping lip lesion between skin and the vermillion border. We were instructed to go with area of greatest involvement. Case would be reportable if >50% of tumor was on the vermillion border and site would be coded to vermillion border (C00._). Often times percentage of involvement is not stated and all that is known is that the lesion overlaps skin and mucosa. |
Determine whether the lesion is on the mucosa or skin based on the pathology report, history and physical, and operative notes when available. The gross description of the pathology report should include information to help in determining whether the site of origin is epithelium (skin) or mucosa (lip). Do not report the case when the site of origin cannot be determined between a reportable site and non-reportable site for this histology. This includes situations where the site of origin or the site with the greatest involvement is undetermined. In this case, you cannot confirm reportability. |
2024 |