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Do not use FIGO grade to code the grade field. See the sentence below the table in Instruction #6 in the Grade Coding Instructions for cases diagnosed 2014 and later, http://seer.cancer.gov/tools/grade/

Assign grade code 4 using the sarcoma table. Nottingham or Bloom-Richardson (BR) Score/Grade does not apply to angiosarcomas. This is a good question and points out needed clarification of the grade rules.

For cases diagnosed prior to 2018

Assign grade code 2 for "differentiating" retroperitoneal neuroblastoma. The rationale of our expert pathologist advisor is that "it leaves the grade 1 category open (since a "well differentiated neuroblastoma" is actually called ganglioneuroblastoma), and it also avoids putting "differentiating" into what is usually a well differentiated category."

Additionally, assign grade code 3 to a poorly differentiated retroperitoneal neuroblastoma and grade code 4 to an undifferentiated retroperitoneal neuroblastoma.

For cases diagnosed 2018+, see the Grade manual https://apps.naaccr.org/ssdi/list/

Assign histology code 8246/3. Assign grade code 4 based on the description "high grade." A high-grade neuroendocrine "tumor" is actually a neuroendocrine "carcinoma" (NEC) according to WHO Classification of Tumors of the Digestive System. If possible, verify this interpretation with the diagnosing pathologist. Use text fields to document the details of this case.

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)

Grade 2 – neuroendocrine carcinoma, moderate differentiation (M8249/3)

For tumors diagnosed prior to 2007:

Code the Histology field for the first example to 8140/2 [Adenocarcinoma, NOS, in situ] and for the second example to 8077/2 [AIN, grade III]. For both of the cases code the Grade, Differentiation field to 9 [Cell type not determined not stated or not applicable]. The 6th digit (grade code) of ICD-O-3 describes how much or how little a malignant tumor resembles the normal tissue from which it arose. In contrast, "grade" is used in the examples above to describe the degree of dysplasia, from mild dysplasia (low grade) to severe dysplasia (high grade). Do not record the degree of dysplasia in the 6th digit grade field.

For tumors diagnosed 2007 or later, refer to the MP/H rules for histology coding instructions. 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.

When all you have is the grade group, you may use the following table to convert the Prostate Grade Groups to the appropriate code for the indicated fields.

Grade Group Gleason Score Gleason Pattern SSF7 SSF8 SSF9 SSF10 Grade/diff

Grade Group 1 6 or less <=3+3 099 999 099 999 1

Grade Group 2 7 3+4 034 007 034 007 2

Grade Group 3 7 4+3 043 007 043 007 2

Grade Group 4 8 4+4, 3+5, 5+3 999 999 999 999 3

Grade Group 5 9-10 4+5, 5+4, 5+5 099 999 099 999 3

Do not record WHO/ISUP grade in the grade/differentiation field.

Designated fields for this grade system are being proposed for future implementation.

Assign code 5 when the diagnosis on the pathology report specifies "T-cell granular lymphocytic leukemia." The Heme DB grade instruction states "Code grade specified by pathologist. If no grade specified, code 9." In this case, T-cell was specified - code it. The code for T-cell (5) was not automatically assigned in the Heme DB because of the alternate names for this neoplasm. Some of these include NK-cell. Assign code 8 for alternate names with NK.

The alternate names are: Chronic lymphoproliferative disorder of NK cells, Chronic NK-cell lymphocytosis, Chronic NK-large granular lymphocyte (LGL) lymphoproliferative disorder, CLPD-NK, Indolent large granular NK-cell lymphoproliferative disorder, NK-cell lineage granular lymphocyte proliferative disorder, NK-cell LGL lymphocytosis

Use the three-grade system table in instruction #7.b to code grade for the situations you describe. Use the Grade Coding Instructions in order. Instruction #7.b (three-grade system) comes before instruction #8 (terminology).

http://seer.cancer.gov/tools/grade/