Report | Question ID | Question | Discussion | Answer | Year |
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20170073 | Histology/Behavior--Brain and CNS: How are histology and behavior coded for a diagnosis of pineal anlage tumor in an infant? See Discussion. |
Patient is an 11 month old with brain biopsy showing final diagnosis of pineal anlage tumor. How are behavior and histology coded for this rare tumor? |
Assign 9362/3 for pineal anlage tumors. According to the WHO Classification of Tumors of the Central Nervous System, 4th edition, pineal anlage tumors, while extremely rare, share features with pineoblastoma. Although they have a distinct morphology, there is no other ICD-O-3 code for pineal anlage tumors. |
2017 |
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20200043 | Histology/Behavior--Bladder: Is the behavior of a bladder tumor with low-grade papillary urothelial carcinoma /2 or /3? See Discussion. |
Transurethral resection: Microscopic Diagnosis: Bladder, transurethral resection: Low-grade papillary urothelial carcinoma Gross Description: Received in formalin labeled with the patient's name and bladder tumor is a 3.0 x 2.0 1.0 cm aggregate of friable tan tissue biopsies. The specimen is submitted in toto, cassettes This is all the information there is on this path report. Extent of Disease (EOD) instructions state inferred description of noninvasive: No statement of invasion (microscopic description present) SEER 2018 Appendix C Bladder Coding Guidelines state code behavior 3 if the only surgery performed is a transurethral resection of the bladder (TURB) documenting that depth of invasion cannot be measured because there is no muscle in the specimen OR the pathology report does not mention whether the submucosa is free of tumor or has been invaded by tumor. |
For cases diagnosed 2021 or later Code the behavior as in situ (/2) when the diagnosis is low grade urothelial carcinoma and there is no information regarding invasion. The SEER Manual Appendix C Bladder Coding Guidelines revision reflects this change. No changes have been made to EOD at this time. The guidelines have been updated as follows. Low grade urothelial carcinoma with no other information: Code to /2. High grade urothelial carcinoma with no other information: Code to /3. For cases diagnosed prior to 2021 Code the behavior as malignant (/3) for a bladder tumor with low-grade papillary urothelial carcinoma. |
2020 |
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20230028 | Histology--Vulva: How is the histology coded for vulvar intraepithelial neoplasia III (VIN III)/Squamous cell carcinoma in situ from a pathology report of the vulva, 8070/2 for squamous cell carcinoma in situ or 8077/2 for VIN III? The rules do not discuss this particular situation. |
Assign 8077/2 for high-grade squamous intraepithelial lesion, VIN 3 in this case. The WHO Classification of Female Genital Tumors, 5th edition, states that squamous intraepithelial lesions (SILs) of the vulva are also known as vulvar intraepithelial neoplasia, HPV-associated. The term squamous cell carcinoma in situ is not recommended. |
2023 | |
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20230060 | Histology--Urinary: How is histology coded for a diagnosis of bladder carcinoma with a mix of different urothelial carcinoma subtypes? See Discussion. |
The 10/2023 TURBT final diagnosis is “Urothelial carcinoma with mixed histologic appearances, see synoptic summary below for details.” The synoptic report includes, “Histologic Type Comment: Invasive carcinoma percentages: Micropapillary 60-70%, high grade or poorly differentiated urothelial 20-30%, squamous 10-20%.” The squamous component is stated to be “Urothelial carcinoma with squamous differentiation.” It appears there are two specific urothelial carcinoma subtypes to consider: Urothelial carcinoma, micropapillary variant (8131/3) and poorly differentiated carcinoma (8020/3). The squamous component would not be considered because there is no specific histology for “squamous differentiation.” The micropapillary component is the predominant histology (60-70%) in this case, and it does seem like this is important to capture. However, the WHO Blue Book indicates poorly differentiated carcinoma of the bladder has a poor prognosis. |
Code histology as urothelial carcinoma, NOS (8120/3). Our subject matter expert advises that WHO Classification of Urinary and Male Genital Tumors, 5th edition, does not recognize mixed urinary histologies; therefore, has not assigned an ICD-O code for urothelial mixed with multiple variants. Only pure variants are coded as they have a different prognosis from those that are mixed. According to WHO, invasive urothelial carcinoma is remarkable for its diversity of morphological appearances and a single lesion can display an admixture of conventional urothelial and various well-defined histological subtypes. |
2023 |
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20220016 | Histology--Thyroid: What is the correct histology code for a follicular carcinoma, minimally invasive, oncocytic variant of the thyroid? See Discussion. |
There is an ICD-O histology code for follicular carcinoma, minimally invasive (8335/3) as well as follicular carcinoma, oxyphilic cell (8290/3). Per SINQ 20150045, the term oncocytic is synonymous with oxyphilic in this context. The Multiple Primaries/Histology General Instructions and histology rules do not include the term “variant” as a term that can be used to code a further histologic subtype. The term “variant” can be used for the Other Sites (non-updated STR sites) when the ICD-O-3.2 (or ICD-O-3 for older cases) provides the term “variant” in the histology name. |
Code follicular carcinoma, minimally invasive, oncocytic variant of the thyroid to follicular carcinoma, oncocytic variant (8290/3). The term "variant" is commonly used in thyroid histologies and if appropriate, used to determine histology code. The WHO Classification of Tumors of Endocrine Organs, 4th edition, lists synonyms for 8290/3 as Hürthle cell carcinoma; oncoycytic carcinoma; oxyphilic carcinoma; follicular carcinoma, Hürthle cell type; and follicular carcinoma, oncocytic variant. |
2022 |
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20220020 | Histology--Thyroid: What is the correct histology code for a thyroidectomy with final diagnosis of “Right lower lobe: papillary microcarcinoma, conventional type, 0.8 cm. Isthmus: papillary microcarcinoma, follicular variant, 0.2 cm. Left lobe: Papillary carcinoma, conventional, unencapsulated.” See Discussion. |
We were previously told that papillary microcarcinoma is coded to 8260 (papillary thyroid carcinoma) and not papillary microcarcinoma (8341). That is an area of confusion. |
Based on the information provided, code histology to follicular variant of papillary thyroid carcinoma (8340/3). The tumor is a mix of papillary and follicular variants. |
2022 |
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20220017 | Histology--Thyroid: What is the correct histology code for a thyroid resection showing papillary carcinoma, tall cell variant with oncocytic features with 30% of largest tumor (right) is tall cell variant and both foci contain benign multinucleated giant cells? See Discussion. |
There is an ICD-O histology code for papillary carcinoma, tall cell (8344/3) as well as papillary carcinoma, oxyphilic cell (8342/3). Per SINQ 20150045, the term oncocytic is synonymous with oxyphilic in this context. The term “variant” can be used for the Other Sites (non-updated STR sites) primaries when the ICD-O-3.2 (or ICD-O-3 for older cases) includes the term “variant” in the histology name. The MPH General Instructions did not include the term “variant” as a term that can be used to code histology. |
Code papillary carcinoma, tall cell variant with oncocytic features to papillary carcinoma, tall cell (C73.9) (8344/3). The WHO Classification of Endocrine Organs states that this variant is composed of cells that are as tall as they are wide, and show abundant eosinophilic (oncocytic-like) cytoplasm. Tall cells must account for greater than or equal to 30% of all tumor cells. |
2022 |
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20190018 | Histology--Thyroid: Should any mention of encapsulated be included in the histology coding (8343/3 vs. 8260/3) for papillary thyroid carcinoma cases? See Discussion. |
Example: Left thyroid lobectomy with final diagnosis When the only mention of encapsulation is included in the tumor characteristics of the College of American Pathologists (CAP) summary, not the pathologist's choice of histologic type, what is the preferred histology? |
Assign 8343/3 for encapsulated variant of papillary thyroid carcinoma. If the pathology report is not available, use the histologic type in addition to other information in the CAP Protocol. |
2019 |
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20230021 | Histology--Soft Tissue: How is histology coded for malignant neoplasm with neuroectodermal differentiation and TPR-NTRK1 gene rearrangement diagnosed on left shoulder excision? See Discussion. |
March 2022, left shoulder soft tissue mass excision shows a spindle cell tumor with outside consultation diagnosis of malignant neoplasm with neuroectodermal differentiation and TPR-NTRK1 gene rearrangement. Diagnosis comments indicate the findings most closely resemble the spectrum of kinase-rearranged mesenchymal neoplasms, such as lipofibromatosis-like neural tumor. However, the expression of SOX10 and mature melanocytic markers is unusual, and does not exclude melanocytic differentiation. Should this be classified as a peripheral neuroectodermal tumor (9364) or as an "NTRK-rearranged spindle cell neoplasm (emerging)" (8990) if there is a NTRK gene rearrangement? |
NTRK-rearranged spindle cell neoplasm is a newly identified variant of sarcoma; however, WHO has not yet proposed a specific ICD-O code for this rare neoplasm. Code to spindle cell sarcoma (8801/3). WHO defines NTRK-rearranged spindle cell neoplasm as an emerging group of molecularly defined rare soft tissue tumors that span a wide group of morphologies and histological grades, and are most often characterized by a spindle cell phenotype among other characteristics. |
2023 |
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20170044 | Histology--Sarcoma: What is the histology code for epithelioid angiosarcoma? |
Assign 9120/3 for epithelioid angiosarcoma. |
2017 |