MP/H Rules/Histology--Thyroid: How should histology be coded for a diagnosis of "papillary sclerosing carcinoma" with an additional description of the tumor being "nonencapsulated"? See Discussion.
Pathology report reads, "Papillary sclerosing carcinoma." In one case, the results are in CAP protocol format and next to 'Encapsulation of tumor' it says 'No.' In the other case, it is not in CAP format, but the microscopic description says, 'encapsulation of tumor - no.' Is the correct code 8350?
For cases diagnosed 2007 or later, code 8350 [Nonencapsulated sclerosing carcinoma] per MP/H Other Sites Rule H11. The definition for 8350 in the Morphology section of ICD-O-3 includes nonencapsulated as well as diffuse sclerosing papillary carcinoma. When the pathologist states 'No' for encapsulated, that means nonencapsulated.
Surgery of Primary Site--Ovary: How should this field be coded for an ovarian primary when there is a BSO and only the fundus of uterus is removed (not a full hysterectomy)?
Assign surgery code 52 [Bilateral (salpingo-) oophorectomy; WITH hysterectomy]. Code 52 does not exclude a partial hysterectomy.
Primary Site--Breast: What subsite is to be coded for a case of invasive Paget disease of the nipple with an infiltrating ductal carcinoma of the lower inner quadrant?
Code C50.9 [Breast, NOS]. Code the last digit of the primary site to '9' for single primaries when multiple tumors arise in different subsites of the same anatomic site and the point of origin cannot be determined. Nipple [C50.0] and LIQ [C50.3] fit this rule. This is a single primary per MP/H Breast Rule M9.
MP/H Rules/Multiple primaries--Breast: Would a left chest wall mass excision stated to be ductal carcinoma consistent with a breast primary and, "compatible with either local recurrence or potentially a metastasis" be a new primary per the MP/H rules? See Discussion.
Patient underwent mastectomy in 1986 for infiltrating ductal carcinoma of left breast. Excision of left chest wall mass in March 2009 showed ductal carcinoma consistent with breast primary. The pathology report COMMENT stated it would be compatible with either local recurrence or a metastasis. The patient's primary breast carcinoma material is not available for direct comparison and the MP/H rules instruct us to ignore metastasis.
For cases diagnosed 2007 or later, the MP/H rules do not apply to metastasis. If there is no further information available for this case, the MP/H rules do not apply to the 2009 diagnosis.
Sugery of Primary Site--Breast: When a patient is simultaneously diagnosed with bilateral breast cancer and bilateral mastectomies are done, do you code the total mastectomies to 40 or 41 or 42?
Abstract cancer of the left breast and cancer of the right breast as separate primaries. Code the surgery for each primary independent of the other primary.
For the first primary, assign code 41 [Total (simple) mastectomy, NOS WITHOUT removal of uninvolved contralateral breast].
For the second primary, assign the code for the procedure performed on that site.
MP/H Rules/Histology--Gallbladder: What histology is coded for a tumor described as "90% high grade neuroendocrine ca, large cell type; and 10% low grade adenocarcinoma, conventional type"?
For cases diagnosed 2007 or later:
MP/H Rule H17 for Other Sites applies. Code the histology 8140 [adenocarcinoma].
The ICD-O-3 code for large cell neuroendocrine carcinoma is 8013 and the code for adenocarcinoma is 8140.
MP/H Rules/Multiple primaries--Brain: Does a patient diagnosed with anaplastic astrocytoma of the left temporal lobe in 2000 followed by a diagnosis of oligoastrocytoma of the right frontal lobe in 2007 have a single primary per rule M7 or multiple primaries per rule M8? See Discussion.
MP/H rule M7 states that tumors with ICD-O-3 histologies on the same branch in chart 1 are a single primary. Chart 1 shows that both of the histologies for our sample case are located on the glial branch. However, the glial tumor branch has three secondary branches. Does rule M7 apply to secondary branches? Anaplastic astrocytoma [9402] is classified under the secondary branch for astrocytic tumors. Oligoastrocytoma [9382] is classified under the secondary branch for mixed glioma. Does rule M7 or does rule M8 apply for this case? Does this case represent one or two primaries?
For cases diagnosed 2007 or later, Rule M8 applies. There are two primaries.
Anaplastic astrocytoma and oligoastrocytoma (mixed glioma) are on separate branches in Chart 1. They are both gliomas, but one is a mixed glioma and the other is an astrocytic tumor.
Reportability--Kidney: Is the donor or the recipient the reportable patient when a cyst removed from a pre-transplanted kidney is determined to be cancerous? See Discussion.
A patient received a kidney from her son. The son's kidney had a cyst which was removed prior to the transplant and later determined to be renal cell ca. Who do we report, the donor or the recipient?
The renal cell carcinoma should be reported for the donor. The cyst that was determined to be carcinoma was removed before the kidney was transplanted.
Multiplicity Counter/Type of Multiple Tumors--Breast: How are these fields coded when a patient underwent a lumpectomy demonstrating two measured foci of invasive ductal carcinoma (1.5 cm and 3 mm) and "focally seen" in situ ductal carcinoma (DCIS) followed by a re-excision that is positive for 1.5 mm focus of residual invasive carcinoma? See Discussion.
Lumpectomy path shows two foci of invasive ductal carcinoma, 1.5 cm & 3 mm sizes, and CAP summary lists "DCIS: focally seen", no further description. The re-excision pathology specimen finds a 1.5 mm focus of residual invasive carcinoma, very close to the new inferior margin (so registrar assumed this was probably not part of the previously excised mass), and no mention of any more in situ.
Can we assume the DCIS was associated with/part of the invasive tumors because it was not measured or described separately? If we say there are 3 tumors (for the measured invasive foci), should Type of Multiple Tumors be coded 30 [In situ and invasive] or 40 [Multiple invasive]?
Code 03 [3 tumors] in the multiplicity counter. Do not count the "focally seen" DCIS because it was not measured.
Code 30 [In situ and invasive] in Type of Multiple Tumors Reported as One Primary. The single primary reported for this case is a combination of in situ and invasive tumors.
MP/H Rules/Histology--Breast: How is histology coded when a nipple biopsy shows Paget disease but the mastectomy specimen shows only infiltrating ductal carcinoma in the breast tissue and the nipple is negative for Paget disease? See Discussion.
Biopsy of nipple showed Paget disease. Subsequent mastectomy showed two tumors proven to be infiltrating ductal carcinoma. Nipple is negative. Per MP/H rule M9, this is all counted as a single primary. Do we code histology from the most representative specimen and lose the information about the Paget disease?
For cases diagnosed 2007 or later, code the histology 8541/3 [Paget disease and infiltrating duct carcinoma]. Paget disease of the nipple and infiltrating duct are separate tumors. For each tumor, take the histology from the most representative specimen. The biopsy is the most representative specimen for the Paget disease. The mastectomy is the most representative specimen for the infiltrating duct. According to the multiple primary rules, tumors that are Paget disease and duct are a single primary (M9). According to the histology rules, assign code 8541/3 (H26).
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