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Report Produced: 05/26/2026 15:14 PM

Report Question ID Question Discussion Answer Year
20071007 MP/H Rules/Histology: In the absence of a tissue diagnosis, should the histology field be coded based on the findings of a suspicious cytology or a CT scan that clinically confirmed the diagnosis? See Discussion. Cytology (brushings at ERCP) which are highly suspicious of adenocarcinoma. A CT of the abdomen performed the next day shows a mass, most likely Klatskin tumor. Can the histology be coded to Klatskin tumor [8162/3] based on the CT findings?

For cases diagnosed 2007 or later, code the histology to 8162/3 [Klatskin tumor] using the histology from the CT. This case is confirmed clinically based on the CT. It cannot be accessioned based on suspicious cytology.

Rule H8 in the 2007 Histology Coding Rules for Other Sites provides instructions for coding histology when the pathology report and cytology report are not available.

 2007
20071072 Ambiguous Terminology/Date of Conclusive Terminology: If there is an unknown date of diagnosis, should the Ambiguous Terminology field always be coded to 9 and the Date of Conclusive Terminology be coded to 99999999? See Discussion. Scenario: Mammogram is suspicious for carcinoma, unknown date in 2007. A biopsy prior to admission to reporting facility is positive for carcinoma. Patient seen at reporting facility in June 2007 for treatment. The purpose of the data item "Ambiguous Terminology" is to flag cases entered into the registry based on a diagnosis with ambiguous terminology. Because the case above was entered into the registry based on conclusive terminology, code Ambiguous Terminology to 0 [Conclusive term] and code Date of Conclusive Terminology to 88888888 [not applicable]. 2007
20071097 Multiplicity Counter--Thyroid: How is multiplicity counter to be coded for a thyroid cancer presenting as multiple foci? See Discussion. Thyroidectomy showed papillary thyroid carcinoma. Path diagnosis: tumor focality: multifocal. Path described 3 foci of tumor on each side. The main tumor mass in right thyroid was 1.5 cm. Smaller foci of tumor ranged in size from .1 cm to 1.0 cm. Per guidelines, "we still don't count foci as tumors for the purpose of these rules, even if there is more than one." The 1 cm tumor was probably macroscopic in size. Do we count it in the multiplicity counter? Do we count only the 1.5 cm main tumor mass?

If the number of tumors is known, code the number in Multiplicity Counter. If foci are measured, include them in the multiplicity counter. If the only information available is "multiple foci" assign code 99.

For the case above, code 06 in the multiplicity counter (3 tumors on each side).

 2007
20071062 Primary Site: For malignant gastrointestinal tumors (GISTs), how should the primary site be coded and which Collaborative Stage and TNM staging schemes should be used for disease found in the stomach, small intestine or other locations?

This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code the primary site to the location where the GIST originated. If the primary site cannot be determined, assign code C809 [Unknown primary site].

GIST of gastrointestinal hollow viscera cannot be staged in TNM.

In Collaborative Staging, use the stomach scheme for GIST of the stomach. Use the small intestine scheme for GIST of the small intestine. For GIST of other primary sites, use the CS scheme for the specific site.

 2007
20071092 Reportability/Primary Site--Brain and CNS: Is a chondroma, NOS or a chondroblastoma, NOS that occurs in an intracranial site or along the spinal cord reportable? See Discussion.

In ICD-O-3, chondroma and chondroblastoma are site-associated morphologies for bone. If a chondroma or a chondroblastoma occurs along the spinal cord, is this one of those situations where we can be quite comfortable with a default site to bone and not to spinal cord?

Reference: ICD-O-3; Primary Central Nervous System Tumors, NPCR Training Materials 2004; SINQ 20021152

Chondroma, NOS or chondroblastoma, NOS occuring in intracranial sites or along the spinal cord are not reportable.

Chondroma, NOS and chonroblastoma, NOS are benign tumors of the bone itself, not the intracranial contents.

 2007
20071051 MP/H Rules/Multiple Primaries--Lung: Please clarify the multiple primary rule M6 and the explanatory note that states when there is a single tumor in each lung, they are to be reported as multiple primaries unless stated or proven to be metastasis. See Discussion. Single tumor in left lung, single tumor in right lung. The rules take you to M6. Suppose the tumor in left lung is biopsied and there is a physician statement that right lung tumor is metastatic from left lung tumor. The note under M6 is "When there is a single tumor in each lung, abstract as multiple primaries unless stated or proven to be metastatic." In this case, is it a single primary or multiple primaries?

For cases diagnosed 2007 or later:

When there is a single tumor in one lung and a single tumor in the other lung, apply rule M6 and abstract as multiple primaries. Use this rule whenever there is a single tumor in each lung, even when neither tumor is biopsied or resected.

This rule is unique to lung. Our physician advisors emphasized that it is very unlikely that a single tumor in one lung could be metastatic from a single tumor in the opposite lung. Therefore, the default is to abstract as multiple primaries.

The note at M6 means that there must be proof that one tumor is metastatic in order to abstract as a single primary. For example, a biopsy of the tumor proving that it is metastatic. An opinion or belief that one tumor is metastatic is not sufficient. In the absence of proof, use rule M6 and abstract as multiple primaries.

A list of MP/H clarifications will be available. This issue will be included on the list.

 2007
20071012 Reportability--Melanoma: Is a skin excision final diagnosis of "melanocytic tumor with uncertain malignant potential" reportable if the path COMMENT states the initial shave biopsy diagnosis was "melanocytic tumor with uncertain malignant potential [minimal deviation melanoma]"? See Discussion.

SKIN, RIGHT FOOT, EXCISION: CHRONIC SCARIFICATION WITH RESIDUAL ATYPICAL MELANOCYTES IN THE DERMIS IDENTIFIED, BUT COMPLETELY EXCISED.

Comment: The prior outside biopsy report indicates that the lesion was a melanocytic tumor of uncertain malignant potential (minimal deviation melanoma) measuring at least 2.5 mm in depth. There was apparently no in situ component. Special stains performed here are similar, with positive reactivity for Melan A and S-100. The cells are atypical, but there are reactive changes, making it impossible to accurately assess the true nature of the lesion in this biopsy. If this is a minimal deviation melanoma, it would be classified as a T3 (T3a since there is no description in the outside report of ulceration) lesion. The atypical melanocytes extend to a depth of 1.1 mm in this 2 mm deep biopsy, but are completely excised, both at the deep margin and at all of the peripheral margins (closest margin is superior, with clearance of 7 mm).

PATH FROM INITIAL BIOPSY: Diagnosis: Rt dorsal foot, shave biopsy: Melanocytic tumor of uncertain malignant potential (see comment). Tumor depth at least 2.5mm Deep margin involved. Comment: As a primary lesion, I would favor that this represents a melanocytic tumor with indeterminate biologic potential also known as minimal deviation melanoma. The lesion does extend to the deep margin and wider excision is recommended.

 This case is not reportable. Based on the information provided, there is no definitive diagnosis of malignancy. 2007
20071132

Reportability--Brain and CNS: Does a neurofibroma actually arise in peripheral nerve roots like a schwannoma even if it is referred to as a "C6-T1 intradural spinal cord tumor" and is therefore not reportable?

Schwannomas and neurofibromas of the peripheral nerves are not reportable. Schwannomas of the nerve root or spinal dura are reportable.

2007
20071125 Radiation Therapy--Prostate: Is the regional treatment modality XRT best coded to 50 (brachytherapy, NOS), 53 (LDR) or 54 (HDR) when the documentation indicates only "I-125 seeds" to the prostate? Assign code 53 [Brachytherapy, interstitial, LDR] for seeds to the prostate. Seeds are always low dose because they are left in place and the radioactivity decays over time. 2007
20071048 MP/H Rules/Histology--Breast: If the abstractor only has the CAP protocol information from a pathology report and it does not include a "final diagnosis" label, which fields of the protocol are used to determine the histology and whether there is carcinoma in situ present in the specimen? For cases diagnosed 2007 or later, if the CAP protocol is used in lieu of a final diagnosis, use all of the information in the CAP protocol. 2007