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20170061 | MP/H Rules/Histology--Thyroid: What is the correct histology when final diagnosis of a thyroidectomy includes the descriptor "papillary and follicular architecture?" See Discussion. |
Total thyroidectomy Final Diagnosis: Papillary carcinoma, classical type, with papillary and follicular architecture. The 2007 MP/H rules state that the term architecture is reserved for coding subtype of in situ primaries only. However, SINQ 20130165 appears to indicate this should be coded for invasive thyroid subtypes as well. Can you confirm the addition of the term architecture for determining an invasive histologic subtype for thyroid? |
Assign code 8260/3, papillary carcinoma per Multiple Primaries/Histology Rule H14. Architecture is reserved for coding subtype of in situ primaries only. SINQ 20130165 is not intended to indicate this should be coded for invasive thyroid subtypes. |
2017 |
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20170028 | MP/H Rules/Histology--Kidney: How should histology be coded for a clear cell renal cell carcinoma when the CAP protocol indicates sarcomatoid features are present? See Discussion. |
Sarcomotoid (8318) is listed as a specific renal cell subtype in the MP/H manual, but it is not listed as a renal cell subtype in the most recent WHO blue book for Urinary Organs. We are wondering if sarcomatoid features, as listed in the CAP protocol format in the following example, should be ignored when coding histology? Left kidney, radical nephrectomy: Clear cell renal cell carcinoma, with the following features: Tumor size: 8.5 X 6 cm. Tumor focality: Unifocal. Macroscopic extent of tumor: Tumor limited to kidney. Sarcomatoid features: Present (<20% of tumor shows sarcomatoid features). Histologic grade: G4. Microscopic tumor extension: Tumor limited to kidney. Margins: All margins negative for invasive carcinoma. Lymph-vascular invasion: Not identified. |
Code 8255 (adenocarcinoma with mixed subtypes). The Multiple Primaries/Histology Rule H6 applies as there are two or more specific renal cell carcinoma types, clear cell and sarcomatoid (Spindle cell), as listed in Table 1 of the kidney Terms and definitions. |
2017 |
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20170058 | MP/H Rules/Histology--Lung: What is the correct histology code for an initial biopsy of non-small cell carcinoma with neuroendocrine phenotype, possible large cell neuroendocrine carcinoma with a subsequent re-biopsy showing poorly differentiated small cell carcinoma after chemotherapy with no response? See discussion. |
Patient had a biopsy in April 2014; pathology was reported as non-small cell carcinoma with neuroendocrine phenotype, possible large cell neuroendocrine carcinoma. The patient had five cycles of cisplatin/etoposide with no response. In May 2015, a re-biopsy at a referral institution reports poorly differentiated small cell carcinoma and states "feels that this could have been the histology all along and why patient has failed multi lines of chemo." |
Code to 8041, small cell carcinoma, because the medical opinon confirms that this was the correct histology from the begining. "Possible" is not an ambiguous term used to code histology. The MP/H rules do not include coding phenotype. That leaves non-small cell (8046/3) at time of diagnosis. Chemotherapy does not alter cell type so its likely the tumor was small cell all along only now proven with additional testing. Page 14 of the SEER Coding Manual gives examples of when to change the abstract's original codes and here is one example: When better information is available later. Example 1: Consults from specialty labs, pathology report addendums or comments or other information have been added to the chart. Reports done during the diagnostic workup and placed on the chart after the registrar abstracted the information may contain valuable information. Whenever these later reports give better information about the histology, grade of tumor, primary site, etc., change the codes to reflect the better information. |
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20170055 | First Course of Treatment/Surgery of Primary Site--Corpus uteri: Do you code total hysterectomy or radical hysterectomy when a specimen indicates the uterus, cervix, ovaries, fallopian tubes, and right and left parametrium were resected, but shows no portion of the vagina. See Discussion. |
AFS1-AFS2-frozen section control, endomyometrium; AFS3-frozen section control, subserosal intramural mass; A4-anterior cervix; A5-posterior cervix; A6-anterior cervical endometrial junction; A7-posterior cervical endometrial junction; A8-A10-anterior endomyometrium, including tumor; A11-A13-posterior endomyometrium, including tumor and adjacent mass; A14-random section subserosal mass; A15-left parametrium at margin of resection; A16-right parametrium at margin of resection; A17-A18-left ovary and fallopian tube; A19-A20-right ovary and fallopian tube. The final diagnosis includes Endometrial adenocarcinoma, favor serous carcinoma, with papillary and solid areas. Tumor involves: Cervix present, Right ovary, Left ovary, Right fallopian tube, Left fallopian tube, Right parametrium, Left parametrium. |
Assign code 50 for total hysterectomy. According to Appendix C Surgery Codes for Corpus Uteri of the 2016 SEER Coding and Staging Manual, total hysterectomy is surgery to remove the entire uterus, including the cervix; whereas, radical hysterectomy includes the vagina. |
2017 |
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20170036 | Grade--Prostate: How are the prostate-related fields completed when documentation in pathology reports only includes one of the new grade groups? See Discussion. |
Our pathologists have starting to use a new prostate cancer grading system that was adopted by WHO in 2016. The new grading scheme correlates with the prior Gleason grading scheme as follows: Grade Group 1 = Gleason score 6 or less Grade Group 2 = Gleason score 3+4=7 Grade Group 3 = Gleason score 4+3 = 7 Grade Group 4 = Gleason score 8 Grade Group 5 = Gleason score 9-10 Our pathologists are no longer dictating the Gleason Primary and Secondary Pattern values nor the Gleason's Score. Reverse correlation from the new grade groups to the required patterns and score are difficult with Grade Groups 2 and 3 needing to be distinguished from one another and Grade Group 5 including two unique scores. The prostate-related fields include: Collaborative Site Specific Factor 7: Gleason's Primary Pattern and Secondary Pattern Values on Needle Core Biopsy/TURP Collaborative Site Specific Factor 8: Gleason's Score On Needle Core Biopsy/TURP Collaborative Site Specific Factor 9: Gleason's Primary Pattern and Secondary Pattern Values on Prostatectomy/Autopsy Collaborative Site Specific Factor 10: Gleason's Score on Prostatectomy/Autopsy |
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 |
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20170005 | Reportability/Histology--Testis: Is neoplasm consistent with carcinoid type of monodermal teratoma reportable as a teratoma, NOS, and if yes, what is the histology code? |
Carcinoid type of monodermal teratoma or well differentiated neuroendocrine tumor (carcinoid), monodermal teratoma of the testis is reportable. Assign 8240/3 according to the WHO classification for this neoplasm. |
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20170004 | MP/H Ruels/Histology--Kidney/renal pelvis: How is MiT family translocation renal cell carcinoma (RCC) with Xp11 translocation coded? See Discussion. |
Pathology states: Translocation renal cell carcinoma. Comment Tumor morphology and IHC profile consistent with MiT family translocation RCC with Xp11 translocation. |
Assign 8312/3 to MiT family translocation renal cell carcinoma (RCC) with Xp11 translocation. The recent WHO 4th Ed Tumors of the Urinary System has proposed a new ICD-O-3 code for MiT family translocation RCC, however the implementation of this new code has not yet been approved by the standard setters (SEER, CoC, CDC, NAACCR). Until it is approved, code histology to renal cell carcinoma (8312/3). |
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20170049 | MP/H Rules/Histology--Pancreas: What is the histology code of invasive adenocarcinoma, non-mucinous with intraductal tubulopapillary features, moderately differentiated, from the pathology report final diagnosis of the pancreas? Does 'intraductal" refer to a non-invasive/in-situ component or describe the pattern of growth? |
Assign 8503/3, intraductal papillary adenocarcinoma with invasion, to capture the more specific features of the adenocarcinoma. Histology Rule H13 for Other Sites states to code the most specific histologic term. Examples include Adenocarcinoma and a more specific adenocarcinoma. Note: The specific histology may be identified as type, subtype, predominantly, with features of, major, or with ___ differentiation. |
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20170066 | 2016 SEER Manual/Primary Site--Corpus Uteri: Is the primary site C541 (endometrium) or C543 (uterine fundus) when the histology states endometrial adenocarcinoma, endometrioid type, but tumor site states fundus? See Discussion. |
Pathology--Final description: Uterus, cervix, bilateral fallopian tubes and ovaries, total hysterectomy and bilateral salpingo-oophorectomy: Endometrial adenocarcinoma, endometrioid type, well differentiated, FIGO 1/3. Myometrial invasion: focal myometrial invasion (30% of myometrium) Tumor size: 2 x2 cm Tumor site: Fundus, exophytic/polypoid lesion Gross description: The 3.0 cm in length by 2.5 cm in diameter triangular endometrium is tan-red and smooth with a 2.0 x 2.0 cm tan-pink, exophytic fundic mass which extends on to both anterior and posterior aspects, 4.1 cm from the os. |
We recommend coding endometrium, C541, as the primary site for this case. While coding to fundus would not be incorrect, according to our expert pathologist consultant, "it is more appropriate in a setting in which the region of the uterus is of importance, e.g. with a myoma or a myosarcoma, or if the endometrioid carcinoma were NOT in the endometrium but arising in a focus of adenomyosis within the fundic myometrium." |
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20170052 | MP/H Rules/Histology--Bladder: Is urothelial carcinoma, high-grade, predominantly solid type, coded as 8120/3 or 8230/3? See Discussion. |
Urinary bladder: Invasive urothelial carcinoma, high-grade, 4.5cm, predominantly solid type, arising in background of carcinoma in-situ, carcinoma grossly extends into perivesical adipose tissue; lymph-vascular invasion is seen. |
Assign histology code 8120/3, urothelial carcinoma, NOS. Solid type is not a recognized variant of urothelial tumors and likely represents the appearance of the urothelial cells within the tumor and not a specific histologic type. |
2017 |
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