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A question was posted to CAnswer forum 9/26/18 and answered stating that 8046 is not on the AJCC list of histologies for the lung chapter in the 8th edition. If the final diagnosis on the pathology report is just NSCLC, NOS with no subtype/variant, what histology/solid tumor rule would I use? In this situation, I am not able to query the pathologist. Would I code the histology to 8010 as per AJCC post?

The note in the Urinary Terms and Definition states, Both Ta and Tis tumors are technically noninvasive. Code the histology specified by the pathologist. While it is true that both Ta and Tis are technically noninvasive, the AJCC defines Ta specifically for, A pathologist's use of Ta does indicate the noninvasive carcinoma did arise from a papillary tumor. However, not all pathologists use terminology that, following the Urinary Solid Tumor Histology Coding Rules, will result in a histology coded to 8130, despite an AJCC-defined Ta (noninvasive papillary carcinoma) tumor having been diagnosed because the tumor projected from the wall on a stalk.

In our region a number of pathologists provide the following types of diagnosis.

Histologic type: Noninvasive.

Histologic grade (WHO/ISUP 2016): High-grade.

Tumor configuration: Papillary.

The pathologist and/or physician may then stage this as Ta. How is the histology coded for these cases if the H Rules do not allow one to code the papillary and noninvasive Ta disease as not equivalent to noninvasive papillary carcinoma?

Flat (in situ) urothelial carcinoma has an increased risk of invasive disease compared to the noninvasive papillary urothelial carcinomas. Will there be inconsistencies or a resulting impact to analysis of truly flat/in situ urothelial carcinoma vs. papillary urothelial carcinomas if the papillary tumors are not being coded as such?

The Histology Coding Instructions give priority to the Final Diagnosis over the CAP protocol. However, when pathology reports are formatted using the CAP protocol, the presence of in situ carcinoma is generally only mentioned in the CAP protocol. Can the presence of in situ tumor mentioned only in the CAP protocol be used to apply rule H7 (Single Tumor: Invasive and In Situ Components Module)? Or are the rules in the Single Tumor: Invasive Only module used?

Example: Final diagnosis is invasive ductal carcinoma. CAP protocol mentions,

This comment was added to the pathology report by the pathologist: A focus of neuroendocrine microtumor measured 350 micrometers, qualifying as a neuroendocrine microtumor. Focus was immunohistochemically positive for chromogranin and synaptophysin and negative for gastrin. The Ki-67/CD45 immunostain showed <1% positivity in microtumor.

The Solid Tumor Rules indicate bladder tumors that are urothelial carcinoma (8120) and small cell carcinoma (8041) are separate primaries per Rule M13 (Abstract multiple primaries when separate/non-contiguous tumors are on different rows in Table 2). These are distinctly different histologies and, presumably, one would want to capture the small cell carcinoma (or small cell carcinoma component) as this has a worse prognosis.

However, if a subsequent bladder tumor is composed of invasive urothelial carcinoma and small cell neuroendocrine carcinoma, the histology is coded as 8045/3 per Rule H4, but this is not abstracted as a multiple primary. The only M Rule that applies is Rule M18 (Abstract a single primary when tumors do not meet any of the above criteria). The mixed histology code 8045 is not included in Table 2, so none of the histology-based M Rules apply. Is the subsequent mixed invasive urothelial and small cell carcinoma tumor (8045/3) the same primary as a previously diagnosed invasive urothelial carcinoma (8120/3) when these tumors are diagnosed within three years?

The patient has testicular cancer with bilateral lung metastases and possible liver metastasis. The left orchiectomy final diagnosis was The Summary describes a single tumor that is, Germ cell neoplasia in situ (GCNIS) is also present. Although there is mixed germ cell tumor present, the PNET component of the tumor is locally invasive extending into the epididymis, hilar soft tissues, spermatic cord, and tunica vaginalis. The mixed germ cell tumor is limited to the testis only.

We are instructed not to use to the term to code histology in the MP/H Rules General Instructions (Other Site Rules not updated for 2018), however the PNET comprises the majority of this tumor and represents the most extensive disease. Should the PNET histology be ignored in this case as its a ?

This will be a tough one for registrars to recognize as non-reportable since the terminology contains sarcoma, so we just want to double check.