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Report Produced: 04/26/2026 15:34 PM

Report Question ID Question Discussion Answer Year
20170012

Primary Site/Sarcoma--Breast: How should the primary site and stage be coded for osteosarcoma of breast? Is C509 correct or should the code be a different primary site? When assigning C509, the Collaborative Stage (CS) still pertains to breast cancer and AJCC stages it as a breast cancer and not as a sarcoma.

Code primary osteosarcoma of the breast to breast, C500-C509. Not all site and histology combinations can be staged in CS or AJCC. 9180/3 of breast cannot be staged using the CS breast schema. Breast (C500-C509) cannot be staged using the CS soft tissue schema. The same is true for AJCC. You can stage this case using SEER Summary Stage.

Important: Do NOT change the primary site or histology code based on whether or not the case can be CS or AJCC staged. We need to know how many cases are unable to be staged because of their primary site and histology combinations.

 2017
20170035

MP/H Rules/Histology--Fallopian Tube: What is the histology code of serous tubal intraepithelial (in situ) carcinoma (STIC), bilateral fallopian tubes?

Assign 8441/2. This is based on the WHO classification for female reproductive system tumors.

 2017
20170065

MP/H Rules/Histology--Thyroid: How should histology be coded for a single tumor with final diagnosis undifferentiated (anaplastic) carcinoma arising in association with papillary thyroid carcinoma and the Summary Cancer Data states Histologic type: Undifferentiated (anaplastic) carcinoma only? See Discussion.

The Summary Cancer Data does not seem to describe a more specific histology, but it does describe the tumor histology with the worst outcome and the most extensive tumor. The anaplastic carcinoma grossly extended into skeletal muscle and gave rise to multiple regional lymph node metastases. The more appropriate histology seems to be 8021.

However, current MP/H Rules for a single tumor indicate the histology should be coded to the numerically higher histology code (8260). Coding the histology to 8260 does not account for the more aggressive tumor. Should this histology be 8260 or 8021?

Code the most specific histologic term, 8260, for papillary carcinoma of the thyroid using Multiple Primary/Histology Rule H13 for Other Sites (single tumor, invasive section). Use text fields to describe the complete histology.

 2017
20170080

Reportability/Breast: Is lobular carcinoma in situ (LCIS) reportable? The eighth edition, American Joint Commission on Cancer (AJCC) Cancer Staging Manual does not stage LCIS.

Yes, LCIS is reportable. Staging does not determine reportability. Follow the reportability requirements of your state and national standard setter. SEER reportability requirements are found in the SEER manual starting on page 5, https://seer.cancer.gov/manuals/2016/SPCSM_2016_maindoc.pdf

 2017
20170041

MP/H Rules/Histology--Thyroid: How should histology be coded for a thyroidectomy final diagnosis of papillary thyroid carcinoma, favor cribriform-morula variant? See Discussion.

This specific histology (cribriform-morula variant of papillary thyroid carcinoma) is not found in the ICD-O and is not mentioned in the 2007 MP/H Manual. However, per a web search it appears that this is a distinct type of papillary thyroid carcinoma (http://erc.endocrinology-journals.org/content/24/4/R109.full).

Example: Right lobectomy shows thyroid epithelial neoplasm, pending consultation.

Consultation: Thyroid gland, right lobe: papillary thyroid carcinoma, favor cribriform-morula variant.

Consultation Comment: IHC stains argue against medullary carcinoma. The histologic features of growth patterns and cytologic atypia (with rare grooves and pseudoinclusions) and the immunohistochemical profile support a diagnosis of papillary thyroid carcinoma, favoring the cribriform-morula variant. It is important to note that a significant number of patients with this variant of papillary thyroid carcinoma have been associated with familial adenomatous polyposis syndrome.

Assign code 8260/3 for papillary carcinoma of thyroid. Cribriform-morula variant is not listed in ICD-O-3 for papillary carcinoma. Multiple Primaries/Histology Rule H14 states to code papillary carcinoma of the thyroid to papillary adenocarcinoma, NOS (8260).

 2017
20170081

Grade/Neuroblastoma: What grade is to be used when pathology states only differentiating retroperitoneal neuroblastoma?

For cases diagnosed prior to 2018

Assign grade code 2 for "differentiating" retroperitoneal neuroblastoma. The rationale of our expert pathologist advisor is that "it leaves the grade 1 category open (since a "well differentiated neuroblastoma" is actually called ganglioneuroblastoma), and it also avoids putting "differentiating" into what is usually a well differentiated category."

Additionally, assign grade code 3 to a poorly differentiated retroperitoneal neuroblastoma and grade code 4 to an undifferentiated retroperitoneal neuroblastoma.

For cases diagnosed 2018 and later

Follow the instructions for coding grade in SEER*RSA

 2017
20170022

MP/H Rules/Histology--Brain and CNS: What is the code for an embryonal tumor with multilayered rosettes. WHO shows the code as 9478/3, but this code is not available for use in the United States.

Assign ICD-O-3 code 9392/3 until code 9478/3 is implemented in 2018. Per our expert neuropathologist, embryonal tumor with multilayered rosettes was previously called ependymoblastoma.

 2017
20170071

Reportability/Brain and CNS: Is incidentaloma reportable from brain and central nervous system (CNS) imaging? See Discussion.

We are seeing the term "incidentaloma" on magnetic resonance imaging (MR) reports of head and also with physician statements. For example, this MR of the head: Impression--Suboptimal study due to motion degradation. Heterogeneously enhancing pituitary gland without evidence of acute abnormality. A 3 mm focus of relative hypoenhancement in the left gland is favored to represent an incidentaloma. Advise correlation with clinical findings.

Also, there are cases where the scans show meningioma and then at a later date it is stated to be an incidentaloma in physician notes.

Is the term "incidentaloma" alone reportable, if the term "tumor" for CNS cases is never stated? When I googled the term, it is stated to mean "tumor."

The term "incidentaloma" alone is not reportable. Look for a reportable term elsewhere or in later information. When the term "incidentaloma" is used on a magnetic resonance imaging (MR) report, it refers to "a disease or physical condition found as a secondary by-product of capturing the necessary volume of tissue within the field of view of the MR examination" (http://radsource.us/incidentaloma). It is not necessarily neoplastic.

 2017
20170033

Grade--Appendix: What is the code and term to use for the grade/differentiation field for well differentiated, Grade 2 neuroendocrine tumor (NET)? See Discussion.

Diagnosis: Fragmented appendix with: Goblet cell carcinoid tumor (typical goblet cell carcinoid): WELL DIFFERENTIATED neuroendocrine tumor; INTERMEDIATE GRADE (GRADE 2 NET). Size 3.5 cm according to surgical pathology report. Tumor infiltrates through appendiceal wall to subserosa. Tumor is present in what appears to be the wall of the appendix near the perforation site or in hemorrhagic tissue on the surface of the appendix. MAXIMUM MITOTIC RATE IS TWO (2) FIGURES PER 10 HIGH POWER fields (2/10hpf). (4/10 hpf according to report).

WD indicates a 3- grade system (code 1 for WD) Intermediate grade indicates a 3- grade system (code grade 3 for intermediate grade), Grade 2 indicates a 2- grade system (code 2 for grade 2). Please advise.

See SINQ 20160023 for NET grade coding instructions. Coding grade for NETs is slightly different from coding grade for other solid tumors.

Since this diagnosis includes "Well differentiated" and "Grade 2," assign grade code 2, the higher grade. According to our expert pathologist consultant, "intermediate" fits best with grade 2.

 2017
20170014

Reportability/Histology--Heme & Lymphoid Neoplasms: Is a physician statement that a patient has a malignant histiocytic disorder best described as Erdheim-Chester disease reportable? If reportable, should histology be coded to 9751/3? See Discussion.

The patient had a mediastinal mass biopsy showing fibrosclerotic tissue with patchy lymphohistiocytic foci and scattered plasma cells, followed by a retroperitoneal mass biopsy showing fibrohistiocytic infiltrate. Erdheim-Chester disease is not reportable per the Heme Database. However, the physician specifically states this is a malignant disorder.

Erdheim-Chester disease is not reportable. Use the Hematopoietic and Lymphoid Neoplasm Database to determine reportability.

The WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues states that Erdheim-Chester disease is a possible adult form of disseminated juvenile xanthogranuloma with bone and lung involvement; no histology code is provided.

 2017