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Report Produced: 09/17/2025 18:18 PM

Report Question ID Question Discussion Answer Year
20150021

MP/H Rules/Histology--Skin: How is histology coded for an "endocrine mucin-producing sweat gland carcinoma with transformation to mucinous carcinoma"? See Discussion.

Endocrine mucin-producing sweat gland carcinoma (EMPSCG) is a rare type of low-grade sweat gland carcinoma. Some journal articles indicate that most patients with EMPSCG have coexisting mucinous carcinomas, suggesting that EMPSCG is a precursor to invasive mucinous carcinoma of the skin. Sweat gland carcinoma has its own histology code per the ICD-O-3 (8400/3); should an endocrine mucin-producing sweat gland carcinoma also be coded as 8400/3? If so, would the correct histology for the skin case above be mucinous carcinoma (8480/3) per Rule H17? Conversely, if the terms "mucin-producing" are referring to mucin-producing carcinoma, and not referring to the sweat gland carcinoma, would the histology be coded 8481/3 (mucin-producing carcinoma)?

Assign 8480/3.

There is no mixed ICD-O-3 code for EMPSCG. Both histologies are in the mucinous family: mucinous adenocarcinoma (8480/3) and sweat gland carcinoma (8400/3). Apply Other sites rule H17 and code the numerically higher ICD-O-3 code (8480/3).

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare low-grade sweat gland carcinoma with a strong predilection to the eyelid region. It is histologically analogous to endocrine ductal carcinoma/solid papillary carcinoma of the breast and is characterized by a multinodular solid cystic mucinous tumor with immunoreactivity to neuroendocrine markers. Only 20 cases of this unusual tumor have been reported.

2015
20150062

Grade--Bladder: How is Grade coded for the following cases diagnosed 1/1/2014 and later? See Discussion.

1) Low grade urothelial carcinoma, invasive carcinoma not identified (8120/2)

2) Papillary urothelial carcinoma, high grade, no evidence of invasion (8130/2)

The rules for coding Bladder Grade appear to have changed over time. SPCM 2013 Appendix C instructions state that Grade should be coded to 9 for urothelial carcinoma in situ (8120/2) and to 1 or 3 for non-invasive papillary urothelial carcinoma (8130/2).

When the grade instructions were removed from Appendix C in 2014, these site specific instructions for in situ bladder cases were no longer included. Thus the two grade system, found in SPCSM 2014+ Grade/Differentiation Coding Instructions for Solid Tumors, is being used to code grade for both the in situ and invasive urothelial malignancies stated to be "low grade" (code 2) or "high grade" (code 4). See also, SINQ 20150022. Please clarify the current grade instructions for in situ and invasive urothelial carcinomas of the bladder.

Follow the instructions in the 2014+ Grade Coding Instructions to code grade for cases diagnosed 2014 and later, http://seer.cancer.gov/tools/grade/   Instruction #4.a. states to code grade for in situ tumors when grade is specified. This instruction applies to bladder cases, as well as other in situ tumors.

1. Assign grade code 2

2. Assign grade code 4

See the note below the table in instruction #7.

2015
20150016

Reportability--Stomach:  Is a well-differentiated neuroendocrine tumor of the stomach reportable?

Well-differentiated neuroendocrine tumor (NET) of the stomach is reportable. The WHO classification of digestive system tumors uses the term NET G1 (grade 1) as a synonym for carcinoid and well-differentiated NET, 8240/3.

2015
20150052

Primary Site--Sarcoma: What is the best primary site code for an undifferentiated sarcoma of the pulmonary artery? See discussion.

Consolidation of the case: The operating hospital stated: SOFT TISSUE: Resection: Procedure: Radical resection Other: Pneumonectomy Tumor Site: Right pulmonary artery - They used code C383 (mediastinum NOS).  The consulting hospital stated: Lung, right, pneumonectomy: High grade sarcoma consistent with intimal sarcoma; tumor involves pulmonary artery.  They used code C449 (other soft tissue NOS).  Would C493 (soft tissue thorax) be correct?

Code the primary site to pulmonary artery, C493. According to the WHO classification of tumors, intimal sarcomas are malignant mesenchymal tumors arising in large blood vessels. They show mostly intraluminal growth with obstruction of the vessel. They may occur in the pulmonary vessels or, less often, in the aorta.

2015
20150007

MP/H Rules/Histology: What is the proper histology code -- mucin producing adenocarcinoma or cholangiocarcinoma for the following case? See discussion.

4/10/13 Partial hepatectomy: well differentiated mucin producing adenoca involve right and left hepatic ducts, common hepatic duct & common bile duct. Invasion beyond wall of bile duct. CT Scan after 1st surgery shows residual neoplasm cannot be excluded

7/31/13 Left lateral segmentectomy: residual well differentiated cholangiiocarcinoma involving connective tissue surrounding major bile ducts. Per medical director, histolgically code to cholangiocarcinoma.

Primary site: Extra hepatic bile duct. Chemo (5FU, Leucovorin, Oxaliplatin) was started 5/1.

 

Code the histology as well differentiated mucin producing adenoca based on the 4/10/13 pathology report.

Code histology from the pathology report of the procedure which removed the most tumor tissue -- this is from the MP/H general instructions for coding histology. We are assuming that the partial hepatectomy removed the most tumor tissue in this case.

Per WHO, mucin producing adenoca is a variant of cholangiocarcioma.

2015
20150050

Reportability: Is penile intraepithelial neoplasia, differentiated type, reportable? See discussion.

Foreskin circumcision shows: Penile intraepithelial neoplasia, differentiated type (differentiated PeIN). If reportable, how would the histology and behavior be coded? Is this behavior /2?

For cases diagnosed 2018 and later

Differentiated penile intraepithelial neoplasia (differentiated PeIN), is reportable (8071/2).

Please note: Penile intraepithelial neoplasia, grade 3 (PeIN 3) is also reportable to SEER (C600-C609, 8077/2).

 2015
20150023

MP/H Rules/Histology--Thyroid: When is 8341/3, papillary microcarcinoma coded? The code description in ICD-O-3 is followed by (C739), yet there are two SINQ answers that tell us specifically to not use this code for thyroid primaries. Even the first revision of ICD-O-3 still carries the (C739) as part of this code, which goes against SINQ 20110027 and 20081127.

Per the WHO Tumors of Endocrine Organs, for thyroid primaries/cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult (1cm or less in diameter) and was found incidentally. WHO does not recognize the code 8341 and classifies papillary microcarcinoma of the thyroid as a variant of papillary thyroid and thereby should be coded to 8260. If the primary is thyroid and the pathology states papillary microcarcinoma or micropapillary carcinoma, code 8260 is correct. This information will be included in the upcoming revisions to the MP/H manual.                        

2015
20150013

Surgery of Primary Site: What is the most extensive, invasive or definitive surgical procedure when the second surgical procedure performed has a lower surgery code? See discussion.

 

Examples

8/xx/13 TURBT with path specimen (27): Papillary Urothelial Carcinoma, HG    9/xx/13 Bladder fulgeration w/o path specimen (12)

5/xx/14 Segmental Mastectomy(24): Ductal carcinoma with <1mm marg    6/xx/14 Breast Re-excision (23): Residual ductal carcinoma 1.5mm, marg neg

The code in Surgical Procedure of Primary Site should correspond to the most invasive, extensive, or definitive surgery when the patient has multiple surgical procedures of the primary site even if there is no residual tumor found in the pathologic specimen from the more extensive surgery. The timing of the procedures does not affect the code choice.

Assign code 27 for the first example. Assign code 24 for the second example.

2015
20150003

Reportability/Behavior: Is the following reportable, and if so, what is the histology code? Final Diagnosis (on multiple conjunctive excisions): Conjunctiva - primary acquired melanosis with atypia (see note). Note: "In all 3 specimens the process extends to the margins of excision. Complete extirpation is recommended (primary acquired melanosis with atypia is considered melanoma in situ).

Do not report primary acquired melanosis with atypia.

According to our expert pathologist consultant, "There has been a lot of debate in the literature about the diagnostic criteria, terminology, and natural history of primary acquired melanosis [PAM]. Your case comes down squarely on the main issue, which is whether PAM with atypia should be regarded as melanoma in situ. In most studies it appears that PAMs with no atypia or mild atypia do not progress to melanoma, and only a small percentage of those with severe atypia do so."  "PAM, even with atypia, is not melanoma in situ, and should not be reported."

For further information, see this article for a review of a large number of patients: Shields, Jerry A, Shields, Carol L, et al. Primary Acquired Melanosis of the Conjunctiva: Experience with 311 Eyes. Trans. Am Ophthalmol Soc 105:61-72, Dec 2007.

 

2015
20150011

Surgery Primary Site--Breast: Please clarify how to code both simple mastectomy with tissue expander and AlloDerm reconstruction, and simple mastectomy with tissue expander (NOS). See discussion.

There are multiple SEER Notes in the Breast Surgery Codes of Appendix C instructing us to code tissue expanders as reconstruction but none address the type of reconstruction to be coded.

1. Is a tissue expander always equivalent to Implant reconstruction?

2. Is AlloDerm always equivalent to Tissue reconstruction?

3. Is the combination of AlloDerm and tissue expander always equivalent to Combined (tissue and implant) reconstruction?

Do not code AlloDerm as either a tissue or implant reconstruction, it is a graft material that usually accompanies implant reconstruction. Placement of a tissue expander is an indication of planned reconstruction. Additional information is needed to determine whether the reconstruction involves tissue or implant.

1. A tissue expander is not always equivalent to Implant reconstruction

2. AlloDerm is not equivalent to tissue reconstruction

3. The combination of AlloDerm and tissue expander is not equivalent to combined (tissue and implant) reconstruction

2015