Histology--Pancreas: What is the correct code for "non-secretory pancreatic endocrine tumor" with positive lymph nodes on excision indicating a malignant tumor? Pathologist indicated it was not an exocrine tumor.
Code as islet cell carcinoma [8150/3].
There are several cell types in the islets, and each produces a different hormone. The custom has been to name the tumors by their hormone production e.g. insulinoma, glucagonoma, etc. Occasional tumors do not produce any hormone (at least one that can be determined or measured). These tumors are called non-functioning endocrine tumors. Most of the endocrine tumors in the pancreas are islet cell tumors.
Reportability: Is a tubular adenoma reportable if the final diagnosis is "high grade atypia" and the diagnosis comment is "atypia limited to muscularis mucosa areas of pseudostratification [formerly qualifying for carcinoma in situ]"?
This case is not reportable.
The pathologist would need to include "carcinoma in situ" as part of the final diagnosis in order for this case to be reportable.
MP/H Rules/Histology--Lung: What is the correct histology code for a neuroendocrine neoplasm described as a carcinoid and also referred to as oncocytic? See Discussion.
Left mainstem bronchus mass excised: metaplastic endobronchial mucosa with submucosa containing an infiltrating poorly diff malignant tumor. Origin of tumor is not identified in overlying mucosa. IHC stains will be performed.
Addendum #1. IHC stains show well diff neuroendocrine neoplasm, favor carcinoid. Recommend sending this to expert in lung neoplastic pathologist.
For cases diagnosed 2007 or later, code as 8246 [Neuroendocrine carcinoma, NOS]. According to our pathologist consultant, the neuroendocrine description is more specific than the oncocytic description in this case.
CS Lymph Nodes/CS Mets at Dx--Ovary: How are renal lymph nodes coded for ovary primaries?
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 involvement of renal lymph nodes under CS Mets at Dx. Renal lymph nodes are not listed as regional lymph nodes for ovary; therefore, code involvement of renal lymph nodes under CS Mets at Dx.
MP/H Rules--Lung: Per rule M8, tumors of the same site (left lung), same histology (NSCC), greater than 3 yrs apart are separate primaries.
However, there was a recurrence to mediastinal LNs after 2 years. Would that make a difference as to whether the 2008 left lung carcinoma is reportable as a new primary or not? See Discussion.
Scenario: NSCC 2004 LLL with positive hilar/mediastinal LNs treated with LLL lobectomy, chemo and rad. 2006 per CT/PET recurrence in mediastinal LNs treated with chemoradiation. 2008 left lung nodule positive for NSCC stated by MD to be recurrence from 2004 (2008 path not compared to 2004 path).
For cases diagnosed 2007 or later:
The 2008 lung carcinoma is a separate primary according to rule M8. The 2006 diagnosis is metastases to the lymph nodes. Do not apply the MP/H rules to metastases.
Surgery of Primary Site--Melanoma: Which surgery codes should be used for cases that have a 1 cm margin? See Discussion.
For a melanoma case the surgery codes in the 30's are to be used when margins are stated to be less than 1 cm. The codes in the 40's are to be used for cases where the margins are greater than 1 cm.
If the margin is exactly 1 cm, assign a surgery code from the 20-36 range. Use a code in the 40's only when the margin is greater than 1 cm.
Scope Regional LN Surgery--Melanoma: How is this field coded when there is no primary skin lesion and the only disease present is one axillary lymph node that reveals melanoma? See Discussion.
According to SINQ 20061045, the CS Lymph Node field is coded to 80.
Code scope of regional LN surgery 4 [1 to 3 regional lymph nodes removed] for this case. One lymph node was removed. For this case, the axillary lymph node is coded as regional for the CS Lymph Node field. Therefore, include this lymph node is also coded in the Scope of Regional LN Surgery field.
MP/H Rules: Does the presence of metastases affect the application of the MP/H rules? See Discussion.
Single lung tumors presenting in each lung but the patient also presents with bone mets? Would rule M6 apply? Or do the bone mets represent additional tumors?
For cases diagnosed 2007 or later, the MP/H rules do not apply to metastases. Ignore metastases when applying the rules.
For the case above, use rule M6 and abstract as two primaries (right lung and left lung). The bone mets are ignored.
Histology: Must every word in the ICD-O-3 code definition appear in the diagnosis in order to assign that ICD-O-3 code? See Discussion.
Is the diagnosis "Acute myeloid leukemia, M2" coded to Acute myeloid leukemia with maturation, FAB M2, NOS, (9874/3) or to Acute myeloid leukemia, NOS, (9861/3)?
For cases diagnosed prior to 1/1/2010:The general instructions for assigning histology codes are to code as precisely as possible. Acute myeloid leukemia with maturation is the definition of the FAB M2 category. A pathologist does not need to provide every word in the term associated with an ICD-O code; pathologists don't always talk that way. AML M2 is a very specific diagnosis and should be coded to 9874/3.
For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
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