Home
| Report | Question ID | Question | Discussion | Answer | Year |
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20081119 | Reportability/Date of diagnosis--Liver: Does the final diagnosis of a scan have higher priority than the findings in the discussion in the body of the report? See Discussion. |
A patient with liver cancer becomes transplant eligible when the tumor is 2 cm in size. Frequently, liver tumors will be watched (no biopsy) for months until they meet the 2 cm size criteria. In the meantime, multiple scans will describe the tumor using variations of ambiguous terms that drift in and out of reportablility. One day the tumor is labeled "presumed hepatocellular carcinoma." Weeks later it is back to "worrisome for hepatoma." A single scan will use different terms in different sections of the report. Example case: Abdominal CT reveals a 1 cm liver lesion. Per the discussion portion of the scan, the lesion is consistent with hepatocellular carcinoma. Per final diagnosis: 1 cm liver lesion, possibly hepatocellular carcinoma. Is this report diagnostic of cancer? Would the date of this report be the date of diagnosis? (Patient did receive a liver transplant for hepatocellular carcinoma months later.) |
When a reportable ambiguous term is used in one part of a report or the medical record and a non-reportable ambiguous term is used in another part of the report or the medical record, accept the reportable term and accession the case. The example above is reportable. "Consistent with" is a reportable ambiguous term. Accept "consistent with" over the non-reportable term "possibly." The date of this report would be the date of diagnosis if this is the earliest report using reportable terminology. |
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20081123 | Reportability--Brain: Is angiocentric glioma, WHO grade 1 of the right frontal lobe reportable? If so, how is histology to be coded? | Angiocentric glioma is reportable. The best histology code currently available is 9380/1 [glioma, NOS; uncertain behavior]. According to the WHO Classification of Central Nervous System Tumours, Angiocentric glioma has a behavior of /1. WHO defines it as an epilepsy-associated stable or slowly growing cerebral tumour primarily affecting children and young adults; histopathologicaly characterized by an angiocentric pattern of growth, monomorphous bipolar cells and features of ependymal differentiation. |
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20081070 | CS Lymph Nodes/CS Mets at DX--Ovary: How are the following lymph node regions/chains coded in the Collaborative Stage schema for ovary?
1. pericolonic 2. pelvic, NOS 3. mesenteric, NOS |
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.Revised 7-17-09 Assign CS Lymph Nodes code 10 for involvement of pelvic lymph nodes, NOS. Code involvement of pericolonic nodes or mesenteric nodes, NOS in CS lymph nodes. |
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20081045 | MP/H Rules--Melanoma: How is histology coded for a regressing melanoma? See Discussion. | How is histology to be coded for the following tumors? Example 1: Path showed malignant melanoma Histologic type: superficial spreading. Regression: present. Example 2: Shave, mid back: malignant melanoma, lentigo melanoma type, level II, regression: present and prominent. |
For cases diagnosed 2007-2014: Apply MP/H Melanoma Histology Coding rule H5 and code the histologic type of the melanoma. Code example 1 as 8743 [Superficial spreading melanoma]. Code example 2 as 8742 [Lentigo maligna melanoma]. |
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20081130 | MP/H Rules--Breast: What histology code is used for lobular with focal ductal features? Do we ignore the focal features and code as lobular or do we use the combination code for duct and lobular? | For cases diagnosed 2007 or later, use rule H14 and assign code 8520 [lobular]. Ignore histologies described as "focal," "foci," or "focus." This instruction will be added to the next version of the MP/H manual. | 2008 | |
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20081036 | MP/H Rules--Breast: Is inflammatory breast cancer always one primary per lifetime? Or is a subsequent inflammatory breast cancer a second primary if diagnosed more than five years later? | For cases diagnosed 2007 or later, a diagnosis of inflammatory breast cancer more than five years after a previous diagnosis of inflammatory breast cancer is a separate (new) primary. See rule M5 in the Breast Multiple Primary Rules. | 2008 | |
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20081063 | MP/H Rules--Breast: How many primaries should be abstracted when a patient has a mass at 6:00 that showed poorly differentiated ductal carcinoma and a hypoechoic nodule at 9:00 that was excised with no real tumor present there though path showed angiolymphatic invasion by carcinoma throughout the entire specimen? See Discussion. | Palpable mass in right breast at 6:00. Path stated 'poorly differentiated ductal carcinoma with extensive necrosis and extensive angiolymphatic invasion. Focal high grade comedocarcinoma (1%)'. Another hypoechoic nodule was seen at the 9:00 position. This mass was excised from surrounding tissue. This mass was more like an inflammatory mass; there was no real tumor present there. Path report stated "Breast mass 9:00 excisional biopsy - angiolymphatic invasion by mammary carcinoma throughout the entire specimen." Is this two primaries because of the two different histology codes: 8500 and 8010? |
For cases diagnosed 2007 or later, abstract as a single primary using rule M3 (a single tumor is always a single primary). There was one tumor present according to the information provided. The second specimen was not a separate tumor ("There was no real tumor present there"). | 2008 |
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20081110 | MP/H Rules--Breast: Is a ductal carcinoma diagnosed in August, 2008 following a lobular-ductal primary diagnosed in February 2007 a new primary? See Discussion. |
Patient has two right breast tumors excised in February, 2007. One is lobular and the other ductal - abstracted as single primary per rule M10. Patient presents with new right breast tumor in August, 2008. This is a ductal carcinoma stated to be a recurrence. Would we again stop at M10 (single primary) or continue on to M12 and make this a new primary (difference at third number)? |
For cases diagnosed 2007 or later: Stop at rule M10 -- this is the first rule that applies. The 2008 diagnosis is not a new primary. |
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20081029 | Multiple Primaries--Brain and CNS: Multiple cavernous hemangiomas diagnosed in 1995 are treated with radiation and steroids in 1996. A 1999 MRI states there is no interval change with the lesions in selected location since 1995. How many new primaries should be reported if a 2006 MRI states there are additional cavernous hemangiomas in other parts of the brain? See Discussion. | 7-03-97 PE: Past history significant for cavernous hemangiomas. Has had radiation and was on high-dose steroids in early 1996. Patient reports subsequent MRI done and neurologist gave "clean bill of health." 1-26-99 MRI BRAIN. Clinical information: history of intracranial cavernous hemangiomas. Comparison with prior brain MRI in 12/15/95. IMP: Upper medullary, right parieto-occipital, left frontal cavernous hemangiomas without interval change in size as compared to 12/15/95.
1-25-06 MRI BRAIN. Clinical info: history of prior radiation for cavernous angiomas. Comparison made with prior exam on 1/26/99. Impression: Multiple, variable sized cavernous angiomas within medulla, pontomedullary junction, midbrain, & cerebral hemispheres. Dominant lesion centered within posterior pontomedullary junction. FINDINGS: 8mm lesion in posterior pontomedullary junction. 2mm lesion within right paracentral portion of medulla. Several less than 5mm lesions noted within brain stem bilateral. Two, less than 1-2mm, areas within right inferior aspect of right and left cerebellar hemispheres. 1cm lesion centered within white matter within right posterior parietal/occipital region. Several small, less than 1-2mm, lesion within surrounding white matter. 3rd dominant lesion within left frontal lobe equal 6mm. Several 1-2mm foci of susceptibility artifact within subcortical white matter of high right and left cerebral hemispheres consistent with small cavernous angiomas. |
Benign and borderline brain and CNS tumors diagnosed January 1, 2004 and later are reportable. Multiple tumors in different brain and CNS sites are separate primaries. Different sites are those with ICD-O-3 topography codes that differ at the first, second, third or fourth character. There are four reportable primaries in the scenario described above. |
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20081133 | MP/H Rules--Breast: What histology code is used for lobular carcinoma, pleomorphic type? | For cases diagnosed 2007 or later, use rule H14 and code the histology 8520 [lobular carcinoma]. 8520 is the only ICD-O-3 code for lobular carcinoma. There are no codes for specific lobular types. | 2008 |
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