Report | Question ID | Question | Discussion | Answer | Year |
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20210035 | Update to current manual/Lymphovacular invasion--Thyroid: Are psammoma bodies only recorded as vascular invasion in papillary thyroid cancer cases? See Discussion. |
For example, total thyroidectomy specimen shows right lobe papillary thyroid carcinoma, 4.2 cm, unencapsulated, with numerous psammoma bodies in non-tumoral thyroid parenchyma, without angioinvasion; left lobe with papillary thyroid carcinoma, 0.6 cm, encapsulated, with capsular invasion, with intralymphatic psammoma bodies in non-tumoral thyroid parenchyma, without angioinvasion. The synoptic summary documents vascular invasion present (psammoma bodies only). |
If you are collecting lymphovascular invasion (LVI) for thyroid cases, record "vascular invasion present (psammoma bodies only)" as vascular invasion (code 1, Lymphovascular Invasion Present/Identified) in the LVI data item. Use a text field to specify that this is vascular invasion by psammoma bodies. |
2021 |
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20210062 | Histology/Reportability--Heme and Lymphoid Neoplasms: Is a case that is compatible with low grade myelodysplastic syndrome with multilineage dysplasia (MDS-MLD) reportable, and if so, is the histology plasma cell myeloma or myelodysplastic syndrome (MDS)? See Discussion. |
HL-7 e-path report, Final Diagnosis High normocellular marrow with maturing trilineage hematopoiesis, multilineage dyspoiesis, compatible with MDS-MLD and involvement by plasma cell neoplasm/myeloma, IgA kappa positive, approximately 20-25% of total cellularity present. See comment. Comments Correlation with other relevant laboratory (amount and type of serum and urine paraprotein levels, renal function tests, serum calcium level, and anemia) and radiologic (lytic bone lesions) findings is recommended for complete interpretation. Dyspoiesis of all lineages is seen and the findings are compatible with low grade myelodysplastic syndrome (MDS-MLD), assuming that other possible causes are excluded. Correlation with cytogenetic and molecular studies is recommended for complete characterization |
This case is reportable. Assign MDS, NOS (9989/3) based on the information provided for this case. “Compatible with” can be used for reportability; however, it cannot be used for assigning histology. There is no confirmed diagnosis of plasma cell myeloma/neoplasm; the comment specifically addresses the need for further evaluation of this case. |
2021 |
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20210064 | Solid Tumor Rules (2018/2021)/Multiple primaries--Ovary: How many primaries should be reported when patient has right fallopian tube high-grade serous carcinoma and bilateral serous tubal intraepithelial carcinoma (STIC)? See Discussion. |
Patient is diagnosed March 2021, with malignant pleural effusion, clinical impression supports either endometrial or tubo-ovarian primary and neoadjuvant chemotherapy is given. Subsequent total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAH/BSO) in July, shows high-grade serous carcinoma involving the right fallopian tube and bilateral ovaries, as well as bilateral STIC. Summary Stage lists tumor site as right fallopian tube, with the serous tubal intraepithelial carcinoma (STIC) noted under “additional findings.” Should the contralateral (left-sided) STIC be accessioned as an additional primary, per MP/H Rule M8, the since fallopian tubes are listed in Table 1 as Paired Organs with Laterality? |
Abstract as multiple primaries per rule M8. There are bilateral fallopian tube primaries. It sounds like the "primary" tumor was identified in the right fallopian tube with bilateral spread of disease. Incidental STIC was also identifed in the left fallopian tube. Do not record the STIC as another primary. |
2021 |
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20210053 | Reportability/Heme & Lymphoid Neoplasms: Is ALK positive (ALK+) histiocytosis involving the bone marrow and kidney reportable? See Discussion. |
2021 Bone marrow biopsy showed erythroid hyperplasia, increased histiocytes with hemophagocytosis and Factor XIIIa positive histocytic cells. Moderate cytoplasmic staining for ALK 1, consistent with bone marrow involvement of ALK-positive histiocytosis. A subsequent kidney lesion biopsy was also found to have ALK-positive histiocytosis. The patient was then treated with clofarabine. Patient is 3 years old. 07/2020-Chart indicates patient presented in June with fevers and refusing to walk with pancytopenia, bone marrow biopsy showed no leukemia buthistiocytes. Impression: ALK positive histiocytosis involving BM and kidney. 10/2020 Bone marrow final diagnosis states right and left bone marrow aspirates and biopsies: No morphologic or immunohistochemical evidence of involvement by the patient's previously diagnosed ALK+ histiocytosis (see Comments) - Multiple histiocytic collections with prominent hemosiderin; favor reactive - background normocellular bone marrow with maturing trilineage hematopoiesis. The patient's prior bone marrow samples are reviewed (9/2020 and 7/2020). Similar to the September bone marrow sample, the current marrow shows numerous histiocyte collections with abundant associated hemosiderin deposition. These histiocytes have a stellate/dendritic appearance and lack the atypical features noted in the patient's marrow at diagnosis, favoring a reactive process. This impression is further supported by the lack of immunoreactivity for either Factor XIIIa or ALK1 among these cells. There is no convincing morphologic or immunohistochemical evidence of marrow involvement by the patient's previously diagnosed ALK+ histiocytosis within the sampled material. Of note, the marrow otherwise appears normocellular for the patient's age, indicative of ongoing marrow recovery post therapy. It is not clear whether this would be equivalent to Langerhans cell histiocytosis, disseminated (9751/3) as there is not a statement of Langerhans cell or whether this is just histiocytosis, NOS and not reportable. |
Do not report this case of histiocytosis. Based on the information provided, this case is not reportable. |
2021 |
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20210072 | Hormone Therapy--Breast: How are hormone therapy (HT) and other related data items coded when a patient had a previous breast primary and is still on HT when diagnosed with a new breast primary? See Discussion. |
In this scenario, we record that HT began for the second primary on the date of diagnosis, and the Systemic/Surgery Sequence ends up usually being coded 4 because the HT continues even if the specific agent may be changed. This does not seem to meet the definition of neoadjuvant therapy for the second primary so we approach the staging and grade coding as just clinical/pathological? For example, if the tumor size at surgery is a little larger than estimated on imaging, we would use the pathologic size for our staging. The tumor size and grade of the second primary are not being changed by the ongoing HT. Do we have the right approach? |
For this example: 1. Code HT as treatment on the date of diagnosis for the second primary. 2. Code Systemic/Surgery Sequence as 4. 3. Do not code neoadjuvant data items as neoadjuvant started/completed. The HT given would not qualify for neoadjuvant therapy since the intent of the HT was not neoadjuvant. The HT would affect the second primary, but it is still not neoadjuvant. 4. Code clinical and pathological tumor size accordingly, based on the imaging and the pathological findings. 5. Code Extent of Disease data items based on the pathological findings since pathological findings take priority over clinical and this is not neoadjuvant therapy. |
2021 |
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20210065 | Solid Tumor Rules (2018/2021)/Histology--Lung: Should there be an exception to the Solid Tumor Rules for Lung to allow coding a more specific histology described by ambiguous terminology, when the only pathologic workup done is a cytology report? Due to the unique nature of lung cases which are often diagnosed on imaging and cytology without more definitive pathology, we are seeing many cases where the existing Solid Tumor guidelines result in very generic NOS histology codes. For example, lung mass found on imaging with a fine needle aspirate of a lymph node, final diagnosis "positive for malignancy" and comment "consistent with squamous cell carcinoma." See Discussion. |
The Solid Tumor histology coding guideline #3 for Lung states that an ambiguous histology can only be coded over an NOS when a physician clinically confirms it or the patient receives treatment based on the ambiguous histology; similar instructions exist in rules H3 and H12. We are in a central registry and don't typically have access to physician notes or treatment plans; unfortunately our hospital abstracts rarely document physician confirmation of ambiguous histology and we are uncertain if we should accept their coding of the more specific histology, assuming they did find clinical confirmation that was not documented. If not, our understanding of the Solid Tumor rules is that the histology in such a case would have to be coded as malignancy NOS (8000/3) per the non-ambiguous final diagnosis, and that we cannot use the more specific but ambiguous squamous cell carcinoma since we don't have definite clinical confirmation. We also have a fair number of cytology-only lung cases without any hospital information to clinically confirm an ambiguous histology. |
Code histology as squamous cell carcinoma, NOS (8070/3) using Lung Solid Tumor Rules, Rule H3 if no other information is available. Rule H3 states: If the case is accessioned (added to your database) based on a single histology described by ambiguous terminology and no other histology information is available/documented, code that histology. |
2021 |
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20210046 | Reportability--Skin: Is dermatofibrosarcoma protuberans (DFSP) with fibrosarcomatous transformation synonymous with dermatofibrosarcoma protuberans, fibrosarcomatous, and therefore reportable for diagnosis year 2021 and forward? See Discussion. |
Patient has a 2021 skin excision showing an atypical spindle cell neoplasm, most consistent with dermatofibrosarcoma protuberans (DFSP) with fibrosarcomatous transformation. Per the ICD-O-3.2 Coding Table, DFSP, NOS has a behavior code of /1, and DFSP, fibrosarcomatous has a behavior code of /3. There is no code listed for DFSP with fibrosarcomatous transformation. Transformation is not included as a term that can/cannot be used for the Other Sites Schema, but this type of DFSP is often described as DFSP with fibrosarcomatous transformation. How do we code DFSP when transformation is used to describe fibrosarcomatous? |
Report DFSP with fibrosarcomatous transformation as it is synonymous with fibrosarcomatous DFSP (8832/3). According to the WHO Classification of Skin Tumors, 4th edition, fibrosarcomatous DFSP is a variant of DFSP and that fibrosarcomatous transformation is seen in approximately 10% of DFSP cases. It is characterized by an often abrupt transition of DFSP. |
2021 |
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20210022 | Solid Tumor Rules (2018/2021)/Multiple primaries--Prostate: Is basal cell carcinoma with focal squamous differentiation and a small focus of infiltrating prostatic adenocarcinoma one or two primaries and if one, is the histology 8147/3? See Discussion. |
Scenario: Patient had a transurethral resection of the prostate on 8-29-19, positive for basal cell carcinoma with focal squamous differentiation involving approximately 50% of tissue (determined not to be mets by consult). On 11-14-19, the patient had a prostatectomy positive for residual basal cell carcinoma and a small focus of infiltrating prostatic adenocarcinoma. According to AJCC, 8th edition, page 724, basal cell carcinoma of the prostate is 8147/3 and we ignored the small focus of adenocarcinoma. The above scenario was reported as two primaries (8090/3 and 8140/3), but we are thinking it is one. |
Abstract a single primary and code as 8147/3 using Rule M18 and Rule H17 of the 2018 Other Sites Solid Tumor Rules. This is based on the findings of basal cell carcinoma of the prostate (8147/3) and adenocarcinoma (8140/3). We consulted with the Subject Matter Expert who advises that basal cell carcinoma and basal cell adenocarcinoma can be used interchangeably. This updates previous consultation regarding this histology. The Other Sites rules will be updated for 2022 and include this information in the prostate histology table. |
2021 |
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20210010 | Reportability--Head & Neck: Is chondrosarcoma, grade 1 reportable for cases diagnosed 01/01/2021 and later? See Discussion. |
Neither the ICD-O-3.2 Implementation Guidelines nor the ICD-O-3.2 Coding Guidelines (including Tables 1-7) address reportability changes for chondrosarcoma grade 1. In the Solid Tumor Rules Manual, Head and Neck Equivalent Terms and Definitions, Table 7 (Tumors of Odontogenic and Maxillofacial Bone (Mandible, Maxilla)), Chrondrosarcoma grade 2/3 (9220/3) is included as a subtype/variant for sarcomas in these sites, but it does not address chrondrosarcoma, grade 1. The ICD-O-3.2 Coding Table lists Chondrosarcoma, grade 1 as morphology code 9222/1. If Chondrosarcoma, grade 1 is no longer a reportable tumor for cases diagnosed 01/01/2021 and later, why wasn't this reportability change included in the ICD-O-3.2 Implementation Guidelines? If the standard setters chose not to include this reportability change, shouldn't Table 7 also indicate that all chondrosarcomas (NOS, grade 1, grade 2 or grade 3) are reportable for cases diagnosed 2018 and later? How are registrars to make reportability and histology coding decisions for chondrosarcomas when neither source provides clear instructions regarding these tumors? |
Chrondrosarcoma, grade 1 (9222/1) is not reportable according to the Reportability section in the 2021 SEER Manual. The histology (9222/1) is listed in ICD-O-3.2 as a synonym for atypical cartilaginous tumor (preferred term). In general, the tables do not include non-reportable terms and codes. Registrars should refer to their standard setter (to whom they submit data) for reportable neoplasms. Currently, /0 and /1 neoplasms are reportable for central nervous system sites only. ICD-O-3.2 includes all neoplasms but that does not mean they are reportable. If a facility collects non-malignant neoplasms, use the corresponding ICD-O code in 3.2. |
2021 |
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20210024 | Primary Site--Vulva: What is the primary site of patient with an excision of a left vulvar cystic mass showing focal mammary-type ductal carcinoma in situ (DCIS) on 11/06/2020? See Discussion. |
Final Pathologic Diagnosis: Vulvar cyst, excision: Focal mammary-type ductal carcinoma in situ, intermediate grade, arising within cystically dilated duct (See Comment) Size of DCIS: 0.7 CM. Margins: Negative. Comment Sections demonstrate a cystically dilated duct. Focally, at the periphery of the duct, there is a neoplastic monomorphic proliferation of ductal cells with intermediate grade nuclei. No associated necrosis is identified. Immunostains for GATA-3 and estrogen receptor are strongly positive within the neoplastic cells, supporting origin from mammary-like epithelium. Immunostain for p63 demonstrates preservation of a basal layer around the dilated duct, including the region involved by DCIS. Immunostain for cytokeratin 5/6 shows loss of expression within the DCIS. No stromal invasion is identified. The cyst appears to be completely excised. 12/01/2020 post op visit with surgeon: Ductal carcinoma in situ (DCIS) of the left vulva in an excised cystic lesion. PLAN: I reviewed the pathologic findings from the excision of the left vulvar cyst. This appears to be a cystic lesion in the mammary line with focal DCIS. It was excised completely with negative margins. It would not warrant any additional treatment except expectant management. |
Code the primary site to vulva. Use text fields to record the details. According to the WHO classification, several types of primary vulvar mammary-like carcinoma have been reported. It is rare and is thought to arise from specialized anogenital mammary-like glands within the vulva. It does not arise from ectopic breast tissue and is does not represent metastatic breast carcinoma. |
2021 |