Report | Question ID | Question | Discussion | Answer | Year |
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20180105 | 2018 Solid Tumor Rules/Histology--Lung: What is the appropriate histology code for the case below in the Discussion section? Is there a difference between adenocarcinoma in situ (bronchioloalveolar carcinoma), non-mucinous type (8252/2) and adenocarcinoma in-situ, mucinous? See Discussion. |
Procedure: Wedge, resection specimen, Laterality: Right, Tumor site: Right upper lobe, Tumor size: 1.0 cm in greatest dimension, Histologic type: Adenocarcinoma in-situ, mucinous, Histologic grade: N/A, Visceral pleura invasion: Not identified, Tumor extension: N/A, Margins: Uninvolved, Lymphocytosis. |
Assign 8253/2 for adenocarcinoma in situ, mucinous. New codes were added in 2018 for mucinous adenocarcinoma in situ for lung cancer only as all cases were not invasive. Pathologist are discouraged from using the term BAC. In-situ lung tumors can now be identified as either mucinous or non-mucinous and the appropriate ICD-O code should be assigned based on diagnosis. |
2018 |
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20180035 | Solid Tumor Rules (2018)/Multiple Primaries--Lung: How many primaries should be abstracted in this 2018 lung case? See Discussion. |
CT chest findings: 1. There is a dominant 1 cm. nodule in the left mid lung. 2. In addition, there is a new rather dominant bilobed nodule in the left lung base. 3. Distant metastases are not identified. Four months later, a doctor's note says routine follow-up visit status post Cyber Knife stereotactic body radiation therapy for synchronous early stage non-small cell carcinomas of the left upper and left lower lobes, both Stage IA. He is medically inoperable. This situation is described as a second primary tumor in AJCC8 page 438. However, by the 2018 Lung Solid Tumor rules, this would be a single primary, per rule M7. Is that correct? |
Abstract one primary per Rule M7. Follow the Lung Solid Tumor Rules to determine the number of primaries. The AJCC TNM manual is used for staging. Do not apply AJCC instructions to determine the number of primaries. |
2018 |
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20180098 | Solid Tumor Rules (2018)/Histology: Please provide further explanation for prioritizing biomarkers in the histology coding rules. See Discussion. |
The 2018 Solid Tumor (ST) Rules General Rules state: For those sites/histologies which have recognized biomarkers, the biomarkers frequently identify the histologic type. Currently there are clinical trials being conducted to determine whether these biomarkers can be used to identify multiple primaries. Follow the Multiple Primary Rules; do not code multiple primaries based on biomarkers. Additionally, Biomarkers is at the top of the priority order to identify histology in several sections (it appears to be excluded from only Colon, Melanoma and Other sections). In the sections that include this rule, there is not much additional information on using biomarkers. Can you please provide further explanation for prioritizing biomarkers in the histology coding rules? For example, will the ST manual be updated when we need to look for specific biomarkers in a diagnosis? |
Instructions for biomarkers will be added to other site rules when applicable. The use of biomarkers to determine a specific histologic type is not yet a standard of care in the majority of cases. |
2018 |
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20180111 | Reportability/Histology--Appendix: Is high grade appendiceal mucinous neoplasm (HAMN) diagnosed in 2018 reportable? See Discussion. |
Example: Initial CT scan impression is large appendiceal mucocele with a moderate amount of right-sided abdominal ascites. Faint mural enhancement suggesting an underlying appendiceal neoplasm (mucinous adenoma or adenocarcinoma). Appendectomy follows two days later with final diagnosis of high-grade appendiceal mucinous neoplasm, see comment. Histologic grade: Grade G2 of 4 (based on the CAP protocol) . . . Ascites fluid (ThinPrep(r) and cell block preparations): Mucin, fragments of debris, and macrophages. No diagnostic neoplastic cells are identified . . . Pathologic stage: pT4a, pNX, pM1a (AJCC 8th ed). Diagnosis Comment states, We feel that there are areas of this tumor where the cytologic atypia is beyond what one would expect in low-grade appendiceal mucinous neoplasm. While mitotic figures are not strikingly increased, there are focal nuclear changes that would support classification of this tumor as high-grade appendiceal mucinous neoplasm. Approximately two weeks later the patient has an Oncology assessment stating new diagnosis of T4a, NX, M1a, Stage IVA high-grade mucinous adenocarcinoma of the appendix with mucinous ascites. Patient has had an appendectomy but no further surgery so far. However, anecdotally, the best reported case series has been with surgical debulking followed by HIPEC chemotherapy In that instance I have recommended surgery with intraperitoneal chemotherapy. Is this a reportable malignancy? If so, what is the best histology for the diagnosis? |
2022 and later HAMN is reportable. Assign 8480/2. |
2018 |
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20180023 | Reportability/Behavior: Is myxoinflammatory fibroblastic sarcoma (MIFS) reportable for 2018? This histology is on the 2018 ICD-O-3 histology update list with a behavior code of /1. See discussion. |
This will be a tough one for registrars to recognize as non-reportable since the terminology contains sarcoma, so we just want to double check. |
Myxoinflammatory fibroblastic sarcoma (MIFS) (C49._), 8811/1, is not reportable for 2018 based on the 2018 ICD-O-3 New Codes, Behaviors, and Terms list. This is a new histology/behavior not previously listed in ICD-O-3. According to the WHO 4th Ed Tumors of Soft Tissue & Bone, this histology has been given a benign (/1) behavior; however, if the pathologist and/or physician state the tumor is malignant or metastatic, report the case and assign behavior code /3. |
2018 |
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20180040 | Reportability--Kidney: Is congenital cellular mesoblastic nephroma reportable for a newborn baby? See discussion. |
2015 Rt kidney nephrectomy pathology states: congenital cellular mesoblastic nephroma, tumor sz 5.9cm, tumor limited to kidney, extension into pelvicalyceal system, margin not applicable, LVI negative. Per PubMed.gov: (In newborns) among the low-grade malignant tumors, congenital mesoblastic nephromas can be successfully treated with simple nephrectomy. Per ScienceDirect: ...currently thought that cellular mesoblastic nephroma is actually a renal variant of infantile fibrosarcoma. |
Do not report congenital mesoblastic nephroma (8960/1). Congenital mesoblastic mephromas are low-grade fibroblastic neoplasms of the infantile renal sinus according to WHO Classification of Tumors of the Urinary System and Male Genital Organs. The WHO classification is the standard used to determine behavior and histology for entities not listed in ICD-O-3. |
2018 |
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20180057 | Solid Tumor Rules (2018)/Histology--Bladder: Which Solid Tumor H Rule applies when the patient has a single tumor removed by transurethral resection of bladder tumor and the final diagnosis is: Carcinoma of the bladder with the following features: Histologic type: Urothelial carcinoma? See Discussion. |
Instruction number 1 under the Coding Multiple Histologies instructions states to code histology when the histology is described as subtype, type or variant. The general rules do indicate we can code the histology identified as type, but when applying the H Rules, it seems an argument could be made for either H1 or H3. H1 applies if you ignore the diagnosis of carcinoma and only code the histologic type: urothelial carcinoma. However, the rules do seem to imply that you take all histologies into account (e.g., code the subtype/variant when there is a not otherwise specified (NOS) and single subtype/variant). Following this logic, Rule H3 seems to be the only rule that fits, and one would code the subtype/variant urothelial carcinoma when the diagnosis is carcinoma NOS, histologic type: urothelial carcinoma. The problem is that urothelial carcinoma is not a subtype/variant of carcinoma (NOS) per Table 2. The entry for Carcinoma NOS in Table 2 states, Subtypes of carcinoma NOS include adenocarcinoma and all subtypes/variants of adenocarcinoma. To some, urothelial carcinoma is a more specific type of carcinoma; however, urothelial carcinoma is not also listed as a subtype of carcinoma or of adenocarcinoma; only adenocarcinoma is categorized as a subtype of carcinoma. Consistently applying the rules becomes an issue when rules are interpreted in different ways. Should this Table be amended to include urothelial carcinoma as a subtype/variant of carcinoma NOS with the same caveat given to adenocarcinoma in Table 2? |
Code the most specific histology or subtype/variant. Urothelial carcinoma is more specific than carcinoma. See instruction #1 on page 29 of the April 2019 update. |
2018 |
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20180012 | First course of treatment: What is the correct code to use for allogenic stem cell transplant? |
Code an allogenic stem cell transplant as 20 (Stem cell harvest (stem cell transplant) and infusion) in Hematologic Transplant and Endocrine Procedures in the 2016 SEER Manual. |
2018 | |
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20180088 | Solid Tumor Rules (2018)/Multiple primaries--Prostate: How many primaries are abstracted and what M Rule applies when a patient is diagnosed with prostate adenocarcinoma in 2014, followed by liver mass biopsy showing neuroendocrine carcinoma, small cell type of the prostate in 2018? See Discussion. |
The patient has a history of prostate adenocarcinoma with lymph node metastases, status post prostatectomy and treatment by Lupron in 2014. The most recent prostate serum antigen measurement (April 2018) was normal. CT scan of the abdomen and pelvis revealed new hypodense liver lesions, a slightly enlarging lung right lower lobe nodule, and enlarging lobular mass in the prostatectomy bed. The core liver biopsy contains areas of metastatic tumor with a differential diagnosis on pathology of high-grade neuroendocrine carcinoma of the prostate (small cell type), which may have been seen in association with prostate adenocarcinoma, or metastatic small cell carcinoma of a different site. Clinically, the physician impression is that this represents metastatic castration-resistant prostate cancer. The Solid Tumor Rules note that the Multiple Primary Rules are not used for tumor(s) described as metastases. However, SINQ 20130221 indicates that, at least historically, these would have been accessioned as multiple primaries (histology 8140 & 8041 per Rule M10). Does the previous SINQ note still apply to these types of cases, and if so how would one know to move beyond the initial note indicating metastases are not new primaries? |
The guidance provided in SINQ 20130221 still applies. Accession two primaries, adenocarcinoma [8140/3] of the prostate [C619], followed by small cell (neuroendocrine) carcinoma [8041/3] of the prostate [C619] for each of the examples given per Rule M10 of the 2018 Solid Tumor Rules, Prostate. In each case, the second histology (because it is not adenocarcinoma) is a new prostate primary. Small cell carcinoma and small cell neuroendocrine carcinoma are not adenocarcinomas. As a result, they are not covered by Rule M3. For the case described in this SINQ submission, based on the findings of a lobular mass in the prostate bed, this is a second primary (there is residual prostatic tissue). This is unchanged from the 2007 Multiple Primaries Rules for Other Sites. |
2018 |
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20180107 | Solid Tumor Rules (2018)/Histology--Lung: If the pathology states non-small cell carcinoma of the lung (NSCLC), consistent with squamous cell carcinoma, is the code non-small cell carcinoma according to the Solid Tumor Rules? The Medical Oncologist states that the tumor is a squamous cell carcinoma. In these instances would you code the squamous cell carcinoma since you have a definite physician statement? |
Code the histology to SCC 8070/3. Based on registrar feedback on the NSCLC rule, we added a rule that specifically addresses when ambiguous terminology can be used to code histology other than NSCLC. The lung rules were update 10/12/2018 so please make sure you are using the currently posted rules. The new rule is: Rule H3-Code the specific histology when the diagnosis is non-small cell lung carcinoma (NSCLC) consistent with (or any other ambiguous term) a specific carcinoma (such as adenocarcinoma, squamous cell carcinoma, etc.) when: * Clinically confirmed by a physician (attending, pathologist, oncologist, pulmonologist, etc.) * Patient is treated for the histology described by an ambiguous term * The case is accessioned (added to your database) based on ambiguous terminology and no other histology information is available/documented Example 1: The pathology diagnosis is NSCLC consistent with adenocarcinoma. The oncology consult says the patient has adenocarcinoma of the right lung. This is clinical confirmation of the diagnosis, code adenocarcinoma. Your case meets the criteria in bullet 1. |
2018 |