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An endometrial cancer was diagnosed in 2018. The endometrial biopsy showed malignant mixed mullerian tumor (MMMT/Carcinosarcoma). The total abdominal hysterectomy/bilateral salpingo-oophorectomy showed Endometrial Carcinosarcoma (50% serous carcinoma, 50% high grade sarcoma with rhabdomyoblastic differentiation) with invasion of 100% of the myometrium and involvement of the uterine serosa. I am not finding this in the Solid Tumor Rules or the site-specific ICD-O-3 code lists.

The SEER Manual states that Marriage is self-reported for the instruction in code 2, but it does not indicate if all other marital statuses are self-reported.

Examples: How is Marital Status reported for the following situations?

1. Patient with multiple tumors in the database, for the first tumor marital status is reported as married (code 2), for the subsequent tumor, marital status is reported as single (code 1).

2. Patient self- reports as single, but also has children.

3. Patient states they are in common law marriage, but our state is not a common law marriage state.

The Histology Coding Instructions give priority to the Final Diagnosis over the CAP protocol. However, when pathology reports are formatted using the CAP protocol, the presence of in situ carcinoma is generally only mentioned in the CAP protocol. Can the presence of in situ tumor mentioned only in the CAP protocol be used to apply rule H7 (Single Tumor: Invasive and In Situ Components Module)? Or are the rules in the Single Tumor: Invasive Only module used?

Example: Final diagnosis is invasive ductal carcinoma. CAP protocol mentions,

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.

10/27/2017 partial nephrectomy final path diagnosis: renal oncocytic neoplasm, favor hybrid oncocytic tumor. Comment:

Patient presented with hoarseness and palpable neck mass. No palpable adenopathy (per hospital abstract).

02/19/16 Thyroid Ultrasound: Right thyroid lobe with mass, 63X35X44XMM (per hospital abstract).

06/01/16 Right thyroid lobectomy, radical resection right laryngeal tumor (per hospital abstract).

06/01/16 Operative Procedure: Tumor was invading laryngeal soft tissue and cartilage anteriorly and to the right. There may be a small amount of residual tumor invading cartilage although this was not clear (per hospital abstract).

GROSS DESCRIPTION: 1. The specimen is received fresh for intraoperative consultation, labeled with the patient's name and "right thyroid mass." It consists of a 3.0 x 2.2 x 2.0 cm irregular, ragged fragment of tan-red, firm, rubbery soft tissue. The specimen is serially sectioned to reveal a tan-red, gritty cut surface with focal fleshy areas. A touch prep is performed. A representative section is submitted for frozen section analysis in 1FSA. A portion of tissue is submitted for flow cytometry with the accession number MSO-16-1786. The remaining specimen is entirely submitted in 4 additional cassettes (1B-1E). 2. The specimen is received in formalin and is labeled "right thyroid lobe." It consists of a thyroid lobe measuring 4.3 x 4.0 x 1.3 cm and weighing 10.0 g. The external surface is covered by a thin fibrous capsule with a focal area of roughening on the posterior surface. The lobe is inked black posterior, blue anterior and orange isthmus margin. Serial sectioning reveals a red-brown and beefy parenchyma. A definitive nodule is not grossly identified. The entire specimen is serially submitted from superior to inferior in 9 cassettes. 3. The specimen is received in formalin, labeled with the patient's name and "right neck/laryngeal mass." It consists of an irregular, focally nodular red-tan mass measuring 7.0 x 5.5 x 4.0 cm and weighing 54 g. The convex portion of the specimen is mostly encapsulated with focal adherent red-brown striated skeletal muscle. The concave portion of the specimen is focally ragged and disrupted. The convex portion of the specimen is inked black and the concave portion is inked blue. The specimen is serially sectioned to reveal a white-grey to red, granular, gritty cut surface with focal fleshy areas. Representative sections are submitted in 12 cassettes.

Final DX DIAGNOSIS: 1. Right thyroid mass excision Plasma cell tumor /plasmacytoma 3 cm. Tumor cells are positive for kappa and negative for lambda immunostains. Recommend correlation with flow cytometry MSO-16-1786, monoclonal plasma cell population with cytoplasmic kappa positivity. Ki-67 stains 7 percent of cells. Focal stromal hyalinization. Congo red stain for amyloid negative. No thyroidal tissue identified. 2. Right thyroid lobe excision Benign thyroid tissue with focal solid cell nest negative for malignancy. One out of two 1/2 perithyroidal lymph nodes positive for plasma cell tumor. 3. Laryngeal mass excision Plasma cell tumor /plasmacytoma 7 cm involving soft tissue and skeletal muscle. Tumor cells are positive for kappa and negative for lambda immunostains. Ki-67 stains 7 percent of cells. Focal stromal hyalinization and calcification. Congo red stain for amyloid negative

Code 9920/3 is not included under rule M3. However, disease process knowledge would indicate that because the patient has an underlying AML subtype, the leukemia cutis is due to the AML cells that have migrated into the skin tissue. This appears to be a single advanced disease process essentially diagnosed simultaneously.

Pathology--Right breast, lumpectomy with needle localization: Encapsulated papillary carcinoma of the breast. A separate focus of ductal carcinoma in situ is present. Sentinel lymph node, right breast, biopsy: One lymph node, negative for malignancy. No metastatic carcinoma is seen on slides stained with immunostain for cytokeratin (AE1/AE3). Specimen laterality: Right. Tumor size: 1.2 cm. Histologic type: Encapsulated papillary carcinoma. Nuclear grade: Grade 1 (low). Mitotic rate: Score 1. Ductal carcinoma in situ (DCIS): DCIS is present. Estimated size (extent) of DCIS: 3 mm. Architectural patterns: Cribriform and papillary. Nuclear grade: grade 1 (low). Necrosis: Not identified. Margins: Margins uninvolved by encapsulated papillary carcinoma. Distance from closest margin: 8 mm, superior Margins uninvolved by DCIS. Distance from closest margin: 11 mm, superior Lymph nodes: Total number of lymph nodes examined (sentinel and nonsentinel): 1. Number of sentinel lymph nodes examined: 1. Number of lymph nodes with tumor cells: 0. Pathologic staging: Primary tumor: See comment. Regional lymph nodes: pN0(i-). Comment: In the WHO Classification of Tumours of the Breast (2012), it is stated that "there is no universal agreement on how to stage encapsulated papillary carcinomas. In the absence of conventional invasive carcinoma, the consensus of the WHO Working Group was that such lesions should be staged and managed as Tis disease."