Reportability--Prostate: According to the 2018 SEER Program Manual, a prostatic intraepithelial neoplasia (PIN) III is not reportable, but is an atypical small acinar proliferation (ASAP) PIN 4 reportable?
ASAP is not reportable. Patients with ASAP found on needle biopsy will likely undergo another biopsy.
Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of a 2018 lung case whose pathology states adenocarcinoma, acinar predominant?
The Solid Tumor Rules for Lung rule H4 applies. Per Table 3, page 12, third column on adenocarcinoma row, adenocarcinoma, acinar predominant is coded to 8551/3.
Do not report renal HTOC. According to our expert pathologist consultant, "the genetic studies seem to indicate that the chromosomal changes of chromophobe renal carcinoma are not found in the hybrid tumors."
2018 SEER Manual/Primary Site--Ovary, Fallopian Tube: How should primary site be coded for a previously diagnosed ovarian cancer which is now being reclassified as fallopian tube? See Discussion.
There is a group of patients diagnosed within the past few years with ovarian cancers who are now enrolled in a clinical trial and are being screened as potential patients for a particular protocol. The screening for these particular cases is being done by a pathologist who has a particular interest in GYN pathology. As the pathologist is screening the cases, there are some which the pathologist is reclassifying as being fallopian tube primaries rather than ovarian primaries. This is apparently due to newly emerging findings and literature. The problem for me is that these cases have been entered into the registry as ovarian primaries, which was correct as of the time of the initial diagnosis. Should the abstracts remain as they were initially coded, since the diagnosis was ovarian cancer at the time they were diagnosed, or should these cases be updated to reflect the current pathologist's interpretation that these are fallopian tube primaries?
Do not change the primary site in this situation. Since the review was done for a clinical trial and the change was not officially made in the patient's medical record, the primary site remains ovary for the cancer registry. Add an explanatory note in a text field for future reference.
First Course of Treatment/Surgery of Primary Site--Melanoma: How do you code UVB therapy treatment for melanoma?
Code UVB therapy for melanoma as photodynamic therapy under Surgery of Primary Site for skin. Assign code 11 [Photodynamic therapy (PDT)] if there is no pathology specimen. Assign code 21 [Photodynamic therapy (PDT)] if there is a pathology specimen. Use text fields to document details.
Diagnostic confirmation--Heme & Lymphoid Neoplasms: Is Diagnostic Confirmation coded as 5 (positive laboratory test/ marker study) or code 8 (clinical diagnosis only) for a case that has a positive JAK2 mutation, and based on the results of the JAK2, the physician diagnosed the patient with polycythemia vera? There were no blood smears or bone marrow biopsies done.
Assign diagnostic confirmation code 5 for a positive laboratory test/marker study. A note was added to the Hematopoietic manual to state that code 5 now includes cases with no histological confirmation but there is positive immunophenotyping or genetic studies.
Solid Tumor Rules 2018/Histology--Testis: What is the histology code for a 2018 diagnosis of left testis tumor diagnosed as mixed germ cell tumor with secondary malignant components: primitive neuroectodermal tumor (PNET) and rhabdomyosarcoma? See Discussion.
The patient has testicular cancer with bilateral lung metastases and possible liver metastasis. The left orchiectomy final diagnosis was The Summary describes a single tumor that is, Germ cell neoplasia in situ (GCNIS) is also present. Although there is mixed germ cell tumor present, the PNET component of the tumor is locally invasive extending into the epididymis, hilar soft tissues, spermatic cord, and tunica vaginalis. The mixed germ cell tumor is limited to the testis only.
We are instructed not to use to the term to code histology in the MP/H Rules General Instructions (Other Site Rules not updated for 2018), however the PNET comprises the majority of this tumor and represents the most extensive disease. Should the PNET histology be ignored in this case as its a ?
Assign code 9084/3. According to our expert pathologist consultant, this is a teratoma with a somatic-type malignancy. This code is the best choice even though it does not capture the mixed germ cell elements of the tumor, or the character of the somatic component (rhadomyosarcoma, PNET).There aren't enough histology code numbers to cover all of the possibilities. Use text fields to describe the specifics of this case.
Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of a 2018 lung cancer case with invasive non-mucinous adenocarcinoma? For non-mucinous carcinoma/adenocarcinoma, the Solid Tumor Rules have codes for microinvasive, minimally invasive, preinvasive, and in situ. Do we default to the microinvasive/minimally invasive code?
Code histology to adenocarcinoma, NOS (8140/3). The World Health Organization and the College of American Pathologists no longer recognize non-mucinous carcinoma/adenocarcinoma, NOS. Pathologists are discouraged from using this term. Microinvasive/minimally invasive lung tumors have very specific criteria and these criteria do not apply to non-mucinous carcinoma, NOS.
Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of a non-small cell lung cancer (NSCLC), NOS as this is not on the AJCC list of histologies? See Discussion.
A question was posted to CAnswer forum 9/26/18 and answered stating that 8046 is not on the AJCC list of histologies for the lung chapter in the 8th edition. If the final diagnosis on the pathology report is just NSCLC, NOS with no subtype/variant, what histology/solid tumor rule would I use? In this situation, I am not able to query the pathologist. Would I code the histology to 8010 as per AJCC post?
Code NSCLC to 8046/3.
Do not change a histology code simply to assign TNM to the case. AJCC does not determine histology coding. While pathologists are no longer encouraged to use NSCLC, it does not mean the term and code are obsolete. NSCLC could be any number of histologies such as adenocarcinoma or squamous carcinoma. A diagnosis of NSCLC indicates that the initial exam of the tissue did not identify a more specific type of NSCLC. Additional immunohistochemical testing is needed to determine the histology. Update the case if better information becomes available from subsequent tests/review.
When analyzing the data, researchers and physicians will be able to identify the cases where the pathologist was unable to or did not perform further testing to determine a specific histology which drives treatment and survival.
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.
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