MP/H Rules/Histology--Kidney: What is the correct histology for this diagnosis? See discussion.
Procedure: Nephrectomy
Laterality: Left
Tumor type: SOLID VARIANT RENAL CELL CARCINOMA
Nuclear grade: High grade (3/4)
Histologic grade: Poorly differentiated
Pattern of growth: Solid
Tumor size: 5x4.5x4cm
Local invasion: Present
Renal vein invasion: None
Surgical margins: Negative
Non-neoplastic kidney: Unremarkable
Adrenal gland: Not submitted
Lymph nodes: Not present
Pathologic stage: T1b
There are solid sheets of tumor cells without papillary structure. The tumor stains positive for Pax-2, negative for Ecadherin, P63 and CK7, consistent with renal cell carcinoma, solid variant.
Assign histology code 8312, renal cell ca, NOS. There is no specific code for the solid variant of renal cell carcinoma.
Surgery of Primary Site--Breast: Is the surgery code 42 or 52? Does it matter that the procedure states no axillary LN, but the pathology found 2 additional LN? See discussion.
Procedure stated = Bilateral skin-sparing mastectomies, left axillary sentinel lymph node biopsy. On the pathology report it indicates two additional lymph nodes were removed that were not SLN. The axillary aspect measures 2 x 2 x 1 cm. Two lymph nodes are identified ranging from 0.5 up to 1 cm. The lymph nodes are bisected and entirely submitted. Final Diagnosis Left breast, mastectomy including nipple: no residual carcinoma; FINAL DIAGNOSIS for LN = Lymph nodes, left axillary sentinel #1; excision: Two lymph nodes examined - negative for tumor (0/2); Two lymph nodes - negative for tumor (0/2)
Assign surgery of primary site code 42. It is possible to obtain lymph nodes in a mastectomy specimen without an axillary dissection. Remember to capture the excised lymph nodes in the scope of lymph node surgery field.
Reportablility--Breast: Is lobular neoplasia reportable as lobular carcinoma in situ? See Discussion.
According to College of American Pathologists (CAP), lobular neoplasia is also known as lobular carcinoma in situ. In a previous SEER question 20041089, it was stated that they were not the same and should not be reported unless it was a Grade 3. I assume this has changed and we are to report lobular neoplasia as lobular carcinoma in situ, is this correct?
According to the WHO classification of breast tumors, "lobular neoplasia (LN) refers to the entire spectrum of atypical epithelial lesions originating in the terminal-duct lobular unit…" Report the case when lobular carcinoma in situ (LCIS) is stated. When LN or lobular intraepithelial neoplasia (LIN) are described using the three-grade system, report LN/LIN grade 3. Only LN/LIN grade 3 is reportable since those terms are analogous to ductal intraepithelial neoplasia grade 3 (See Intraepithelial neoplasia 3, ductal in ICD-O-3). WHO Classifications of Tumors are the preferred references for questions like this.
Reportability/MP/H Rules/Histology: Is malignant perivascular epithelioid cell tumor (PEComa) reportable, and if so, what is the histology code?
Malignant perivascular epithelioid cell tumor (PEComa) is reportable because it is malignant. Assign 8005/3 to malignant PEComa.
We consulted an ICD-O-3 expert who explained that some PEComas such as angiomyolipoma and lymphangiomyomatosis have specific ICD-O codes and their malignant counterparts may be coded to 8860/3 and 9174/3 respectively. There are no separate ICD-O codes for other specific PEComas, e.g., clear cell “sugar” tumor of lung, clear cell myomelanocytic tumor of the falciform ligament and some “unusual” clear cell tumors occurring in other organs—or for PEComa, NOS. These PEComas may therefore be coded to 8005 as clear cell tumors NOS; in other words as clear cell tumors that are not clear cell variants of carcinomas, sarcomas, or other specific tumor type.
Please note, PEComa is non-specific as to behavior. Unless the pathologist states that it is malignant, (as was the case for this question), the default code is 8005/1 (non-reportable).
Reportability--Brain and CNS: Is "Lhermitte-Duclos disease" is reportable? See discussion.
The MRI states "Lhermitte-Duclos disease" but does not include "dysplastic gangliocytoma of cerebellum"; is this the same as "Lhermitte-Duclos dysplastic gangliocytoma of cerebellum (C716)"?
"Lhermitte-Duclos disease" alone can be interpreted as "Lhermitte-Duclos dysplastic gangliocytoma of cerebellum (C716)" and reportable. The WHO classification for CNS tumors lists this entity as "Dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease)" signifying that the terms are used synonymously.
Reportability: Is penile intraepithelial neoplasia, differentiated type, reportable? See discussion.
Foreskin circumcision shows: Penile intraepithelial neoplasia, differentiated type (differentiated PeIN). If reportable, how would the histology and behavior be coded? Is this behavior /2?
For cases diagnosed 2018 and later
Differentiated penile intraepithelial neoplasia (differentiated PeIN), is reportable (8071/2).
Please note: Penile intraepithelial neoplasia, grade 3 (PeIN 3) is also reportable to SEER (C600-C609, 8077/2).
MP/H Rules/Histology--Head and Neck: What is the histology code for salivary duct carcinoma of parotid gland?
Code salivary duct carcinoma to invasive ductal carcinoma (8500/3). Salivary duct carcinoma is an aggressive adenocarcinoma which resembles high-grade breast ductal carcinoma according to the WHO Classification of Tumors of Head & Neck.
Reportability--Bladder: Please explain the reportability of UroVysion for bladder cancer in the following circumstances.
1. Patient has positive UroVysion test and follow up biopsy is negative. Is this case reportable with a diagnosis date the date of the UroVysion?
2. Patient has positive UroVysion test and follow up biopsy is positive for cancer. Is the diagnosis date of the date of the positive UroVysion or the date of the positive biopsy? Thank you.
Do not report a case based on UroVysion test results alone. Report a case when there is positive histology, a physician statement of malignancy, and/or the patient was treated for cancer.
Grade--Bladder: How is Grade coded for the following cases diagnosed 1/1/2014 and later? See Discussion.
1) Low grade urothelial carcinoma, invasive carcinoma not identified (8120/2)
2) Papillary urothelial carcinoma, high grade, no evidence of invasion (8130/2)
The rules for coding Bladder Grade appear to have changed over time. SPCM 2013 Appendix C instructions state that Grade should be coded to 9 for urothelial carcinoma in situ (8120/2) and to 1 or 3 for non-invasive papillary urothelial carcinoma (8130/2).
When the grade instructions were removed from Appendix C in 2014, these site specific instructions for in situ bladder cases were no longer included. Thus the two grade system, found in SPCSM 2014+ Grade/Differentiation Coding Instructions for Solid Tumors, is being used to code grade for both the in situ and invasive urothelial malignancies stated to be "low grade" (code 2) or "high grade" (code 4). See also, SINQ 20150022. Please clarify the current grade instructions for in situ and invasive urothelial carcinomas of the bladder.
Follow the instructions in the 2014+ Grade Coding Instructions to code grade for cases diagnosed 2014 and later, http://seer.cancer.gov/tools/grade/ Instruction #4.a. states to code grade for in situ tumors when grade is specified. This instruction applies to bladder cases, as well as other in situ tumors.
Reportability--Brain and CNS: Is schwannoma of the extracranial part of a cranial nerve reportable? Some cranial nerves, like facial nerve, have intracranial and extracranial branches.
An extracranial schwannoma is not reportable. The schwannoma must arise on the intracranial part of the nerve to be reportable.
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