Report | Question ID | Question | Discussion | Answer | Year |
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20140080 | Behavior--Breast: Is behavior for encapsulated papillary carcinoma (EPC) of the breast coded as noninvasive or invasive? |
The pathologist has the final say on behavior. Code behavior based on the pathologist's final diagnosis. See Rule F in ICD-O-3.
According the WHO Classification of Breast Tumors, encapsulated papillary carcinoma of the breast is in situ, /2. Encapsulated papillary carcinoma with invasion is assigned /3. WHO describes "frank invasive carcinoma" for this histology as "neoplastic epithelial elements infiltrate beyond the fibrous capsule of encapsulated papillary carcinomas." WHO cautions that true infiltration should be "differentiated from entrapment of neoplastic epithelial cells in the fibrous capsule and from epithelial displacement into the biopsy site, which is frequently encountered following needle-core procedures of papillary lesions." |
2014 | |
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20140061 | Primary Site/In Situ: How is primary site coded for an in situ carcinoma arising in a mucinous cystadenoma with ovarian stroma (focal) located in the right lobe of the liver? See discussion. |
The SEER Coding and Staging Manual instructs one to code the primary site to the location where the tumor originated, in this case the liver. However, there is no CS Extension code for in situ tumors found in the CS Manual Liver Schema. |
Based on the information provided, the primary site is liver. Submit the CS question to the CoC CAnswer Forum, http://cancerbulletin.facs.org/forums/content.php |
2014 |
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20140058 | Reportability--Pancreas: Is a solid pseudopapillary neoplasm of the pancreas reportable? |
Solid pseudopapillary neoplasm of the pancreas is reportable. According to the WHO classification, it is a "low-grade malignant neoplasm…[which] frequently undergoes hemorrhagic-cystic degeneration and occurs predominantly in young women."
Assign topography code C25 with the appropriate 4th digit. Code the histology as 8452/3. |
2014 | |
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20140011 | MP/H Rules/Multiple primaries--Breast: Is the diagnosis of Paget disease two years after a diagnosis of infiltrating duct carcinoma of the same breast a new primary? See discussion. | A patient was diagnosed and treated in 2010 for infiltrating duct carcinoma of the left breast. There was no mention of Paget disease. Then in 2012, the same patient was diagnosed with Paget disease of the nipple of the left breast. Rule M9 seems to apply; so this is the same primary, correct? And the information about the Paget disease is simply never captured, correct? | Yes, Rule M9 makes this a single primary. You could revise the original histology code to 8541/3 on the assumption that Paget was present at the original diagnosis, but not yet identified. | 2014 |
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20140005 | Primary site--Testis: In the absence of a specific statement that the patient's testicle(s) are descended, should the primary site for a testicular tumor be coded as C621 (Descended Testis) when the mass is palpable on physical exam or demonstrated on scrotal ultrasound? See discussion. | It seems the non-specific Testis, NOS (C629) code is being over used. Many testis cases have no documentation of the patient's testicular descention. However, testicular tumors in adults are frequently detected by palpation or scrotal ultrasound. An undescended testis (a testis absent from the normal scrotal position) would be non-palpable or not amenable to imaging via a scrotal ultrasound. | Unless the testicle is stated to be undescended, it is reasonable to code C621 for primary site. Reserve C629 for cases with minimal or conflicting information. | 2014 |
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20140015 | Primary site--Heme & Lymphoid Neoplasms: Is there an instruction missing under Rule PH22 of the 2014 Heme Manual that addresses when it might be appropriate to code primary site to C779 for a Stage II lymphoma? See discussion. | It appears there is no instruction under PH22 that covers Example 5 (The patient has a history of Stage II lymphoma, no other information is available). All the bulleted instructions are for organ and lymph node combination involvement. Was the 2010 Heme Rule PH31 (Code the primary site to lymph nodes, NOS (C779) when lymph node(s) are involved but no primary site/particular lymph node region is identified) supposed to be listed under PH22? There does appear to be an empty bullet on the current web version. | The 5th bullet under Rule PH 22 was inadvertently omitted. A corrected version of the Heme manual will be posted soon. Thank you for identifying this omission. In the meantime, please add the following to PH22: Code the primary site to lymph nodes, NOS (C779) when lymph node(s) are involved but no primary site/particular lymph node region is identified. |
2014 |
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20140046 | MP/H/Multiple Primaries--Urinary: Is this one primary with a C689 primary code and morphology 8130/3? Or is this 2 primaries: 1. C679 8130/3 and 2.C680 8120/2. See discussion. |
Urinary: Transitional Cell Carcinoma and open prostatectomy: Path from Bladder: Papillary and solid transitional cell carcinoma of bladder - grade II and III Stage A.
Path from prostatectomy: The prostatic tissue samples shows areas of urothelia carcinoma in situ - related to the tumor present in the bladder.
Conclusion: Prostatectomy showing foci of transitional cell carcinoma in situ of prostatic urethra. |
Abstract a single primary, C679 8130/3. Rules M2 and H4 apply. Transitional cell/urothelial carcinoma in the prostatic urethra is likely an extension from the known bladder TCC in this case, not a separate primary. See prostatic urethra on page 63 in the Urinary Terms and Definitions, http://www.seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf |
2014 |
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20140050 | MP/H Rules/Histology--Sarcoma: What would be the morphology code for a low grade myofibroblastic sarcoma of the left distal forearm? I tried several different combinations but the closest I could come up with is myosarcoma. |
Assign code 8825/3. Apply the ICD-O-3 Matrix Concept, Rule F, page 29 of the hardcover ICD-O-3. The WHO Classification of Soft tissue and Bone, page 85, lists low grade myofibroblastic sarcoma, also called myofibrosarcoma, 8825/3. |
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20140033 | Reportability/Ambiguous Terminology--Prostate: Can you clarify why a prostate biopsy diagnosis of “highly suspicious for, but not diagnostic of adenocarcinoma, suggest another biopsy” is not reportable while a biopsy diagnosis of “atypical glands suspicious for adenocarcinoma with insufficient atypia to establish a definitive diagnosis of malignancy” is reportable? See discussion. |
SINQ 20091103 states that prostate biopsies showing “highly suspicious for, but not diagnostic of adenocarcinoma, suggest another biopsy” are NOT reportable. However, SINQ 20071056 states that “atypical glands suspicious for adenocarcinoma with insufficient atypia to establish a definitive diagnosis of malignancy” is reportable. This appears to be an issue of semantics with no clearly outlined method to determine reportability of such cases.
We have two recent cases with similar semantic issues and want to know whether they are reportable.
1) Prostate biopsy with “atypical small acinar proliferation, highly suspicious for adenocarcinoma, with quality/quantity insufficient for outright diagnosis of cancer.”
2) Prostate biopsy with “atypical small acinar proliferation highly suspicious for adenocarcinoma but due to the small size of focus, findings are not definitively diagnostic.” |
Both case examples provided are reportable using instructions for ambiguous terminology. The diagnoses are qualified by the words "highly suspicious" because neither diagnosis is definitive ("insufficient for outright diagnosis of cancer" and "not definitively diagnostic."). However, we follow our instructions for interpreting ambiguous terminology and report these cases.
SINQ 20091103 differs slightly. The final diagnosis in 20091103 declares unequivocally "not diagnostic of adenocarcinoma." That phrase in the final diagnosis negates the ambiguous terminology. The situation in 20071056 is similar to the two examples above - the ambiguous terminology instructions apply. |
2014 |
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20140084 | Histology--Heme & Lymphoid Neoplasms: Should the 1995 diagnosis be changed to plasmacytoma? A 1995 case on the central registry database indicates that MRI and bone surveys revealed a pubic ramus lesion that was biopsied. There are no other bone lesions. A bone marrow biopsy was negative. The pathologist's diagnosis at that time was "Plasma Cell Myeloma". In 2013 there was a positive bone marrow biopsy and a diagnosis of Plasma Cell Myeloma. In 2013, a history of "sequential plasmacytomas since 1995" was mentioned. Since the 1995 diagnosis was only a solitary bone lesion with no marrow involvement, it certainly seems to fit a diagnosis of plasmacytoma better than myeloma. |
Do not change the 1995 diagnosis in this case. It is best to code the histology according to information from the time of the diagnosis. Using information obtained many years later is less reliable. |
2014 |