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20140014 | First course treatment/Surgery of Primary Site--Anus: Would infrared coagulation be coded as treatment for AIN III of the anus/anal canal? See discussion. | SINQ 20051064 indicates infrared coagulation is not treatment for cancer. Internet search explains that infrared coagulation delivers heat to destroy the tissue so it can be removed. In our region it is currently used to treat internal and external anal low grade squamous intraepithelial lesions (LSIL) and high grade squamous intraepithelial lesions (HSIL). While it is understandable that this wouldn't be coded as treatment for an invasive anal primary, could it be treatment for an in situ tumor? If it is treatment, should it be coded under Surgery code 15 | The answer to SINQ 20050164 still applies. Do not code infrared coagulation as cancer treatment. It is used to coagulate blood vessels and not to destroy cancer tissue. | 2014 |
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20140009 | Primary site: What primary site do I assign to a Squamous Cell Carcinoma of the parapharyngeal space when there is no other info available regarding a more definitive site within the parapharyngeal space? Each physician involved with the case states the primary site is the parapharyngeal space. This is a patient who was diagosed and treated elswhere and was seen at our hospital several months later for a radical neck dissection for suspected lymph node mets. |
Assign C139 for a primary originating in the parapharyngeal space. This space contains part of the parotid gland, adipose tissue, lymph nodes, nerves, arteries and veins. |
2014 | |
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20140057 | MP/H Rules/Histology--Bladder: What is the correct histology code for a diagnosis of urothelial plasmacytoma carcinoma of the bladder per pathology report? |
Assign code 8120/3, urothelial carcinoma, NOS, to urothelial plasmacytoma carcinoma of the bladder. The WHO classification describes plasmacytoid variants of urothelial carcinoma. There is no specific ICD-O-3 code for these variants; however, and 8120/3 must be used. |
2014 | |
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20140008 | Primary site: If text supports a pancreatobiliary primary with no other information what primary site code would be assigned? C249 biliary tract NOS, or C269 GI tract nos, or C809 unknown? | Assign C269 in the absence of any additional information. | 2014 | |
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20140054 | MP/H/Multiple primaries--Stomach: How should I report this case? I reviwed both the MP/H and the Heme Rules and could not determine whether or not this case is multiple primaries in a single site but two histologies and therefore needing two separate abstracts.
Path Diagnosis: Gastric Mass Biopsy: 1) Signet Ring Cell Carcinoma. 2) Extranodal Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT Lymphoma). 3) Mild Intestinal Metaplasia and Marked Fundic Gland Atrophy, Negative for H Pylori. Comments: Biopsy shows presence of both signet ring carcinoma and MALT Lymphoma. |
Report two primaries: MALT lymphoma and signet ring carcinoma. Use the 2007 MP/H rules and the Heme rules for this case.
This case could be an example of a "collision tumor" - two separate tumors that grow together into one mass. Collision tumors are a rare exception to rule M2 in the MP/H rules. |
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20140063 | MP/H Rules--Histology: How is histology coded when a metastatic site is biopsy positive for adenocarcinoma, but the physician clinically states this is cholangiocarcinoma? See discussion. |
The patient underwent a PTA biopsy of a lytic mass showing metastatic adenocarcinoma. Imaging revealed a large hepatic mass consistent with cholangiocarcinoma. The physician's impression on a physical exam note was the PTA biopsy was most consistent with intrahepatic cholangiocarcinoma. However, the PTA pathology report was reviewed at this facility and the final diagnosis was not stated to be cholangiocarcinoma, only adenocarcinoma, NOS.
The priority order for coding histology rules in the MP/H Manual indicates pathology has priority over documentation in the medical record. Following the rules in the MP/H Manual, the histology would be coded as 8140 [Adenocarcinoma, NOS]. While this may be technically correct, it seems that intrahepatic cholangiocarcinoma is often diagnosed as adenocarcinoma on biopsy, but further stated to be cholangiocarcinoma by the physician once other primary sites have been excluded. By applying the rules in the MP/H Manual, cases that seem better characterized as cholangiocarcinomas are being collected as adenocarcinoma, NOS. Should the histology be adenocarcinoma [8140/3] or cholangiocarcinoma [8160/3] for these cases? |
When the physician has reviewed all of the pertinent information, and the physician's opinion is documented stating that the histology is cholangiocarcinoma, code cholangiocarcinoma.
A pathology report from a primary site has the highest priority for coding histology; however, there is no such pathology report in this case. We will review the histology coding instructions and add clarification in the next version. |
2014 |
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20140077 | MP/H Rules/Histology/Multiple primaries--GE junction: How is histology coded for a goblet cell carcinoma in the GE junction? See discussion. |
The patient was diagnosed with GE junction signet ring adenocarcinoma (8490/3) in 5/2012, treated with radiation. GE junction biopsy on 9/20/2012 showed residual signet ring carcinoma. Subsequent biopsies on 7/8/2013 showed GE junction biopsy of invasive adenocarcinoma, signet ring cell type along with “Esophagus, distal and GE junction biopsies” (site not further clarified in available documentation) with Goblet cell carcinoma. The histology code for the goblet cell carcinoma is needed to determine the number of primaries. |
According to our expert pathologist consultant, goblet cell is a descriptive term and not a specific histology in this context. There is no ICD-O-3 code for it. The "goblet cell carcinoma" in this case is not a new primary.
Goblet cell is used to describe some cells containing mucin. In addition to individual tumor cells containing mucin which compresses the nucleus to give the appearance of signet rings, the mucin is present in columnar cells with the nuclei at one end -- this latter is a pattern often seen when glandular structures are formed by the tumor cells. It is also often intermixed with the signet ring cells in the surrounding stroma. |
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20140078 | Surgery of Primary Site--Bladder: Is any mention of cautery in the gross description of pathology for a TURBT specimen sufficient to code 22 (excisional biopsy with electrocautery), or does there need to be a statement in the operative report that electrocautery was performed? See discussion. |
Often, pathology for TURBT with non-invasive papillary TCC includes a gross description with a variety of cautery descriptions. For example, "received are three cautery roughened gray-pale pink tissue fragments.” However, the operative report is documented as a "TURBT" with no further description of the procedure. |
Assign code 22 when cautery is mentioned n the gross description of pathology for a TURBT specimen. |
2014 |
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20140048 | MP/H Rules/Histology--Sarcoma: Is 8811/3 the correct code for myxofibrosarcoma (myxoid malignant fibrous histiocytoma) high-grade (grade 3/3)? |
8811/3 is the correct code for myxofibrosarcoma. See Rule J on page 33 in ICD-O-3. Fibromyxosarcoma is equivalent to myxofibrosarcoma. |
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20140034 | Reportability--Ovary: Can you clarify when widely metastatic borderline histologies of the ovary and various other sites are reportable? See discussion. |
SINQ 20130176 states that an adult granulosa cell tumor of the ovary with metastases is malignant. However, SINQ 20091087 states that a borderline tumor of the appendix with metastasis is not reportable.
The first statement of 20130176 “though granulosa cell tumor is coded 8620/1, the presence of peritoneal or lymph node metastases indicate the tumor is malignant and coded as /3” does not coincide with the second statement of “the behavior of borderline/LMP ovarian epithelial tumors is determined by the ovarian primary, even though there may be peritoneal implants or metastatic disease in the lymph nodes”. If the ovarian metastases do make this a reportable malignancy, can this line of thinking be used to determine reportability for borderline histologies for other sites such as the appendix? |
The case in 20130176 is adult granulosa cell tumor. The answer points out an important difference in the way "metastases" from this histology should be interpreted versus low malignant potential ovarian epithelial tumors. Metastases from adult granulosa cell tumor of the ovary indicates a malignant primary. So-called metastases from a LMP epithelial tumor do not indicate a malignant primary when the metastatic deposits are also LMP/borderline in behavior.
Do not apply instructions for ovarian cases to other primary sites including appendix. |
2014 |
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