System Guide
Back to Search Results

Search Results

Display Options
Display Options
Select Fields
Export Results to CSV Create Report 0
+ Add all results to report

Report Produced: 02/24/2026 07:39 AM

Report Question ID Question Discussion Answer Year
20140001 Grade--Brain and CNS: How should grade be coded for a pineal parenchymal tumor of "intermediate differentiation"? See discussion.

Per a web search, the term "pineal parenchymal tumor of intermediate differentiation" refers to a pineal tumor with the histology/behavior that falls somewhere between the category of pineocytoma (9361/1) and pineoblastoma (9362/3). In other words, it is a malignant tumor that is a WHO grade II/III neoplasm because it's histologic features and behavior are not quite equivalent to a pineoblastoma (WHO grade IV). Thus, it appears the expression "intermediate differentiation" is actually referring to a type of WHO classification system rather than the grade field.

Should the type of documentation provided in pathology report be used to imply the grade field is being referenced and thus be coded to 2 for "intermediate differentiation" or should grade be coded to 9 based on the information found during the web search?

Code the grade as 2 based on instruction #8 in the revised grade instructions for 2014.

Do not use WHO grade to code the grade field for CNS tumors.

 2014
20140070

Reportability--Pancreas: Is this reportable? Is this benign? If reportable, what histology code and behavior code should be used? A final pathology diagnosis reads: "Cystic pancreatic endocrine neoplasm (CPEN)".

"Cystic pancreatic endocrine neoplasm (CPEN)" is reportable. Assign 8150/3 based on the information provided. We consulted our expert pathologist and he states "Since metastases have been reported in a few, and all the rest of the pancreatic endocrine tumors are now designated malignant, …we are safe considering them /3 until proven otherwise. Since most of them are non-functioning, [assign code] 8150/3 unless specified as to G1 (8240/3) or G2 (8249/3)."

2014
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
20140021 Reportability--Breast: Is an inflammatory myofibroblastic tumor of the breast with metastasis to the lung reportable? Inflammatory myofibroblastic tumor of the breast with metastasis to the lung is reportable. Metastasis to the lung from the breast tumor indicates that the breast tumor is malignant. All malignant neoplasms are reportable. 2014
20140062

MP/H Rules/Multiple Primaries--Lung: Does lung MP/H Rule M6 apply to synchronous tumors only, metachronous tumors only, or both? See discussion.

How many primaries should be reported when a patient has a history of RLL adenocarcinoma diagnosed on 10/8/2009 followed by diagnoses of LUL adenocarcinoma on 10/5/2012 and a RUL adenocarcinoma on 3/26/2014?

We applied Rule M6 to the 10/5/2012 diagnosis of LUL adenocarcinoma and reported an additional primary. However, we are unsure how to apply the MP/H rules for the 3/26/2014 RUL adenocarcinoma.

Should we apply Rule M8 because the RUL adenocarcinoma was diagnosed more than 3 years after the original RLL adenocarcinoma and then apply M6 because the RUL and LUL indicate a single tumor in each lung (resulting in a third primary); or does Rule M12 apply because there has been more than a single tumor in each lung (no new primary)?

Assuming each of the three diagnoses is a single tumor and there are no other tumors in either lung, abstract two primaries: 1 in the RLL diagnosed on 10/8/2009 and 1 in the LUL diagnosed on 10/5/2012. Do not abstract the 3/26/2014 diagnosis as a new primary.

Rule M6 applies to the 2009 and 2012 diagnoses. Rule M12 applies to the 2012 and 2014 diagnoses. Do not compare the 2014 diagnosis to the 2009 diagnosis. Always compare the latest diagnosis to the most recent previous diagnosis in cases like this.

2014
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.

2014
20140040

Reportability/Primary Site--Lip: Is a right lower lip (NOS) squamous cell carcinoma reportable when the microscopic description states the tumor arises from the epidermis and extends through the dermis? See discussion.

We are having difficulty determining whether the primary site is lip, NOS (C009) or skin of lip (C440). Usually we look for a statement of “skin” or “mucosa” in the microscopic description if the specimen label is only lip, NOS as instructed by the previous SINQ 20051049. Is a statement of "epidermis" or "dermis" in the microscopic description enough to indicate carcinoma is arising in the skin of the lip (C440) and thus not reportable?

This case is interpreted as skin of lip and not reportable. According to our expert pathologist consultant, the pathologist in this case "is specifically saying "epidermis" and "dermis" and I would have to think it is skin, and thus not reportable."

2014
20140025

Grade--Heme & Lymphoid Neoplasms: Why isn't "T-cell granular lymphocytic leukemia" (9831/3) coded as "5 T-cell" instead of "9" as specified in the Heme database? My path department did not specify any type of grade, but since "T-cell" is part of the name, wouldn't you code it to "5"?

Assign code 5 when the diagnosis on the pathology report specifies "T-cell granular lymphocytic leukemia." The Heme DB grade instruction states "Code grade specified by pathologist. If no grade specified, code 9." In this case, T-cell was specified - code it. The code for T-cell (5) was not automatically assigned in the Heme DB because of the alternate names for this neoplasm. Some of these include NK-cell. Assign code 8 for alternate names with NK.

The alternate names are: Chronic lymphoproliferative disorder of NK cells, Chronic NK-cell lymphocytosis, Chronic NK-large granular lymphocyte (LGL) lymphoproliferative disorder, CLPD-NK, Indolent large granular NK-cell lymphoproliferative disorder, NK-cell lineage granular lymphocyte proliferative disorder, NK-cell LGL lymphocytosis

2014
20140016 MP/H Rules/Histology--Bladder: What is the correct histology code for this situation? See discussion. Patient has 2 bladder tumors, both invasive -- one is transitional cell carcinoma (8120/3) and the other is papillary TCC (8130/3). They have the same extent of disease, both involve the lamina propria. Is this 8120, because of the Note under rule H11 or is this 8130 because under rule H12, it says 'papillary carcinoma and transitional cell carcinoma'? If so, what is the meaning of the note under rule H11?

Rule H12 applies, code to 8130.

The note under H11 is intended to explain the order of the rules; that is, why the rule to code papillary transitional/urothelial cell carcinoma (H12) follows the rule to code transitional/urothelial cell carcinoma (H11).

 2014
20140007 Surgery of Primary Site--Lung: How is surgery coded when a patient undergoes a mediastinoscopy with mediastinal lymph node sampling and then a later upper lobectomy? See discussion.

The mediastinal nodes were submitted as a separate specimen. The patient also had several peribronchial nodes identified within the lobectomy specimen.

Does code 33 (Lobectomy with mediastinal lymph node dissection) require a complete mediastinal lymph node dissection (i.e. the removal of all lymph nodes in mediastinal chain(s) as opposed to a selective sampling/dissection of lymph nodes from multiple mediastinal chains)?

 Assign code 33 in this situation. Code 33 can include mediastinal lymph node sampling. 2014