Report | Question ID | Question | Discussion | Answer | Year |
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20130174 | MP/H Rules/Histology--Breast: Given that the current MP/H rules do not recognize specific types of lobular carcinoma, should the histology for an invasive pleomorphic lobular carcinoma be coded to 8022/3 [pleomorphic carcinoma] or 8520/3 [lobular carcinoma]? See Discussion. | The MP/H rules do not seem to recognize specific types lobular carcinomas. As invasive pleomorphic lobular carcinoma is "a very rare and distinct morphological variant of invasive lobular carcinoma," (ncbi.nim.nih.gov). Is this histology best reflected in code 8022/3 [pleomorphic carcinoma] or 8520/3 [lobular carcinoma]? | Code the histology to 8520/3 [lobular carcinoma].
The 4th Edition of the WHO Classification of Tumors of the Breast now describes five variants of invasive lobular carcinoma. These variants are solid type, alveolar, pleomorphic, tubulolobular, and mixed-type. WHO has not yet proposed new ICD-O codes be assigned to these variants. The upcoming solid tumor (MP/H) revisions will include instructions on coding these variants. |
2013 |
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20130109 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a 2004 diagnosis of acute myeloid leukemia is followed by a 2013 diagnosis of myeloid sarcoma? See Discussion. |
Patient was diagnosed in 2004 with acute myeloid leukemia [9861/3] and treated with chemotherapy and transplant. Now the patient has a biopsy of an umbilical mass that is positive for myeloid sarcoma (granulocytic sarcoma) [9930/3]. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Accession a single primary, acute myeloid leukemia [9861/3] diagnosed in 2004 per Rule M3.
When there is a myeloid sarcoma diagnosed simultaneously or after a leukemia of the same lineage, it is a single primary. The myeloid sarcoma is actually caused by the AML progressing. The myeloid cells in the bone marrow or blood literally "seep out" and implant in the tissue.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
2013 |
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20130152 | Primary site/Histology--Brain and CNS: How is the primary site and histology coded for a 2013 diagnosis of squamous cell carcinoma arising in a dermoid cyst of the third ventricle? See Discussion. | Patient has a dermoid cyst of the third ventricle of the brain diagnosed in 1998. In 2013 the cyst was removed and was diagnosed as squamous cell carcinoma. An internet search revealed a journal article in the Journal or Neuro-Oncology that states, "Although rare, malignant transformation of intracranial epithelial cysts has a poor prognosis." The combination of site C715 [third ventricle, NOS] and histology 8070/3 [squamous cell carcinoma] fails SEER Edit IF 38_3: Primary site and Morphology Impossible. | According to the literature, intracranial squamous cell carcinoma is very rare with most cases arising from a preexisting benign epidermoid cyst. The combination of C71_ and 8070/3 should be allowed. We will submit a request to have this edit revised. | 2013 |
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20130003 | MP/H Rules/Histology--Head & Neck: How is the histology coded for a mammary analogue secretory carcinoma (MASC) of the parotid gland? See Discussion. |
There is no histology listed in the ICD-O-3 for a mammary analogue secretory carcinoma. The pathologist stated that, "MASC is a recently described salivary gland tumor type which, as the name implies, resembles secretory carcinoma of the breast." Should the histology be coded 8550/3 [acinar carcinoma] or 8502/3 [secretory carcinoma of breast]? |
Assign code 8502/3 [secretory carcinoma of breast]. Acinar carcinoma [8550/3] describes a very typical type of salivary gland tumor only. This histology code does not adequately capture the histology in this case which describes a secretory carcinoma that is similar to mammary cancer. Both of these elements are reflected in the histology code 8502/3 [secretory carcinoma of breast]. |
2013 |
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20130138 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a 2010 diagnosis of a preleukemic condition is subsequently diagnosed in 2012 with a specific leukemia that is not listed as a transformation? See Discussion. |
10/02/10 bone marrow biopsy showed myelodysplastic syndrome, unclassified [9989/3]. 6/19/12 bone marrow biopsy showed chronic myelomonocytic leukemia (CMML-2) [9945/3]. CMML-2 is not listed as an acute neoplasm for MDS. Is this the same disease? Per the pre-2010 rules, this would be the same disease. The current Heme DB indicates these are separate primaries. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. This case should be accessioned as two primaries, myelodysplastic syndrome (MDS) [9989/3] diagnosed 10/2/10 and chronic myelomonocytic leukemia (CMML-2) [9945/3] diagnosed 6/19/12 per Rule M15. Per Rule M15, use the Multiple Primaries Calculator when rules M1-M14 do not apply. When myelodysplastic syndrome (MDS) became reportable, the rules in effect at that time resulted in MDS often being the only diagnosis reported when both MDS and a leukemia were diagnosed. Statistics for some leukemias were impacted. Now we report both the MDS and the leukemia for greater accuracy. SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
2013 |
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20130213 | Primary site--Heme & Lymphoid Neoplasms: How do you code the primary site for a marginal zone lymphoma involving bilateral axillary lymph nodes and inguinal lymph nodes, bone marrow and bilateral orbits that the physician refers to as a bilateral orbital lymphoma, Stage IV? See Discussion. | None of the rules seem to apply when the lymphoma is present in an organ, distant lymph nodes and bone marrow only. No regional nodes are involved.
Does rule PH22 infer that the organ should be coded as the primary site because it has been named by the physician? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule PH24, code primary site to orbit. According to Rule PH24, one is to code the primary site to the organ when lymphoma is present only in an organ. Note 2 under this rule also instructs one to capture the secondary involvement of distant lymph nodes and/or bone marrow in CS extension fields.
If the physician had not confirmed the primary site as orbit, you would have used Rule PH22 when the primary site is not indicated.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
2013 |
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20130065 | Histology--Heme & Lymphoid Neoplasms: Should the higher histology code associated with grade 1 follicular lymphoma [9695/3] be used rather than grade 2 follicular lymphoma [9691/3] in cases of follicular lymphoma grade 1-2? | Code histology to 9691/3 [follicular lymphoma, grade 2], histology. For follicular lymphoma, when there is a grade such as 1-2 indicated, take the histology associated with the higher grade disease process, even though the lower grade histology code is higher. | 2013 | |
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20130072 | MP/H Rules/Multiple primaries--Lung: How many primaries are accessioned when the right lower lobe lung has two adenocarcinomas, both with lepidic pattern, if the tumor board staged these tumors as separate primaries? See Discussion. |
Per pathology report
The tumor board has staged this as two separate primaries and is treating it as such. They are not considering the second focus metastatic even though it is the same histology. Lepidic is not in the ICD-O-3. Is lepidic a new term for histology? |
For cases diagnosed 2007 and later, accession a single primary, adenocarcinoma [8140/3] of the right lower lobe lung. The steps used to arrive at this decision are: Step 1: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Lung MP rules because site specific rules have been developed for this primary. Step 2: Start at the MULTIPLE TUMORS module, rule M3. The rules are intended to be reviewed in consecutive order within a module. Stop at rule M12. Accession a single primary when the patient has two tumors in the same lung with the same histology. Keep in mind that physicians follow different "rules" to determine the number of primaries. Even though the physicians consider this case to represent two primaries, the MP/H rules instruct you to accession one primary. We have received quite a few questions about the term lepidic. Below is the general definition of lepidic that will be added to the next MP/H revision. "Lepidic" is a growth pattern meaning that tumor cells are growing along the alveolar septa. It is characteristic of bronchioloalveolar carcinoma (BAC), but not diagnostic of it. The diagnosis of BAC also requires no stromal, vascular, or pleural invasion. Lepidic growth may be seen in other adenocarcinomas, including metastases to lung from other sites. It is not a type/subtype of adenocarcinoma. For lepidic lung neoplasms, code the histology indicated, for example BAC. |
2013 |
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20130092 | Reportability--Head & Neck: What are the correct site and histology codes if a glomus tympanicum tumor of the middle ear is reportable? |
Glomus tympanicum tumors of the middle ear are not reportable. The 2005 WHO Classification of Head and Neck Tumors classified these tumors as a borderline [/1] behavior and recorded them in the ICD-O-3 with histology code 8690 [glomus jugulare tumor, NOS]. According to WHO, "the distinction between jugular and tympanic paragangliomas can easily be made in the patient by modern imaging methods ... the jugular neoplasm is identified as arising from the jugular bulb region ... while the tympanic neoplasm is confined to the middle ear." Benign and borderline neoplasms of the middle ear [C301] are not reportable. The middle ear is not a reportable CNS site for benign and borderline tumors. |
2013 | |
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20130198 | MP/H Rules/Multiple primaries--Rectosigmoid: How many primaries are accessioned for a synchronous diagnosis of neuroendocrine carcinoma and a separate adenocarcinoma arising in a villous adenoma when both arise in the rectosigmoid junction? See Discussion. | Total colectomy showed neuroendocrine carcinoma of the rectosigmoid junction, as well as a separate adenocarcinoma arising in a villous adenoma of the rectosigmoid junction. Is this a single primary per Rule M13 (a frank adenocarcinoma and an adenocarcinoma in a polyp) or Rule M16 (adenocarcinoma and a more specific adenocarcinoma)? Or are these two primaries? | Accession two primaries per Rule M17, neuroendocrine carcinoma [8246/3] of the rectosigmoid junction [C199], and adenocarcinoma in a villous adenoma [8261/3] of the rectosigmoid junction [C199]. There are two tumors with ICD-O-3 histology codes that differ at the third number.
Rule M13 does not apply to neuroendocrine carcinoma. Rule M16 does not apply to this case because there are two specific histologies. |
2013 |