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The term "incidentaloma" alone is not reportable. Look for a reportable term elsewhere or in later information. When the term "incidentaloma" is used on a magnetic resonance imaging (MR) report, it refers to "a disease or physical condition found as a secondary by-product of capturing the necessary volume of tissue within the field of view of the MR examination" (http://radsource.us/incidentaloma). It is not necessarily neoplastic.

The term "mixed" implies a single tumor comprised of metaplastic carcinoma or variants of metaplastic and duct or lobular. The metaplastic histology is coded regardless of whether it comprises the majority (greater than 50% of the tumor). M13 is the only rule specific to metaplastic and is in the single tumor module. This implies a single tumor with both histologies. When there are multiple tumors, one with metaplastic or a subtype/variant of metaplastic and another with a histology listed on a different row, continue to the Multiple Tumors module. M13 applies and there are two primaries. We will add "single tumor" to the note in Table 2 in the next update.

The term neuroendocrine is often included with other histologies and usually means that neuroendocrine cells are present but not neuroendocrine tumor.

1.  If the neuroendocrine cells are stated to be either small cell or large cell, code that histology; however, neuroendocrine, NOS mixed with urothelial does not have an applicable mixed code. Code histology to 8120.

2.   Code histology to squamous cell carcinoma, nonkeratinizing, NOS (8072/3). The neuroendocrine component is not specified as either small cell or large cell.

3.  Code to 8523/2 per MP/H Rule H6 as intraductal mixed with other types of carcinoma present.

Note that while neuroendocrine differentiation can be identified, it seems to have no prognostic implications. We have consulted with our site specific Subject Matter Experts on how best to capture neuroendocrine, NOS when combined with other histologies. These instructions will be included in the revision of the MP/H rules including the wording of MP/H breast rule H6.

The term/modifier "patterns" is no longer allowed to code a specific histology according to the Lung Solid Tumor H rules. Disregard the papillary, lepidic, and solid patterns and code histology to adenocarcinoma, NOS (8140/3).

The terms "bordering on" and "may represent" are not diagnostic of cancer. These terms are not on the list of ambiguous terms that constitute a diagnosis of cancer. The diagnosis in the example above is not reportable to SEER.

The tonsil lies in an indentation called the tonsillar fossa. The tonsillar fossa is bordered on either side by the tonsillar pillars. The tonsillar pillars are part of the supporting structure of the throat opening.

Code C09.9 [Tonsil NOS] as the primary site for the case above.

The treatment with cryoablation is second course. Once the initial treatment plan is changed, everything after the change is no longer first course of treatment. If the cryoablation was not mentioned as part of the original treatment plan, it is second course.

The two cases above are benign meningiomas and not reportable prior to 2004. According to an expert consultant, meningiomas are in the lining cells for the inner table of the skull and as such have an affinity for bone that allows them to penetrate adjacent bone without being "malignant."

The WHO Nervous System Tumor Classification states malignant meningioma exibits histological features of frank malignancy far in excess of the abnormalities present in atypical meningioma (WHO grade II). Examples of the histologic features of malignant meningioma are obviously malignant cytology, or high mitotic index (20 or more mitoses per 10 high-power fields). They correspond to WHO grade III and are usually fatal.

There are two primaries according to the information provided.

1. VAIN III March 2001.

2. SCCA of vagina Dec. 2006 (invasive tumor following an in situ

For cases diagnosed 2007 or later, the MP/H rules apply to new tumors, which means that there has been a disease-free interval at some point. In this case, the patient has never been declared disease-free (NED) using the information provided in the question. The consistent recurrence of VAIN is typical of this disease.

There are two primaries. For cases diagnosed 1/1/2003 and after: For the rt breast, code Surgery of Primary Site to 51. The contralateral left breast malignancy is not involved with the right breast primary by either direct extension or metastasis. Codes 42 and 52 are used to capture prophylactic mastectomy of the opposite noncancerous breast. In this case, the opposite breast has cancer so these codes cannot be used. Code Scope of Regional Lymph Node Surgery to 5 and Surgical Procedure of Other Site to 0.

For the lt breast, code Surgery of Primary Site to 41, Scope of Reg LN Surgery to 0, and Surgical Procedure of Other Site to 0.