MP/H Rules/Histology--Testis: How should histology be coded for a mixed germ cell tumor that also includes choriocarcinoma now that non-seminomatous mixed germ cell tumors (9065) and seminomatous mixed germ cell tumors (9085) are collapsed for analysis? See Discussion.
The MP/H Rules (Other Sites Terms and Definitions, Table 2) currently lists a separate mixed germ cell tumor code (9101) for germ cell tumors with choriocarcinoma plus teratoma, seminoma or embryonal carcinoma. Is this separate mixed germ cell tumor code still to be used now that all mixed germ cell tumors (9065 and 9085) have been collapsed into code 9085 for analysis per SINQs 20160056 and 20110013? The current WHO Classification for testis tumors does not list code 9101, but also collapses all seminomatous and nonseminomatous mixed germ cell tumors of more than one histologic type under code 9085.
While WHO 4th Ed Tumors of Urinary and Male Genital System does not include 9101/3, this code has not been made obsolete. Follow the 2007 MP/H rules and code histology to 9101/3 per Other sites rule H16, Table 2.
Histology--Lung: Is it acceptable to code histology as 8042/3 for a 2020 lung primary when the pathology report states only "oat cell carcinoma?" See Discussion.
In the old 2007 Multiple Primaries/Histology rules, Lung Equivalent Terms and Definitions section, oat cell carcinoma (8042) was listed as one of the obsolete terms that was no longer recognized for small cell carcinoma. That note is not in the current 2018 Solid Tumor Manual lung chapter, and ICDO-3.2 lists oat cell carcinoma as the preferred term for code 8042/3. Would rule H4, Note 2 apply -- only one histology present, if not listed in Table 3 use ICD-O and all updates, to code oat cell carcinoma as 8042/3?
While oat cell carcinoma is an outdated term, if that is all the pathology report states, code histology as 8042/3.
Yes, Rule H4 applies: the diagnosis was a single histology. H4 instructs you to refer to the solid tumor H table, and if the term is not found there, check ICD-O and ICD-O updates. All possible histologic types that could occur in the lung may not be included in the table.
Solid Tumor Rules (2018)/Histology--Colon: Is the term phenotype equivalent to type, subtype, variant for the purpose of coding histology? See Discussion.
In our region, pathologists often describe histology using the term phenotype. However, the use of the term phenotype is not discussed in the Solid Tumor Manual.
Example: Final Diagnosis of a colon tumor is invasive adenocarcinoma with a mixed phenotype, and the Diagnosis Comment states: The majority of the disease is poorly differentiated/signet ring cell phenotype.
Would the histology be coded to 8490 (signet ring cell carcinoma), if the majority of the tumor is a more specific histology described by the term phenotype?
While variant, type, and subtype can be used interchangeably according to the Solid Tumor Rules, SINQ 20170058 states that the Multiple Primaries/Histology (now Solid Tumor) Rules do not include coding phenotype. Code as invasive adenocarcinoma NOS (8140).
First Course Treatment/Reportability: Are there situations for which a case with a class-of-case code in the 30's should be reported to the central registry? We know these are not reportable to the CoC, but should they be reported to the central registry? See Discussion.
Example: 3/22/2017-26 year old white female seen in the emergency room with abdominal pain. Patient was diagnosed about a month ago with breast cancer. Impression: menstrual pain. In this example the patient is newly diagnosed with breast cancer, but the second hospital does not treat or diagnose the patient; pain management for a separate condition is received only. Is this patient reported due to the history of active disease?
Work with your central registry to determine which cases they require you to report. In general, any case still undergoing first course of treatment, even if not given at your facility, should be reported to the central registry. Many central registries will appreciate knowing that the patient was seen at your facility to update date last seen and other data items.
Reportability/Behavior--Skin: Is an "atypical fibroxanthoma (superficial malignant fibrous histiocytoma)" with an ICDO-3 histology code of 8830 reportable with a behavior code of 3 or is it nonreportable with a behavior code of 1?
Yes, "atypical fibroxanthoma (superficial malignant fibrous histiocytoma)" is reportable. The information in parentheses provides more detail and confirms a reportable malignancy.
Radiation: Is "consolidated" radiation therapy coded as part of first course therapy when there is no documentation of "planned treatment" and the radiation is done 4 months after the initiation of treatment?
Yes, "consolidation" treatment is part of a planned treatment regimen. A treatment regimen may consist of the four following phases:
MP/H Rules/Multiple primaries--Breast: Does rule M10 apply in this situation?
L breast biopsy = INVASIVE DUCTAL CARCINOMA
L breast simple mastectomy = 2.0 cm INVASIVE DUCTAL CARCINOMA with an incidental finding of separate 1.0 cm INVASIVE LOBULAR CARCINOMA; pathologist specifically states the tumors are morphologically different. The tumors are both pure Ductal/pure Lobular.
Yes, Breast rule M10 applies. This case is a single primary.
Follow the MP/H rules even though the "pathologist specifically states the tumors are morphologically different" so that situations like this are reported consistenty accross cancer registries, regions, and states for consistent national reporting.
Reportability/Breast: Is lobular carcinoma in situ (LCIS) reportable? The eighth edition, American Joint Commission on Cancer (AJCC) Cancer Staging Manual does not stage LCIS.
Yes, LCIS is reportable. Staging does not determine reportability. Follow the reportability requirements of your state and national standard setter. SEER reportability requirements are found in the SEER manual starting on page 5, https://seer.cancer.gov/manuals/2016/SPCSM_2016_maindoc.pdf
Behavior/Date of Diagnosis--Lung: If the term "Pancoast tumor, NOS" is malignant by definition, should the date of diagnosis be coded to the date of the clinical diagnosis when the clinical diagnosis is made prior to the histologic confirmation of the malignancy?
Yes, Pancoast tumor is by definition malignant. It is defined as a lung cancer in the uppermost segment of the lung that directly invades into the brachial plexus (nerve bundles) of the neck, causing pain. If a Pancoast tumor was identified on imaging prior to the biopsy, the date of diagnosis should be linked to the Pancoast tumor report.
CS Site Specific Factor--Prostate: Please clarify how SEER registries should use code 040 for Site-Specific Factor 3 on prostate cases. See Discussion.
The 6/11/09 NAACCR Webinar on prostate cancer pointed out that SSF 3 code 040 refers the registrar to Note 4, which states "when the apical, distal urethral, bladder base, or bladder neck margins are involved and there is no extracapsular extension, use code 040." The webinar went on to say that code 040 ONLY applies to these specific margins, and that if other margins are involved (for example, the 'right lateral margin'), we should not use code 040. Is this consistent with SEER's interpretation of Note 4? Are we to ignore involvement of margins other than those specified in Note 4, and consequently code SSF 3 within the 000-032 range? Would this also apply to code 048 (extracapsular extension and margins involved)?
Yes, SEER agrees. Code SSF3, code 040 per page C-740 of 2007 SEER manual exactly as stated in Note 4. According to the Inquiry and Response System of the CoC, Note 4 lists specific margins that were once thought to have a prognostic impact. Code 040 in SSF3 should be used only when those margins are involved.
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