Report | Question ID | Question | Discussion | Answer | Year |
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20200057 | Histology--Lung: Is there a better code for SMARCA4-deficient malignant neoplasms than 8000/3 that could be used especially given its aggressive nature? This term is not included in the Lung Solid Tumor Rules or ICD-O-3.1 and 3.2. See Discussion. |
Per Mayo consulting pathologist, the final diagnosis on this right lung biopsy is: SMARCA4-deficient malignant neoplasm (see Comment). Comment: Sections show a poorly-differentiated malignant neoplasm without any apparent glandular, squamous, or stromal differentiation. The tumor near totally replaces the underlying lung tissue without recognizable underlying alveolar parenchyma. Immunohistochemical stains performed at Mayo Clinic (Oscar keratin, INSM1, NUT, S100, desmin and BRG1 protein encoded by SMARCA4 gene) demonstrate that the malignant cells are positive for Oscar keratin (rare cells only), synaptophysin (weak/patchy) and p63 (focal) while negative for the remaining antibodies tested. Of note, SMARCA4 stain is negative in the tumor cells. Thus, this tumor can be categorized as a SMARCA4-deficient malignant neoplasm, which is known to be an aggressive malignancy, likely represent a SMARCA4-deficient thoracic sarcoma, a recently described entity. SMARCA4-deficient carcinomas in the lung have been reported to be mostly adenocarcinomas or squamous cell carcinomas, which would not fit for this case. Please refer to a paper published by our group (Sauter JL et al. Mod Pathol 2017;30:1422-32. |
Assign code 8020/3. SMARCA4-deficient malignant neoplasms are newly identified. WHO has not proposed an ICD-O code as of yet. Our pathology experts suggest coding to undifferentiated carcinoma until they are better classified. |
2020 |
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20220044 | Solid Tumor Rules (2018/2021)/Histology--Head & Neck: What is the histology code for a uvula (C052) primary with histology of squamous cell carcinoma, conventional (keratinizing) and p16 result is negative? See Discussion. |
The Schema ID for C051 (soft palate, NOS) and C052 (uvula) is Oropharynx (either 00100 or 00111 depending on p16). The Solid Tumor Rules Manual includes these site codes are under Table 4: Tumors of Oral Cavity and Mobile Tongue site group for histology coding. We are aware of the notes that allow coding of 8086 for keratinizing SCC, HPV-negative for sites listed in Table 5 only. However, it seems like C051 and C052 were incorrectly omitted from Table 5 (mis-categorized under Table 4). Can we code 8085 for 8086 for C051 or C052 based on p16/HPV status? |
Assign code 8071/3 for keratinizing squamous cell carcinoma. Codes 8085 and 8086 are only valid for the Head and Neck sites listed in Table 5 beginning with cases diagnosed 01/01/2022 and forward. |
2022 |
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20200021 | Solid Tumor Rules/Histology--Head & Neck: What is the histology of human papillomavirus (HPV)--associated multiphenotypic carcinoma? See Discussion. |
Histologic Type: HPV-associated multiphenotypic carcinoma. Overall, the morphology, immunohistochemistry, and HPV testing results support the diagnosis of an HPV-related multiphenotypic carcinoma. This entity has been described in the sinonasal region, where it behaves more indolently than its other salivary gland carcinoma counterparts (e.g., adenoid cystic carcinoma), with local recurrence but rare metastases. |
Assign code 8072/3 for HPV-associated multiphenotypic carcinoma. WHO Classification of Head and Neck Tumors, 4th edition, lists sinonasal tract HPV-related carcinoma with adenoid cystic-like features as a subtype of non-keratinizing squamous cell carcinoma (NKSCC).Use text fields to record the details. |
2020 |
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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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20210028 | Histology/Biliary tract--Ampulla of Vater: What is the histology code for Intra ampullary papillary-tubular neoplasm in association with microinvasion? See discussion. |
Patient was diagnosed on 01/2020, and primary site on the pathology report is Ampulla of Vater (C241). Synoptic Report states histology as: Intra ampullary papillary-tubular neoplasm in association with microinvasion. I have reviewed the ICD-O-3 coding table and found histology Intraductal tubulopapillary neoplasm (C25_) code 8503/2. Based on the Matrix principle (Rule F on the ICD-O-3), I will change the behavior to 3 and code as 8503/3. If I look in ICDO-3, Tubulopapillary adenocarcinoma is coded 8263/3. |
Assign code 8163/3. Based on the microinvasion, the correct term for this neoplasm is pancreatobiliary-type carcinoma. Unfortunately, WHO did not provide all synonyms or related terms for some of the new ICD-O codes. Pathologists may continue using non-preferred terminology as well. |
2021 |
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20210071 | Solid Tumor Rules (2018/2021)/Histology--Breast: How is histology coded for a diagnosis of invasive mammary neuroendocrine tumor (NET), grade 2/3? See Discussion. |
Table 3 (Breast Equivalent Terms and Definitions) lists “Neuroendocrine tumor, well-differentiated” of the breast as histology 8246/3. There is no entry for a grade 2 neuroendocrine tumor of the breast in Table 3. The pathologist did not indicate the neuroendocrine tumor was poorly differentiated (or it would otherwise be a small cell carcinoma). The pathologist noted “By current WHO criteria, this tumor is characteristic of a mammary neuroendocrine tumor, grade 2. These invasive tumors have similar prognostic and predictive features of invasive ductal carcinoma of the same grade and stage.” |
Assign code 8249/3, neuroendocrine tumor, grade 2 based on the pathologist statement of mammary neuroendocrine tumor grade 2. According to WHO Classification of Tumors of the Breast, 5th edition, neuroendocrine tumor (NET) is an invasive tumor characterized by low/intermediate grade. If the histology term is not listed in the Solid Tumor rules, the instructions state to also check ICD-O and updates. Per ICD-O, NET, grade 2 is coded 8249/3. Breast Table 3 will be updated for 2023. |
2021 |
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20170041 | MP/H Rules/Histology--Thyroid: How should histology be coded for a thyroidectomy final diagnosis of papillary thyroid carcinoma, favor cribriform-morula variant? See Discussion. |
This specific histology (cribriform-morula variant of papillary thyroid carcinoma) is not found in the ICD-O and is not mentioned in the 2007 MP/H Manual. However, per a web search it appears that this is a distinct type of papillary thyroid carcinoma (http://erc.endocrinology-journals.org/content/24/4/R109.full). Example: Right lobectomy shows thyroid epithelial neoplasm, pending consultation. Consultation: Thyroid gland, right lobe: papillary thyroid carcinoma, favor cribriform-morula variant. Consultation Comment: IHC stains argue against medullary carcinoma. The histologic features of growth patterns and cytologic atypia (with rare grooves and pseudoinclusions) and the immunohistochemical profile support a diagnosis of papillary thyroid carcinoma, favoring the cribriform-morula variant. It is important to note that a significant number of patients with this variant of papillary thyroid carcinoma have been associated with familial adenomatous polyposis syndrome. |
Assign code 8260/3 for papillary carcinoma of thyroid. Cribriform-morula variant is not listed in ICD-O-3 for papillary carcinoma. Multiple Primaries/Histology Rule H14 states to code papillary carcinoma of the thyroid to papillary adenocarcinoma, NOS (8260). |
2017 |
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20170061 | MP/H Rules/Histology--Thyroid: What is the correct histology when final diagnosis of a thyroidectomy includes the descriptor "papillary and follicular architecture?" See Discussion. |
Total thyroidectomy Final Diagnosis: Papillary carcinoma, classical type, with papillary and follicular architecture. The 2007 MP/H rules state that the term architecture is reserved for coding subtype of in situ primaries only. However, SINQ 20130165 appears to indicate this should be coded for invasive thyroid subtypes as well. Can you confirm the addition of the term architecture for determining an invasive histologic subtype for thyroid? |
Assign code 8260/3, papillary carcinoma per Multiple Primaries/Histology Rule H14. Architecture is reserved for coding subtype of in situ primaries only. SINQ 20130165 is not intended to indicate this should be coded for invasive thyroid subtypes. |
2017 |
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20021025 | Histology: What code is used to represent the histology "endometrioid adenocarcinoma, villoglandular type"? | Assign code 8262/3 [Villous adenocarcinoma]. According to the WHO Classification of Tumours, Breast and Female Genital Organs (2003), villoglandular is one of four variants of endometroid adenocarcinoma. The corresponding ICD-O-3 code according to WHO is 8262/3. |
2002 | |
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20190104 | Histology--Corpus uteri: Is 8020/3 used for a predominantly dedifferentiated carcinoma with focal well-differentiated endometrioid adenocarcinoma diagnosed in 2018? See Discussion. |
After a little research, it appears as though Endometrial Dedifferentiated carcinoma is a relatively new term and is set to be included in ICD-O-3.2: http://www.iacr.com.fr/index.php?option=com_content&view=category&layout=blog&id=100&Itemid=577 If you look at the link on that page for All Additions, Changes, and Revisions to the ICD-O-3, 1st Revision for ICDO-3.2, there is 8020/3 Dedifferentiated carcinoma. Currently, 8020/3 is Carcinoma, undifferentiated, NOS. For 2018 diagnosis, would you use 8020/3 for a predominantly dedifferentiated carcinoma with focal well-differentiated endometrioid adenocarcinoma as stated in the pathology: Uterus, bilateral ovaries and fallopian tubes; supracervical hysterectomy/BSO: Predominantly dedifferentiated carcinoma with focal well-differentiated endometrioid adenocarcinoma in the endometrium, FIGO grade 1 Portion of omentum, omental/anterior abdominal wall/ round ligament/uterine/small bowel mesenteric tumor nodules all involved by dedifferentiated carcinoma. Synoptic reads as follows: Histological Type: Endometrioid carcinoma, NOS Dedifferentiated carcinoma predominantly Histological Grade: Endometrioid carcinoma, FIGO grade 1. |
Assign code 8380/3 for endometrioid carcinoma, NOS as this is listed as the histological type in the synoptic report. |
2019 |