Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20170006 | Diagnostic confirmation--Heme & Lymphoid Neoplasms (Lymphoma): To code "3" in Diagnostic Confirmation, does the genetic testing need to confirm a specific histology or is it enough that is simply rules out others? See Discussion. |
For example, pathology states: Right axillary lymph node, excision: Diffuse large B-cell lymphoma (DLBCL) (see note). COMMENT: FISH studies were performed that were negative for BCL-6, c-Myc/IgH, CCND1/IgH and IgH/BCl-2 gene rearrangement, ruling out the most common forms of double-hit lymphoma. Flow cytometry studies demonstrated positivity for CD45, CD20, HLA-Dr, CD19, CD11c, CD22, CD30, CD38, CD79b, and FMC7. Low positivity was seen for CD5. No reactivity was seen for CD10, CD23, CD25, CD103 or CD123. |
Both histologic plus immunophenotyping or genetic testing should be positive to assign code 3 for Diagnostic Confirmation. The Hematopoietic and Lymphoid Neoplasm Coding Manual Diagnostic Confirmation instructions state, assign 3 for Cases positive for neoplasm being abstracted (including acceptable ambiguous terminology and provisional diagnosis) AND Immunophenotyping, genetic testing, or JAK2 is listed in the Definitive Diagnosis in the Heme DB AND a.) Confirms the neoplasm OR b.) Identifies a more specific histology (not preceded by ambiguous terminology). Because the patient was diagnosed with DLBCL by histology, and flow cytometry was positive for CD antigens (immunophenotyping) 20, 22, and 30 for DLBCL, code 3 is appropriate. |
2017 |
|
20190029 | Reportability--Testis: Is demarcated scar tissue with atrophic seminiferous tubules and cortical bone consistent with burnt-out germ cell tumor and no evidence of germ cell neoplasia in situ (GCNIS) reportable? See Discussion. |
The patient is a 34 year old who presented with testicular pain radiating into the abdomen approximately 1 month before orchiectomy in 2018. CT abdomen/pelvis: Multiple focal sclerotic bone lesions. Given the lack of change from July 2014, these are likely benign bone islands. No adenopathy mentioned. He has no prior history of germ cell tumor nor any surgery for any tumor/cancer before this. Pathology: Testis, left, radical orchiectomy: - Demarcated scar tissue (1.3 cm), with atrophic seminiferous tubules and cortical bone consistent with burnt-out germ cell tumor. No evidence of germ cell neoplasia in situ (GCNIS). - Margins are unremarkable. |
Burnt-out germ cell tumor (9080/1) is not reportable. According to WHO Classification of Urinary System and Male Genital Organ, regressed germ cell tumors are germ cell tumors that have undergone partial or complete regression leaving a generally well-delineated nodular focus of scar or fibrosis in the testis. |
2019 |
|
20190102 | Solid Tumor Rules/Histology--Head & Neck: What is the histology code of an external ear lesion when the dermatopathology report is the only available information (follow-up with the physician or pathologist is not possible) and the final diagnosis is malignant spindle cell neoplasm, most consistent with atypical fibroxanthoma? See Discussion. |
There are two histologies provided in the final diagnosis, malignant spindle cell neoplasm (8004/3) and atypical fibroxanthoma (8830/3). There is a definitive diagnosis of the non-specific histology, but the more specific histology is only described using ambiguous terminology. The external ear (C442) is included in the Head and Neck schema for diagnosis year 2018 and later. The Head and Neck Histology Rules indicate ambiguous terminology cannot be used to code a more specific histology. So ignoring the atypical fibroxanthoma, because it is modified by ambiguous terminology, we are left with a non-reportable site and histology combination (C442, 8004/3). Diagnoses of malignant atypical fibroxanthomas are regularly diagnosed using the syntax above in our area. Follow-up with the physician or pathologist is generally not possible as these cases are received from dermatopathology clinics only. The pathology report is the only information that will be received. If the reportable diagnosis of malignant atypical fibroxanthoma is ignored per the current Solid Tumor Rules, incidence cases will be lost. |
By definition, atypical fibroxanthoma (AFX) is a diagnosis of exclusion. Markers of specific differentiation must be negative. As written in your example, neither histology is reportable for skin. If possible, clarify the behavior of the AFX (8830/1) with the pathologist to determine reportability of the case. |
2019 |
|
20160030 | Reportability--Carcinoid: Is a diagnosis of carcinoid heart disease, based solely on clinical information and no pathology, reportable? |
Carcinoid heart disease is not reportable but this diagnosis indicates that the patient likely has a carcinoid tumor which may be reportable. Obtain further information. |
2016 | |
|
20170005 | Reportability/Histology--Testis: Is neoplasm consistent with carcinoid type of monodermal teratoma reportable as a teratoma, NOS, and if yes, what is the histology code? |
Carcinoid type of monodermal teratoma or well differentiated neuroendocrine tumor (carcinoid), monodermal teratoma of the testis is reportable. Assign 8240/3 according to the WHO classification for this neoplasm. |
2017 | |
|
20100050 | Reportability--Colon: Would a carcinoid tumor, NOS, of the appendix with perineural or angiolymphatic invasion be reportable if there is no mention of malignancy in the pathology report? |
Carcinoid, NOS, of the appendix diagnosed in 2015 or later is reportable.
For cases diagnosed prior to 2015
Carcinoids of the appendix are reportable when they meet any of the following conditions.
Note that the implants/involvement must be designated as malignant. Many benign tumors will spawn implants that are also benign. If implants are benign, this is not a reportable tumor. |
2010 | |
|
20210018 | Reportability/Histology--Head & Neck: Is carcinoma cuniculatum of the hard palate diagnosed in 2017 reportable? Was this rare variant of squamous cell carcinoma (SCC) missed in Casefinding? If reportable, what is the histology code? |
Carcinoma cuniculatum of the hard palate is reportable. Code to SCC, NOS (8070/3). Use text fields to record the details. While WHO recognizes carcinoma cuniculatum to be a new variant of oral cancer, it has not proposed a new ICD-O code for this neoplasm. |
2021 | |
|
20140072 | Reportability--Head & Neck: Would this be reportable and if so what histology would be coded? Soft tissue mass left cheek excision reveals Carcinoma Ex Pleomorphic Adenoma Non-Invasive with focal vascular invasion. Margins clear. |
Carcinoma ex pleomorphic adenoma (Ca-ex-PA) is reportable. Assign 8941/3. The WHO classification of head and neck tumors defines Ca-ex-PA as an epithelial malignancy arising in a benign pleomorphic adenoma. Most of these originate in the parotid gland but can also arise in other salivary glands. |
2014 | |
|
20081113 | Reportability--Brain and CNS: Is a cavernoma reportable as a benign brain tumor? See Discussion. |
Cavernous hemangiomas are typically described as vascular malformations in the brain. Per a search of the literature, cavernoma, cavernous hemangioma and cavernous malformation are all synonymous. There is some controversy as to whether cavernomas are vascular malformations or tumors. Cavernous hemangioma (9121/0) has been assigned a code in the ICD-O-3. The other terms are not even listed. Benign brain guidelines indicate that named tumors that have been assigned an ICD-O-3 code are reportable. Would we report a lesion that is labeled cavernous hemangioma but not one that is labeled carvernoma? Are cavernous malformations of the brain to be reported as benign brain tumors? The MP/H guidelines for benign brain tumors do not include blood vessel tumors in chart 1. Are the following tumors reportable? If so, what is the primary site? Example 1: Patient admitted for resection. Clinical diagnosis is left temporal cavernous hemangioma. Path diagnosis is cerebral cortex and white matter showing cavernoma. Example 2: Patient admitted for resection with clinical diagnosis of parietal cavernous hemangioma. Path shows A-V malformation. Example 3: Patient had T4 spinal tumor removed. Path showed cavernous angioma. Reference: I&R 18109 and 23460 |
Cavernoma is a reportable benign brain tumor. According to our pathologist consultant, cavernoma is synonymous with cavernous hemangioma. Examples 1. Reportable. Primary site - C710 [cerebrum] 2. Not reportable. Path dx disproves clinical diagnosis. 3. Not reportable. Not a brain tumor. |
2008 |
|
20170002 | Reportability--Brain and CNS: Are cavernous sinus meningiomas reportable? See Discussion.
|
Per SINQ 20160068, sphenoid wing meningiomas are reportable (unless stated to be intraosseous) because they arise from the meninges overlying or along the sphenoid wing/sphenoid bone. These are intracranial and not intraosseous meningiomas.
Therefore, wouldn't this logic also apply to cavernous sinus meningiomas? These are tumors that arise from the meninges of an intracranial space, not from bone or soft tissue. The cavernous sinus is a "true dural venous sinus" within the skull. While not specifically about meningiomas, SINQ 20071095 states a benign tumor in the cavernous sinus is coded to C490. This SINQ would still seem valid for a benign tumor like a blood vessel tumor, but not for a meningioma that doesn't arise from soft tissue or blood vessels. |
Cavernous sinus meningiomas are reportable, as the meningioma arises in the meninges unless stated otherwise. This is similar to sphenoid wing meningiomas. |
2017 |