Report | Question ID | Question | Discussion | Answer | Year |
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20240017 | EOD/Prostate Pathologic Extension--Prostate: Is a pathology report from a prostate biopsy/transurethral resection of the prostate that states "with intraductal spread" extraprostatic/extracapsular extension or localized? |
Code as a localized, intracapsular tumor as ductal carcinoma in situ does not invade. Intraductal spread is describing the neoplasm spreading through the acinar/ductal cells in the prostate specimen. It is an in-situ type of spread and not invasive but almost always presents with an invasive tumor. |
2024 | |
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20140017 | Multiple Primaries--Heme & Lymphoid Neoplasms: 2012 path report for removal of an "axillary mass" which consists of 80% diffuse large B-cell lymphoma (DLBCL) and 20% follicular lymphoma. In the original manual, Module 6 instructed us to code as a single primary, DLBCL. However, the multiple primary calculator says each disease is a separate primary. When I looked them up in the data base, I did not get an option to review a current manual. Can you please advise? |
Code as a single primary with histology Diffuse Large B-Cell Lymphoma.
In this case, there are two NHLs in the same location at the same time. Apply Rule M4, this is one primary. Per Note 5 under Rule M4, go to Rules PH11and PH15 to assign primary site and histology.
Rule PH11 states to code to the site of the origin (axillary mass) and to diffuse large b-cell lymphoma (9680/3) when DLBCL and any other non-Hodgkin lymphoma (follicular in this case) are present in the same location at the same time.
Using the multiple primaries calculator in this situation will give you two primaries, which is the wrong answer. Use the rules before using the calculator.
To get to the manual, go to the "Help me code for dx year." section. Choose 2010 or later and the most current manual will appear. We recommend that you save a copy of the PDF on your computer. |
2014 | |
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20110046 | MP/H Rules/Multiple primaries--Stomach: If there is no statement of recurrence, how many primaries are to be abstracted when a patient is diagnosed with multiple gastric carcinoid tumors between 12/2003 and 3/2009? See Discussion. |
Are the multiple primary rules applicable when a patient has multiple gastric carcinoid tumors? The patient was diagnosed with carcinoid tumors starting in 12/2003 through 3/2009. According to the 2004 SEER Manual, rule 5, if a tumor with the same histology is identified in the same site at least two months after the original diagnosis, this is a separate primary. The physician does not indicate that the pre-2007 carcinoid tumors were recurrent. The patient does not have familial polyposis syndrome. Should each of the following tumors be a separate primary? 12/2003 - Gastric Polyp Removal - Path: Gastric carcinoid tumor 05/2004 - Stomach body polyp removal - Path: Carcinoid Tumor (endocrine cell tumor) 09/2004 - Single polyp in body removal - Path: Gastric carcinoid 03/2005 - Multiple gastric body polyps removed - Path: Carcinoid tumor 07/2005 - 3 small polyps in fundus removal - Path: Carcinoid tumor 02/2007 - Localized nodularity in lesser curvature - Path: Carcinoid (neuroendocrine) tumor 03/2009 - Stomach body polypectomy - Path: Carcinoid tumor |
Code as a single primary. The histology is carcinoid. Our expert pathology consultant replied as follows: "This patient clearly has a condition driving the proliferation of neuroendocrine cells. Possibilities include hypergastrinemia from a gastrinoma or from response of antral gastrin cells due to achlorhydria from long standing chronic atrophic gastritis, or multiple endocrine neoplasia (MEN1) syndrome (genetically driven). How should these cases be coded given we do not have a way to code the inciting situation. (I suspect the gastroenterologist knows what it is, but we haven't obtained that information.) We do not have an ICD-O-3 code for the underlying condition, MEN1 or hypergastrinemia. Therefore, the only choice is to code the resulting tumor, carcinoid [8240/3]." |
2011 |
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20190039 | Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of invasive moderately differentiated adenocarcinoma, predominantly papillary subtype, with minor acinar and lepidic subtypes? See Discussion. |
11/01/2018, lung, left upper lobe, wedge resection: Invasive moderately differentiated adenocarcinoma, predominantly papillary subtype, with minor acinar and lepidic subtypes. Would this be 8260/3 since the acinar and lepidic subtypes are described as minor or would this be 8255/3 because there is papillary plus two other subtypes/variants described as subtypes? |
Code as adenocarcinoma, papillary predominant (8260/3) according to the Lung Solid Tumor Rules, Coding Multiple Histologies, which says to code the specific histology. The most specific histology may be described as component, majority/majority of, or predominantly, where predominantly describes the greater amount of tumor. |
2019 |
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20240006 | Primary Site/Histology--Heme & Lymphoid Neoplasms: What are the correct primary site and histology for patient diagnosed with an oropharyngeal soft tissue mass revealing plasma cell neoplasm with 5-10% of marrow cellularity in 2022? See Discussion. |
Patient underwent excision of an oropharyngeal soft tissue mass revealing plasma cell neoplasm with extensive amyloid deposition. During work-up, bone marrow biopsy also revealed involvement by plasma cell neoplasm, with 5-10% of marrow cellularity. No amyloid seen in bone marrow. Patient was referred for radiation of the oropharyngeal mass. Per medical oncology qualifying best for the diagnosis of solitary extramedullary plasmacytoma with minimal marrow involvement. Decision made for observation by medical oncology in view of “minimal” bone marrow involvement. Question: Is rule M11 correct, and I abstract this case as a plasma cell myeloma, 9732/3, C421? |
Code as an oropharyngeal primary site and histology as solitary plasmacytoma (9734/3) based on consultation with our hematological expert. The WHO Classification of Hematopoietic and Lymphoid Tissues defines multiple myeloma as "bone marrow plasma cell percentage >60%." There are several other factors, but the bone marrow involvement is the key point for your case. The pathologist also states that the bone marrow is consistent with "plasma cell neoplasm," which by itself is not the same as multiple myeloma. This case has 5-10% involvement by plasma cell neoplasm. This does not meet the bone marrow qualifications for multiple myeloma and is consistent with the pathologist's statement that there is minimal bone marrow involvement. We will be updating the Hematopoietic and Lymphoid Neoplasms Database and Manual to clarify this (2025 updates). |
2024 |
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20081049 | Histology--Pancreas: What is the correct code for "non-secretory pancreatic endocrine tumor" with positive lymph nodes on excision indicating a malignant tumor? Pathologist indicated it was not an exocrine tumor. | Code as islet cell carcinoma [8150/3]. There are several cell types in the islets, and each produces a different hormone. The custom has been to name the tumors by their hormone production e.g. insulinoma, glucagonoma, etc. Occasional tumors do not produce any hormone (at least one that can be determined or measured). These tumors are called non-functioning endocrine tumors. Most of the endocrine tumors in the pancreas are islet cell tumors. |
2008 | |
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20200042 | Solid Tumor Rules (2018)/Histology--Brain and CNS: How is the histology coded when the diagnosis comment for a posterior fossa tumor resection states: Taken together, these findings are indicative of medulloblastoma with extensive nodularity? See Discussion. |
Example: Posterior fossa tumor resection final diagnosis was medulloblastoma, WHO Grade IV. The diagnosis comment notes the current tumor resection reveals large irregular reticulin-free nodules with streams of neoplastic cells in a fibrillary background in association with narrow reticulin-rich internodular strands of poorly differentiated neoplastic cells. Taken together, these findings are indicative of medulloblastoma with extensive nodularity. The diagnosis comment provided only one histology. Per the 2018 Solid Tumor Manual, Malignant CNS, Priority Order for Using Documentation to Identify Histology instructions, an addendum or comment has priority over the final diagnosis. Although indicative is not listed on any ambiguous terminology list, is this an ambiguous diagnosis that must be ignored? Or does the diagnosis comment in this case provide a single, specific diagnosis of medulloblastoma with extensive nodularity? |
Code as medulloblastoma, nodular (9471/3) based on the findings from both the comment and final diagnosis. |
2020 |
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20170076 | MP/H Rules/Histology--Brain and CNS: Is meningioma with atypical features coded as meningioma (9530/0) or atypical meningioma (9539/1)? See Discussion. |
Pathology report microscopic description: The tumor is a meningothelial neoplasm (EMA+; BCL-2 and CD34 negative) with prominent collagen deposition. Necrosis and prominent nucleoli are present; no other atypical features are seen. Mitoses are present, up to 2 per 10 high-powered fields. Final Diagnosis: Dura, bicoronal craniotomy (specimen A): Meningioma with atypical features. There is no rule in benign brain and CNS section of Multiple Primary/Histology (MP/H) Rules stating to code the most specific histologic term when the diagnosis is (something less specific, i.e., adenocarcinoma). This rule is in other site chapters of MP/H but appears missing in the benign brain and CNS section. |
Code as meningioma, NOS (9530/0). This lesion has some of the features of an atypical meningioma (necrosis and prominent nucleoli), but it does not fit the definition of atypical meningioma in WHO Classification of Tumors of the Central Nervous System. Use text fields to document the details. |
2017 |
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20190064 | Multiple Primaries--Heme & Lymphoid Neoplasms: Patient is diagnosed with myelodysplastic syndrome (MDS) with an early/evolving acute myeloid leukemia (AML) thought to be treatment related. Does rule M11 apply since there are two biopsies within 21 days, and therefore, two primaries, or one primary (9920/3)? See Discussion. |
Patient has a history of breast cancer and diffuse large B-cell lymphoma (DLBCL), both treated with chemotherapy and radiation. On 6/26/19, bone marrow biopsy: MDS with excess blasts-2 (18% dysplastic blasts) in a normocellular marrow (overall 40% cellularity) with trilineage dysplasia. Comment: least myelodysplastic syndrome with excess blasts-2. However, an early/evolving AML cannot be completely excluded. The findings likely represent therapy-related myeloid neoplasm. MD note on 7/15/19: Diagnosis: MDS, high grade borderline AML with complex karyotype secondary disease. Patient has high grade MDS which is bordering on AML transformation with 20% blasts by IHC and areas higher than this. This is likely secondary to the treatment she has received for her other cancers particularly pelvic radiation for her DLBCL. Given her very high IPSS score, it is likely she will eventually develop AML. No treatment given. On 7/15/19, bone marrow biopsy: Persistent acute leukemia in a marrow with trilineage dyspoiesis and 23% blasts. |
Code as one primary (9920/3). This case does not fit the rules very well, since it is a treatment-related neoplasm and involves a transformation of MDS to AML during the clinical workup. Per the abstractor notes for 9920/3, code 9920/3 when the physician comments that the neoplasm is treatment related. This can be for the MDS or the AML. Use text fields to document that it was first referred to as MDS and then transformed to AML. If you followed the rules strictly and coded this as two primaries (the MDS and AML), you would lose the information that this was treatment related, which is more important. |
2019 |
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20190063 | Solid Tumor Rules (2018)/Histology--Sarcoma: How is histology coded for a CIC gene rearrangement sarcoma? See Discussion. |
According to the literature, CIC gene rearrangement sarcomas in young patients are soft tissue sarcomas with an aggressive clinical course and may have previously been grouped under the Ewing-like family of tumors or as undifferentiated round cell sarcomas. There is currently no guideline in the solid tumor rules for coding a CIC gene rearrangement sarcoma. However, coding the histology to 8800 (sarcoma, NOS) seems unlikely to capture the more aggressive nature of these tumors. Can a more specific histology be coded? |
Code as undifferentiated round cell sarcoma (8803/3). The CIC rearrangement exists as a distinct molecular and clinical subset of small round cell tumors, and though similar, is felt to be a distinct entity from Ewing sarcoma. According to WHO Classification of Soft Tissues and Bone, 4th Edition, CID-DUX4 is a recurrent gene fusion associated with pediatric round cell undifferentiated soft tissue sarcoma (USTS). Although the genes involved in the fusion are different from those in Ewing sarcoma, the CIC-DUX4 protein has been shown to upregulate genes of the ETS family of genes thus providing a molecular link between Ewing sarcoma and round cell USTS. In contrast, there are strong arguments to suggest that Ewing-like sarcomas represent a separate and distinct entity. |
2019 |