Home
| Report | Question ID | Question | Discussion | Answer | Cancer Site Category | Data Item Category | Year |
|---|---|---|---|---|---|---|---|
|
|
20210060 | Reportability/Histology--Thymus: Is a 2021 diagnosis of a type A microscopic thymoma reportable? See Discussion. |
ICD-O-3.2 lists microscopic thymoma as benign (8580/0) and thymoma, type A as malignant (8581/3). January 2021: Left central neck node dissection for thyroid carcinoma with thymic tissue showing an incidental type A microscopic thymoma, described as a small (<0.2 cm) focus. Diagnosis comments further indicate this is morphologically consistent with a microscopic thymoma (type A). |
Report this case as type A thymoma. We consulted an expert physician and his advice on this specific case is to interpret it as a malignancy and report. Use text fields to record the details of this case. |
N/A | Histology | 2021 |
|
|
20210062 | Histology/Reportability--Heme and Lymphoid Neoplasms: Is a case that is compatible with low grade myelodysplastic syndrome with multilineage dysplasia (MDS-MLD) reportable, and if so, is the histology plasma cell myeloma or myelodysplastic syndrome (MDS)? See Discussion. |
HL-7 e-path report, Final Diagnosis High normocellular marrow with maturing trilineage hematopoiesis, multilineage dyspoiesis, compatible with MDS-MLD and involvement by plasma cell neoplasm/myeloma, IgA kappa positive, approximately 20-25% of total cellularity present. See comment. Comments Correlation with other relevant laboratory (amount and type of serum and urine paraprotein levels, renal function tests, serum calcium level, and anemia) and radiologic (lytic bone lesions) findings is recommended for complete interpretation. Dyspoiesis of all lineages is seen and the findings are compatible with low grade myelodysplastic syndrome (MDS-MLD), assuming that other possible causes are excluded. Correlation with cytogenetic and molecular studies is recommended for complete characterization |
This case is reportable. Assign MDS, NOS (9989/3) based on the information provided for this case. “Compatible with” can be used for reportability; however, it cannot be used for assigning histology. There is no confirmed diagnosis of plasma cell myeloma/neoplasm; the comment specifically addresses the need for further evaluation of this case. |
Heme & Lymphoid Neoplasms | Histology | 2021 |
|
|
20110024 | MP/H Rules/Histology--Breast: How is histology coded, and which MP/H rule applies for a diagnosis of ductal carcinoma in situ with clear cell features? See Discussion. | None of the histology rules for in situ breast seem to apply to this case:
|
For cases diagnosed 2007 or later: Code 8523/2 [intraductal carcinoma mixed with other types of in situ carcinoma]. Rule H6 should apply to this case.
The wording in the Rule H6 needs to be clarified to handle a case of intraductal carcinoma with one or more subtypes that are not ductal. This will also require a modification to Table 3. A row needs to be added to the table labeled, "Intraductal and one or more of the histologies in Column 2." The Column 3 text for the newly added row would read, " Intraductal mixed with other types of carcinoma." The appropriate histology code to be reported per Column 4 would be 8523/2. This will be done in the next revision of the rules. |
Breast | Histology | 2011 |
|
|
20010003 | Histology (Pre-2007)--Prostate: What code is used to represent the histology "prostatic duct carcinoma"? See discussion. | Should the histology be coded to duct carcinoma [8500/3] or endometrioid carcinoma [8380/3]? Prostatic duct carcinoma is defined as endometrioid carcinoma; however, sometimes the pathology report describes the histology as being only "prostatic duct carcinoma." | For tumors diagnosed prior to 2007:
If there is no mention of endometrioid carcinoma in the microscopic description, code the Histology field to 8500/3 [duct carcinoma]. If "endometrioid carcinoma" is mentioned in either the final diagnosis or in the microscopic description, code the Histology field to 8380/3 [endometrioid carcinoma].
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules. |
Prostate | Histology | 2001 |
|
|
20091009 | MP/H Rules/Histology--Kidney: How do you code histology for a renal cell carcinoma when pathologists disagree as to whether or not the tumor is consistent with thyroid-like follicular carcinoma of the kidney? See Discussion. | Final diagnosis states 'left radical nephrectomy, renal cell carcinoma.' The CAP Histologic Type is listed as: Unclassified, most consistent with primary thyroid-like follicular carcinoma of the kidney.' Because of the unusual histology it was sent for a consult to a genitourinary pathology specialist. His response was: 'histologic features not typical for any of the known subtypes of renal cell carcinoma and are not consistent with primary thyroid-like follicular carcinoma of the kidney, a distinct renal tumor that we have recently published in the literature.' The tumor was TTF-1 negative, arguing against metastasis from a thyroid primary. | For cases diagnosed 2007 or later, assign code 8312 [renal cell carcinoma, NOS]. The diagnosis is renal cell carcinoma, but the specific type is in question. | Kidney, renal pelvis | Histology | 2009 |
|
|
20210065 | Solid Tumor Rules (2018/2021)/Histology--Lung: Should there be an exception to the Solid Tumor Rules for Lung to allow coding a more specific histology described by ambiguous terminology, when the only pathologic workup done is a cytology report? Due to the unique nature of lung cases which are often diagnosed on imaging and cytology without more definitive pathology, we are seeing many cases where the existing Solid Tumor guidelines result in very generic NOS histology codes. For example, lung mass found on imaging with a fine needle aspirate of a lymph node, final diagnosis "positive for malignancy" and comment "consistent with squamous cell carcinoma." See Discussion. |
The Solid Tumor histology coding guideline #3 for Lung states that an ambiguous histology can only be coded over an NOS when a physician clinically confirms it or the patient receives treatment based on the ambiguous histology; similar instructions exist in rules H3 and H12. We are in a central registry and don't typically have access to physician notes or treatment plans; unfortunately our hospital abstracts rarely document physician confirmation of ambiguous histology and we are uncertain if we should accept their coding of the more specific histology, assuming they did find clinical confirmation that was not documented. If not, our understanding of the Solid Tumor rules is that the histology in such a case would have to be coded as malignancy NOS (8000/3) per the non-ambiguous final diagnosis, and that we cannot use the more specific but ambiguous squamous cell carcinoma since we don't have definite clinical confirmation. We also have a fair number of cytology-only lung cases without any hospital information to clinically confirm an ambiguous histology. |
Code histology as squamous cell carcinoma, NOS (8070/3) using Lung Solid Tumor Rules, Rule H3 if no other information is available. Rule H3 states: If the case is accessioned (added to your database) based on a single histology described by ambiguous terminology and no other histology information is available/documented, code that histology. |
Lung | Histology | 2021 |
|
|
20091003 | MP/H Rules/Histology--Peritoneal primary: Can the cell types from the primary site and a metastatic site be combined to code histology? See Discussion. | Patient has vaginal mass biopsy diagnosed as 'papillary carcinoma with psammoma bodies.' Two weeks later the patient has laparoscopy with multiple peritoneal biopsies, diagnosed as 'well differentiated serous adenocarcinoma'. Patient stated to have peritoneal primary with mets to vagina and was treated with chemotherapy. Do we code the histology to 8441/31 from the primary site biopsies, or can we use 8460/3, combining the cell types from the primary and metastatic sites? Please see SINQ 20041062 for a similar question before the 2007 MP/H rules. | For cases diagnosed 2007 or later, assign code 8441 [serous adenocarcinoma, NOS]. Code the histology from the primary site when available. Do not combine histologies from primary and metastatic sites. In this primary peritoneal case, the diagnosis from the peritoneal biopsies was serous adenocarcinoma. |
N/A | Histology | 2009 |
|
|
20130093 | MP/H Rules/Histology--Lung: What histology code is used for an adenocarcinoma in situ/bronchioloalveolar carcinoma (BAC) of the lung? See Discussion. | Classification of lung malignancies has undergone a change. The bronchioloalveolar carcinoma histology is being replaced by adenocarcinoma in situ and minimally invasive adenocarcinoma, using an evaluation of lepidic growth pattern in the tumor.
The final diagnosis is "adenocarcinoma in situ/BAC" and the comment states, "The findings in the current biopsy are most compatible with low grade malignant lesions which, in this sample, shows features of adenocarcinoma in situ (former bronchioloalveolar adenocarcinoma), given the proliferation of pneumocytes is limited to the alveolar lining with no evidence of invasion. However, classification of the lesion depends, per reference guidelines (Travis et al. J THOR ONCOL 2011 6,(2):244-275), on its size and its overall histologic features, to rule out the presence of an invasive component and therefore can only be performed upon examination of it in its entirety, upon resection." The radiation oncologist staged this T1N0M0, stage 1 BAC. |
Code the histology to 8140/2 [adenocarcinoma in situ, NOS].
The comment for this case is consistent with information from the CAP protocol, which says, "The diagnosis of bronchioloalveolar carcinoma requires exclusion of stromal, vascular, and pleural invasiona requirement that demands the tumor be evaluated histologically in its entirety. It is therefore recommended that a definitive diagnosis of bronchioloalveolar adenocarcinoma not be made on specimens in which the tumor is incompletely represented."
This tumor was not completely resected. Therefore, code to adenocarcinoma in situ based on the information provided. |
Lung | Histology | 2013 |
|
|
20110014 | MP/H Rules/Histology--Corpus Uteri: Which MP/H rule applies in coding histology for a "high grade endometrioid adenocarcinoma with squamous differentiation (adenosquamous carcinoma)"? See Discussion. | Is the pathology describing a specific histology, adenosquamous carcinoma [8560/3]? Or is this a combination/mixed histology code per rule H16? The Rule H16 instruction is to code a mixed histology code, 8323/3 [mixed cell adenocarcinoma] from Table 2 when two or more of the histologies are present (i.e., endometrioid and squamous in this case). | For cases diagnosed 2007 or later: Endometrioid adenocarcinoma with squamous differentiation is coded to 8570 [Adenocarcinoma with squamous metaplasia].
The following row needs to be added to Table 2 in order to be able to correctly use the MP/H rules to reach this conclusion.
Column 1: Endometrioid adenocarcinoma Column 2: Squamous metaplasia Squamous differentiation Column 3: Adenocarcinoma with squamous metaplasia Column 4: 8570
The change will be made in the next revision of the rules. |
Corpus uteri | Histology | 2011 |
|
|
20190022 | Solid Tumor Rules (2018)/Histology--Lung: Is histology code or the number of primaries assigned differently in SINQ 20180093 if the word "pattern' was omitted? See Discussion. |
Regarding the answer to SINQ 20180093: This is a single primary; coded 8140/3 adenocarcinoma. In the biopsy and the two tumors found on lobectomy, the specific adenocarcinoma histologies are described as acinar predominant pattern, solid growth pattern and lepidic predominant pattern. You do not code a pattern, so rule M7 above applies and this is a single primary. My question is based on Note 2 in Coding Multiple Histologies for lung cancers that says: Predominantly describes the greater amount of tumor. Predominant and majority are synonyms. Per the CAP protocol, the term predominant is acceptable for the following specific subtypes of adenocarcinoma. For these subtypes only, the word predominant is used to describe both the subtype and the grade of the tumor. |
If the word "pattern' was omitted, you would abstract multiple primaries per the Lung Solid Tumor Rule M6 and code histology to adenocarcinoma, acinar predominant (8551/3) and adenocarcinoma, lepidic predominant (8250/3) per Rule H4 as the word "pattern' is not included in each histology. |
Lung | Histology | 2019 |
An official website of the United States government
