Histology--Vulva: How is the histology coded for vulvar intraepithelial neoplasia III (VIN III)/Squamous cell carcinoma in situ from a pathology report of the vulva, 8070/2 for squamous cell carcinoma in situ or 8077/2 for VIN III? The rules do not discuss this particular situation.
Assign 8077/2 for high-grade squamous intraepithelial lesion, VIN 3 in this case. The WHO Classification of Female Genital Tumors, 5th edition, states that squamous intraepithelial lesions (SILs) of the vulva are also known as vulvar intraepithelial neoplasia, HPV-associated. The term squamous cell carcinoma in situ is not recommended.
The diagnosis of "myelodysplasia" is not reportable.
Myelodysplasia covers a group of disorders that result in the inability to produce enough healthy mature blood cells. Those disorders include: anemia, leukopenia, thrombocytopenia, MDS, refractory anemia, refractory anemia with excess blasts in transformation, refractory anemia with ring sideroblasts, refractory anemia with excess blasts, chronic myelomonocytic leukemia, acute myeloid leukemia. Follow-back to the physician is necessary to determine whether or not a particular case represents a malignancy.
"Myelodysplasia" is also listed in Appendix F: Non-Reportable List for Hematopoietic Diseases.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
Histology (Pre-2007)--Head & Neck: How is a "sinonasal undifferentiated carcinoma (SNUC)" coded?
For tumors diagnosed prior to 2007:
Code histology to 8020 [carcinoma, undifferentiated]. "Sinonasal" refers to anatomic location of primary site not histology.
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.
MP/H/Histology--Lung: What is the histology code for "heterologous biphasic sarcomatoid carcinoma of the lung with prominent rhabdomyoblastic and adenoca differentiation"?
The expert pathologist recommends coding histology to 8980/3 [Carcinosarcoma] for this combination histology.
Expert consultation: The designation "carcinosarcoma" is given when the pathology shows differentiation in both the sarcomatous (rhabdomyoblastic) and carcinomatous (adenoca) elements. This is emphasized in the path for this case with the term "biphasic." The term "heterologous" mean that the sarcomatous component is of a type not normal to lung. Rhabdomyoblastic means skeletal muscle differentiation. Because skeletal muscle is not normally found in lung it is heterologous. If it were smooth muscle, it would be homologous because smooth muscle is found in lung (as a part of the bronchi).
Histology--Heme & Lymphoid Neoplasms: How is this field coded when the final diagnosis for excisional biopsy of two cervical lymph nodes shows classical Hodgkin lymphoma, histologic subtype cannot be determined, but the COMMENT section of the report indicates there are features of both lymphocyte rich and nodular sclerosis subtypes?
Per Rule PH28, code histology to 9650/3 [Classical Hodgkin lymphoma]. This rule states to code the non-specific (NOS) histology when the diagnosis is one non-specific (NOS) histology and two or more specific histologies.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. http://seer.cancer.gov/seertools/hemelymph.
Grade, Differentiation--All Sites: What code is used to represent this field when a pathology report describes a tumor as a low grade neoplasm consistent with a specific histologic type (e.g., Low grade neoplasm consistent with carcinoid)?
Code the Grade, Differentiation field to 2 [Low grade].
Surgery of Primary Site/Surgery Codes, NOS--Pancreas: What exactly is an extended pancreatoduodenectomy? Must the entire pancreas be resected in order to use code 70? What minimal requirements must be met to use code 70? How should a Whipple with cholecystectomy, partial omentectomy, common hepatic excision, portal vein resection, and lymphadenectomy be coded?
According to our research, a pancreaticoduodenectomy (PD) includes an en bloc resection of the pancreatic head, the common bile duct, the gallbladder, the duodenum, the upper jejunum, the distal portion of the stomach and the adjacent lymph nodes. The extended PD procedure includes extended lymphadenectomy, extended organ resection, and extended vascular resection and reconstruction.
Code 70 could be assigned without the entire pancreas being resected.
A Whipple procedure removes the head of the pancreas, duodenum, stomach and gallbladder and part the common bile duct. The portal vein resection is probably part of the common bile duct excision. If the omentectomy was performed for treatment of this primary, record it in "Surgical Procedure of Other Site." Record the lymphadenectomy in the lymph node data items.
Primary Site--Breast: If a patient has multifocal tumors all in the upper outer quadrant of the breast, is the primary site coded to C-504 because all of the tumors are in UOQ or would the site be coded to C509 to reflect the fact that multiple tumors exist?
Code the primary site to C504 [Upper outer quadrant]. All disease is located in one quadrant, code that quadrant. When disease involves two or more quadrants and the point of origin cannot be determined, code C509 [Breast, NOS]. See 2004 SEER manual, page C-470 for instructions about invasive and in situ in different quadrants.
Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of a 2018 lung cancer case with invasive non-mucinous adenocarcinoma? For non-mucinous carcinoma/adenocarcinoma, the Solid Tumor Rules have codes for microinvasive, minimally invasive, preinvasive, and in situ. Do we default to the microinvasive/minimally invasive code?
Code histology to adenocarcinoma, NOS (8140/3). The World Health Organization and the College of American Pathologists no longer recognize non-mucinous carcinoma/adenocarcinoma, NOS. Pathologists are discouraged from using this term. Microinvasive/minimally invasive lung tumors have very specific criteria and these criteria do not apply to non-mucinous carcinoma, NOS.