Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned for a patient with a several month history of refractory anemia with excess blasts (RAEB), that may or may not have been treated, who now presents with a bone marrow biopsy that is compatible with acute myeloid leukemia?
Per Rule M10, abstract multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm AND there is a second diagnosis of an acute neoplasm more than 21 days after the chronic diagnosis. Two primaries should be accessioned for this case: refractory anemia with excess blasts (RAEB) [9983/3] (a chronic neoplasm), and acute myeloid leukemia [9861/3] (an acute neoplasm).
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.
Solid Tumor Rules/Histology--Ovary: How is histology coded for an ovary case with a diagnosis of “high grade papillary serous carcinoma” in 2023? This term is not in the Solid Tumor Rules and ICD-O 3.2 updates. Is “high grade papillary serous carcinoma” equivalent to “high grade serous carcinoma” (8461) or to “papillary serous adenocarcinoma” (8441) with high grade captured only in the Grade fields, or is there another more appropriate code?
Assign code 8461/3 for high-grade papillary serous carcinoma.
Histology: Are all well differentiated neuroendocrine carcinomas (carcinoid) tumors coded to 8240 or 8246? When do you use code 8246?
Code 8246 is correct when the mass/lesion is referred to as neuroendocrine "carcinoma" or NEC. Use code 8240 when the mass/lesion is referred to as a neuroendocrine "tumor" or NET G1. The difference is the word tumor versus carcinoma. Carcinoid is most often used interchangeably with neuroendocrine tumor and not with neuroendocrine carcinoma.
Reportability/Histology--Endometrium: Is endometrial hyperplasia with atypia equivalent to atypical hyperplasia of the endometrium (8380/2) and thus reportable?
Endometrial hyperplasia with atypia is equivalent to atypical hyperplasia of the endometrium (8380/2) and thus reportable for cases diagnosed 2021 and later. Our expert pathologist consultant confirmed this for us.
Histology (Pre-2007)--Breast: What code is used to represent the histology "mucinous carcinoma with Paget disease"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8480/3 [mucinous carcinoma]. This answer assumes the patient presented with a single tumor. There is no combination code that includes these two entities. According to the rules for Coding Complex Morphologic Diagnoses, it would appear that the case should be coded to 8540 [Paget disease] because it is the higher code. However, this combination of histologies represents an exception to that rule. The prognosis for mucinous carcinoma is worse than the prognosis for Paget disease. As a result, it would be more appropriate to the histology to mucinous 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.
Other Therapy/Immunotherapy--Hematopoietic, NOS: How should erythropoietin be coded for leukemia or other hematopoietic diseases?
Do not code Erythropoietin as treatment, it is used as an ancillary drug for leukemias or other hematopoietic diseases. Record information about erythropoietin in the text field.
Histology--Melanoma: How is a "malignant melanoma arising in a melanocytic nevus" coded?
The histology code is 8720/3 [malignant melanoma, NOS].
There is no specific code for melanoma arising in melanocytic nevus. According to our pathologist consultant, this is likely because nevi are so common, melanoma arising in association with them is common and appears to have no bearing on prognosis or treatment. Most pathologists do not include the nevus in the diagnosis of melanoma, even when they see it.
Code melanomas arising in melanocytic nevi to the appropriate melanoma code, probably 8720, 8721, or 8743 in most cases.
MP/H Rules--Ovary: Rule M7 states bilateral epithelial tumors (8000-8799) are reportable as a single primary. Are bilateral germ cell tumors of the ovary (e.g., dysgerminoma (9060/3)) that occur simultaneously now reported as two primaries?
For cases diagnosed 2007 or later, rule M7 applies to ovarian epithelial tumors with ICD-O-3 histology codes between 8000 and 8799. Rule M7 does not apply to dysgerminoma which is coded to 9060. Go on to the next rule, M8 and abstract as multiple primaries, left and right.
EOD-Extension--Cervix: Should this field be coded to 11 [minimal microscopic stromal invasion] or 12 [microinvasion] when there is only a statement of "microinvasion" but no measurements describing the level of involvement given?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 12 [microinvasion] when there are no depth of invasion measurements given.
Code the EOD-Extension field to 11 [minimal microscopic stromal invasion] when there is a statement of "minimal STROMAL invasion."
CS Extension--Lung: How is "subpleural extension" coded?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Subpleural extension means that the tumor extends to the subpleural space, but the pleura itself is not involved. Assign the appropriate extension code based on the other facts for the case. Do not code pleural involvement.
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