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20180101 | Histology--Kidney: What is the histology code for renal cell clear cell of the kidney with subsequent epithelioid angiomyolipoma PEComa of the liver stated to be metastatic? Case originaly diagnosed in 2016. See discussion. |
This patient was diagnosed in 2016 with renal cell clear cell and was coded to that. In 2018, the patient's liver lesion was resected and pathology revealed epithelioid angiomyolipoma perivascular epithelioid cell tumor (PEComa) (8714/3), a new term as of 2018. This was compared to the kidney slides and it was determined to be metastatic PEComa from the kidney. The physician's note states: The patient had a nephrectomy for a kidney tumor in 2016, excision of cutaneous melanomas, and resection of liver mass in 2018. These three cases were sent in consultation. The diagnosis of cutaneous melanoma was confirmed by a dermatopathologist of our department, (a separate report had been already issued). The kidney tumor is poorly differentiated composed of sheets of discohesive cells with markedly pleomorphic cells with frequent giant and bizarre cells. Most of the cells have abundant eosinophilic to clear cytoplasm. The nuclei are enlarged and pleomorphic. Multinucleated cells are numerous. Some cells have markedly enlarged nucleoli. Multifocal tumor necrosis is noted. Extensive lymphovascular invasion is observed. There are foci at the periphery of the tumor consisting of a proliferation of spindle cells with entrapped adipocytes consistent with minor element of unusual angiomyolipoma (see block A18). The liver tumor has histologic features that are similar to the poorly differentiated component of the kidney tumor. |
Revise the histology code for the 2016 diagnosis based on the review of slides performed in 2018. When new information becomes available, the information in the abstract can be updated. PEComa is a synonym for epithelioid angiomyolipoma (8860/1). These tumors can be malignant with local recurrence and or mets. For a pre-2018 diagnosis, code histology to 8860/3 using the ICD-O-3 Rule F, aka: Matrix principle. |
2018 |
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20180102 | Solid Tumor Rules 2018/Histology--Brain and CNS: What code should be used for high grade neuroepithelial tumor with BCOR Alteration? See Discussion |
A recent molecular study of PNET tumors at NCI (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139621) seems to indicate the discovery of four new CNS tumor entities, of which HGNET-BCOR is one. The article suggests that these are not primitive neuroectodermal tumors tumors (PNET), but something different. |
This question was reviewed by an expert neuropathologist. He recommends coding these tumors to malignant tumor, clear cell type 8005/3. He states: these tumors are extremely rare. In summary, CNS HGNET-BCOR represents a rare tumor occurring in young patients with dismal prognosis. Whether CNS HGNET-BCOR should be classified among the category of "embryonal tumors" or within the category of "mesenchymal, nonmeningothelial tumors" remains to be clarified. Because CNS HGNET-BCOR share pathologic features and characteristic BCOR-ITD with clear cell sarcoma of the kidney, these tumors may represent local variants of the same entity. |
2018 |
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20180103 | Histology/Grade--Small intestine: For a 2017 diagnosis, is the grade/differentiation field coded 1 or 9 when the diagnosis is well-differentiated neuroendocrine tumor (NET) (carcinoid)? It seems as though the term well-differentiated defines type of neuroendocrine tumor so they can diagnosis the carcinoid. See Discussion. |
5/15/17 Duodenal bulb, biopsy: Fragments of duodenal mucosa with well differentiated neuroendocrine tumor (carcinoid), extending to the edge of specimen and peptic duodenitis in the submitted tissue. No significant intraepithelial lymphocytosis. |
Assign grade code 1 for well-differentiated NET (8240/3). Well-differentiated is synonymous with NET, grade 1, according to WHO Classification of Tumors of the Digestive System. |
2018 |
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20180104 | Reportability--Ambiguous terminology: Are the following terms reportable: almost certainly and until proven otherwise? See Discussion. |
Example 1: Physician states patient has an almost certain melanoma. Due to the patient's age, there is no plan to for any treatment or further workup. Almost certain is not listed as a reportable phrase, so typically we would not accession this case. Example 2: Imaging states a diagnosis of renal cell carcinoma until proven otherwise. No additional workup is available at this facility. This terminology is also not seen on the ambiguous reportable terminology list but we are seeing it more often and wanted confirmation. |
Use the ambiguous terminology list as a last resort. Consult with the physician and search for further information to assist with the decision. If no further information can be obtained, use the ambiguous terms list to decide; in this case, the terms are not on the list and these examples would not be reportable. |
2018 |
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20180105 | 2018 Solid Tumor Rules/Histology--Lung: What is the appropriate histology code for the case below in the Discussion section? Is there a difference between adenocarcinoma in situ (bronchioloalveolar carcinoma), non-mucinous type (8252/2) and adenocarcinoma in-situ, mucinous? See Discussion. |
Procedure: Wedge, resection specimen, Laterality: Right, Tumor site: Right upper lobe, Tumor size: 1.0 cm in greatest dimension, Histologic type: Adenocarcinoma in-situ, mucinous, Histologic grade: N/A, Visceral pleura invasion: Not identified, Tumor extension: N/A, Margins: Uninvolved, Lymphocytosis. |
Assign 8253/2 for adenocarcinoma in situ, mucinous. New codes were added in 2018 for mucinous adenocarcinoma in situ for lung cancer only as all cases were not invasive. Pathologist are discouraged from using the term BAC. In-situ lung tumors can now be identified as either mucinous or non-mucinous and the appropriate ICD-O code should be assigned based on diagnosis. |
2018 |
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20180106 | First Course Treatment--Other Therapy: Please explain how to code this new therapy, peptide receptor radionuclide therapy (PRRT) for rare neuroendocrine tumors. See Discussion. |
According to this article, PRRT treatment lutetium Lu 177 dotatate was approved earlier this year by the United States Food and Drug Administration for adult use. PRRT is a nuclear medicine therapy that travels throughout the body looking for a certain receptor within neuroendocrine tumors. These include pancreatic and small neuroendocrine tumors in the gastrointestinal tract. Once absorbed into the tumor, the radioactive material starts to break down tumor cells, killing them. It is the first radioactive drug approved for the targeted treatment of gastroenteropancreatic neuroendocrine tumors. |
For cases diagnosed prior to 2023: Code Peptide Receptor Radionuclide Therapy (PRRT) in the data item Other Therapy, code 1, Other. See SINQ 20220042 and 20230005 for information pertaining to cases diagnosed in 2023 or later. |
2018 |
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20180107 | Solid Tumor Rules (2018)/Histology--Lung: If the pathology states non-small cell carcinoma of the lung (NSCLC), consistent with squamous cell carcinoma, is the code non-small cell carcinoma according to the Solid Tumor Rules? The Medical Oncologist states that the tumor is a squamous cell carcinoma. In these instances would you code the squamous cell carcinoma since you have a definite physician statement? |
Code the histology to SCC 8070/3. Based on registrar feedback on the NSCLC rule, we added a rule that specifically addresses when ambiguous terminology can be used to code histology other than NSCLC. The lung rules were update 10/12/2018 so please make sure you are using the currently posted rules. The new rule is: Rule H3-Code the specific histology when the diagnosis is non-small cell lung carcinoma (NSCLC) consistent with (or any other ambiguous term) a specific carcinoma (such as adenocarcinoma, squamous cell carcinoma, etc.) when: * Clinically confirmed by a physician (attending, pathologist, oncologist, pulmonologist, etc.) * Patient is treated for the histology described by an ambiguous term * The case is accessioned (added to your database) based on ambiguous terminology and no other histology information is available/documented Example 1: The pathology diagnosis is NSCLC consistent with adenocarcinoma. The oncology consult says the patient has adenocarcinoma of the right lung. This is clinical confirmation of the diagnosis, code adenocarcinoma. Your case meets the criteria in bullet 1. |
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20180108 | Solid Tumor Rules (2018)/Histology--Lung: What is the correct histology of a lung mass with a CT-directed fine needle aspirate "positive for malignancy, favor squamous cell carcinoma. See Discussion. |
Immunostain results of the malignant cells show strong staining with p63 and negative staining with TTF-1 and Napsin. Rare cells stain with CK7. Findings are most compatible with squamous cell carcinoma. The patient is treated as if he has squamous cell carcinoma. The new histology coding rules say you cannot use ambiguous terms which modify the histology to code the histology. So is this 8010/3? |
Code histology to SCC. The lung rules were updated 10/12/2018 to include clarification on using ambiguous terminology to code histology. See page 32. Note 2: Histology described by ambiguous terminology is coded when a case is * Clinically confirmed by a physician (attending, pathologist, oncologist, pulmonologist, etc.) * Patient is treated for the histology described by an ambiguous term Your case meets both of these criteria so code histology to SCC. |
2018 |
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20180109 | Date of diagnosis/Ambiguous terminology--Cervix Uteri: Is the date of diagnosis of a cervical pap smear done in December 2017, that states high-grade squamous intraepithelial lesion with features suspicious for invasion, followed by a cervical biopsy in 2018 positive for squamous cell carcinoma, in 2017? Is the ambiguous term used in the cytology in 2017 (suspicious for invasion) to determine diagnosis as the SEER manual states to use the ambiguous cytology as the date of diagnosis if confirmed later. |
Updated for cases diagnosed 2022 or later For cases diagnosed in 2022 or later, see the instructions in the SEER manual under Reportability and Date of Diagnosis for ambiguous cytology. |
2018 | |
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20180110 | Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of a 2018 lung case whose pathology states adenocarcinoma, acinar predominant? |
The Solid Tumor Rules for Lung rule H4 applies. Per Table 3, page 12, third column on adenocarcinoma row, adenocarcinoma, acinar predominant is coded to 8551/3. |
2018 |
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