Ambiguous terminology/Reportability--Heme & Lymphoid Neoplasms: Is a physician diagnosis of "appears to be a myeloproliferative disorder" reportable if the patient has no treatment and the physician elects to follow the patient with CBC's?.
Yes. This is a reportable diagnosis and should be accessioned with the histology coded to 9975/3 [myelodysplastic/myeloproliferative neoplasm, unclassifiable].
The word is a reportable ambiguous term per the Hematopoietic Coding Manual (Case Reportability Instructions, Rule 4).
Myeloproliferative disorder is synonymous with myeloproliferative disease. Myeloproliferative disease is listed as an alternate name for myelodysplastic/myeloproliferative neoplasm, unclassifiable.
Ambiguous Terminology/Reportability: Are the terms "bordering on" and "may represent" diagnostic of cancer? See Discussion.
Pathology report states "...florid micropapillary hyperplasia, focally atypical with features bordering on low grade micropapillary ductal carcinoma in situ."
The terms "bordering on" and "may represent" are not diagnostic of cancer. These terms are not on the list of ambiguous terms that constitute a diagnosis of cancer. The diagnosis in the example above is not reportable to SEER.
Ambiguous Terminology/Reportability: Is the phrase "indicative of cancer" SEER reportable?
No. The phrase "indicative of cancer" alone is not a definitive cancer diagnosis. The word "indicative" is not on the list of ambiguous terms that is equivalent to a diagnosis of cancer.
Ambiguous Terminology: Is the expression "has the markings of a malignancy" a clinically reportable term? See Discussion.
12/02 Baseline mammogram: spiculated mass with associated marked retraction located in UOQ lt breast. This has the markings of malignancy. Several microcalcifications in outer aspect of rt breast. BI-RADS 5 higly suggestive of malignancy.
Do not accession cases using only the term "has the markings of malignancy." This term is not on the list of ambiguous terms that are reportable. If the term does not appear on either the reportable or not reportable list, the term is not diagnostic of cancer. Do not accession the case.
Please see SINQ 20010094 in reference to BI-RADS terminology.
Behavior--Breast: Is a breast biopsy diagnosis of "ductal carcinoma in situ with focal and very early stromal invasion" an invasive tumor with a behavior code 3?
Code the behavior to /3 [malignant, invasive].
"Stromal invasion" means the cancer is invasive. "Stroma" is the supporting connective tissue around and between ducts. It is outside the duct basement membrane. If the tumor cells extend into the stroma, the proper behavior designation for the tumor is invasive.
Behavior--Breast: Is behavior for encapsulated papillary carcinoma (EPC) of the breast coded as noninvasive or invasive?
The pathologist has the final say on behavior. Code behavior based on the pathologist's final diagnosis. See Rule F in ICD-O-3.
According the WHO Classification of Breast Tumors, encapsulated papillary carcinoma of the breast is in situ, /2. Encapsulated papillary carcinoma with invasion is assigned /3. WHO describes "frank invasive carcinoma" for this histology as "neoplastic epithelial elements infiltrate beyond the fibrous capsule of encapsulated papillary carcinomas." WHO cautions that true infiltration should be "differentiated from entrapment of neoplastic epithelial cells in the fibrous capsule and from epithelial displacement into the biopsy site, which is frequently encountered following needle-core procedures of papillary lesions."
Behavior--Breast: Should the behavior change to /3, invasive, to get a case to clear edits? The histology of this breast case is ductal carcinoma in situ (DCIS), 8500/2. Lymph nodes are positive for micro-mets (0.2 mm-2 mm). SEER Summary Stage: 3, regional lymph nodes positive. This creates an edit for SEER Summary Stage due to the behavior code of /2, in situ.
Code the behavior to /3, not just to pass edits, but because this is an invasive case based on the positive lymph nodes.
For most cases, behavior is based on the primary tumor, but in situations like this where an invasive component cannot be found and there are positive lymph nodes, the /3 behavior is assigned based on the positive lymph nodes.
Behavior--Breast: What is the behavior of a solid papillary carcinoma when a pathologist does not indicate it in the pathology report and follow-up with the pathologist to obtain clarification regarding the behavior is not possible? See Discussion.
Example: Mastectomy specimen final diagnosis shows two foci of invasive ductal carcinoma including: Invasive ductal carcinoma, no special type, in association with solid papillary carcinoma (tumor #1, 1 cm, slices 6 and 7) and invasive ductal carcinoma, no special type (tumor #2, 1.2 cm, slices 9 and 10).
Summary Staging outlines, Tumor #1: Histologic Type: Invasive ductal carcinoma, no special type, in association with solid papillary carcinoma. As well as, Tumor #2: Histologic type: Invasive ductal carcinoma, no special type. Additional findings include ductal carcinoma in situ (DCIS): presently approximately 3.3 cm, spanning slices 10-13.
The behavior of the solid papillary carcinoma component will affect the provisional histology of the first tumor (8523/3) per Rule H17 vs. 8500/3 per Rule H7). Based on the response, we can determine whether this represents a single or multiple primaries (single primary per M13 vs. multiple primaries per M14).
Review all sections of the pathology report carefully for any mention of invasion, or lack of invasion, pertaining to the solid papillary carcinoma.
Per WHO 4th Ed Breast: If there is uncertainty that there is invasion, these lesions should be regarded as in situ. The distinction between in situ and invasive disease in solid papillary carcinoma is difficult.
Behavior--Prostate: What is the correct behavior of intraductal carcinoma from a prostate biopsy with a Gleason score 4+4=8. While highly aggressive, but not suggestive of invasion, coding behavior as /2 seems inappropriate.
WHO classifies intraductal carcinoma of the prostate 8500/2. According to WHO, "the hallmark of intraductal carcinoma of the prostate is a proliferation of prostate carcinoma cells that is within and may significantly expand the native prostatic ducts and acini, with the basal cell layer at least partially preserved." Further, differentiation between intraductal carcinoma and infiltrating high-grade carcinoma of the prostate may require basal cell stains. Under Prognosis, WHO states: " intraductal carcinoma of the prostate on prostate biopsies is often associated with high-grade cancer (with a mean Gleason score of 8) ."
So while it may seem counter-intuitive, assign behavior code /2 when the diagnosis is intraductal carcinoma of the prostate.
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