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Report Produced: 09/06/2024 13:17 PM

Report Question ID Question Discussion Answer Year
20110140 MP/H Rules/Behavior--Breast: How are behavior and histology coded when the pathology report final diagnosis is "ductal carcinoma in situ and lobular carcinoma in situ" if the microscopic examination section of the same pathology report states there are "foci suspicious for microinvasive carcinoma"? See Discussion. The pathology report microscopic examination states, "focally, between ducts involved by DCIS, there are minute tubular structures associated with stromal fibrosis and chronic inflammation. These foci are suspicious for microinvasive carcinoma."

For cases diagnosed 2007 or later, code one primary with histology and behavior coded to 8522/2 [intraductal carcinoma and lobular carcinoma in situ].

The steps used to arrive at this decision are as follows

Open the Multiple Primary and Histology Coding Rules manual. Choose one of the three formats (i.e., flowchart, matrix or text) under the Breast Histology rules. The module you use depends on the behavior and number of tumors identified in the primary site. The information provided does not specify whether this was a single tumor with DCIS and LCIS or multiple tumors with DCIS and LCIS. In this case, the number of tumors does not change the histology code for this patient. For this example, assume this disease process was a single tumor.

Start at the SINGLE TUMOR: In Situ Carcinoma Only module. The rules are intended to be reviewed in consecutive order from Rule H1 to Rule H8. Stop at the first rule that applies to the case you are processing. Code the histology as 8522/2 (intraductal carcinoma and lobular carcinoma in situ) when there is a combination of in situ lobular (LCIS) [8520] and intraductal carcinoma (DCIS).

Do not code the behavior as invasive in this case. The pathologist indicated that these findings were "suspicious" but not definite in the microscopic examination. If the pathologist decided that this was truly an invasive tubular element, it would have been included in the final diagnosis.

2011
20081044 MP/H Rules/Behavior--Melanoma of Skin: How are histology and behavior coded for a "malignant melanoma in situ with regression"? See Discussion. Per the microscopic portion of the path report, there is a zone of regression within the confines of the lesion, such that the possibility of antecedent invasive disease at the site cannot be ruled out with certainty.

For cases diagnosed 2007 or later:

Code malignant melanoma in situ with regression to 8720/2 [Melanoma in situ].

Code the histology according to the histologic type specified in the pathology report final diagnosis. Code the behavior as specified in the pathology report. Regression does not affect the coding of histology or behavior. See Melanoma Histology Coding rule H5. See 2007 SEER manual instructions for coding behavior, page 84.

 2008
20081062 MP/H Rules/Date of Diagnosis/Behavior--Brain and CNS: How many primaries would be reported when a December 2004 MRI shows a pineal region mass with the major differential consideration being pineocytoma; a November 2007 MRI that shows the mass has almost tripled in size; and the December 2007 resection final diagnosis is consistent with pineoblastoma? How would diagnosis date[s] and behavior code[s] be coded? See Discussion.

Dec. 2004 MRI of brain: Pineal region mass. The major differential consideration given patient's gender, age group, and imaging characteristics is pineocytoma. The differential includes pineoblastoma or germ cell line tumor. These are felt less likely.

Nov. 2005 MRI brain: stable exam since last MRI. No change in size.

Nov. 2007 MRI studies: pineal mass has almost tripled in size.

Dec. 2007 Surgical resection of pineal tumor: High grade (WHO Grade IV) pineal parenchymal neoplasm consistent with pineoblastoma.

For cases diagnosed 2007 or later:

Abstract as separate primaries:

  • 12/2004 pineocytoma (9361/1)

  • 12/2007 pineoblastoma (9362/3)

    • Complete two abstracts when a previously diagnosed non-malignant tumor transforms or progresses to a malignancy. Refer to the CDC/NPCR guidelines for Data Collection of Primary Central Nervous System Tumors, 2004. Malignant transformation is discussed on page 50.

    		2008
    		20081025 MP/H Rules/Histology--Anus: What is the correct histology code and MP/H histology rule to use for AIN-3 arising in a polyp? See Discussion.

    Patient has colonoscopy with excision of small 5mm polyp in rectum (no mention of anus or anal canal); path reads out: AIN-3 (anal intraepithelial neoplasm grade 3).

    In coding the histology using the "Other Sites" rules, H2 would be the first rule that applies for this case. However, we lose the fact that the AIN-3 arose in a polyp (H3). Is this how SEER wants these cases coded?

    		 For cases diagnosed 2007 or later, apply rule H2 and assign histology code 8077/2 (squamous intraepithelial neoplasia, grade III). Apply the rules in order, H2 precedes H3. 2008
    		20130222 MP/H Rules/Histology--Bladder: How is the histology coded for a single bladder tumor showing invasive urothelial carcinoma with extensive divergent differentiation including small cell carcinoma, micropapillary carcinoma, and squamous cell carcinoma features? See Discussion. MP/H rules seem to lead to Rule H8 which indicates that one use the numerically higher ICD-O-3 code. If one applies Rule H8, the histology is coded to 8131/3 [micropapillary urothelial carcinoma]. That would ignore the small cell carcinoma, which seems prognostically more significant. Code the histology to 8045/3 [mixed small cell carcinoma], a combination of small cell with other types of carcinoma. There is currently no rule in the urinary site MP/H Rules for this combination of histologies. This will be included in the next revision of the MP/H Rules. 2013
    		20110091 MP/H Rules/Histology--Bladder: How is this field coded for a patient with ureter specimen with "high grade urothelial carcinoma with adenocarcinoma differentiation" and a TURB specimen with "urothelial ca, high grade, a biphasic pattern with cautery-distorted urothelial carcinoma and adenocarcinoma"?

    According to the MP/H rules, code histology to 8120/3 [urothelial carcinoma] for cases diagnosed 2007 or later. The term "glandular differentiation" is equivalent to adenocarcinoma differentiation. 8120/3 [urothelial carcinoma] would be the best way to code a "biphasic pattern with cautery-distorted urothelial carcinoma and adenocarcinoma" according to a pathologist consultant.

    The steps used to arrive at this decision are as follows:

    Go to the Urinary Histo rules found in the Multiple Primary and Histology Coding Rules Manual.

    Start at the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY module, rule H9. Code the histology to 8120 [transitional cell/urothelial carcinoma] when there is transitional cell carcinoma with glandular differentiation.

    		2011
    		20140016 MP/H Rules/Histology--Bladder: What is the correct histology code for this situation? See discussion. Patient has 2 bladder tumors, both invasive -- one is transitional cell carcinoma (8120/3) and the other is papillary TCC (8130/3). They have the same extent of disease, both involve the lamina propria. Is this 8120, because of the Note under rule H11 or is this 8130 because under rule H12, it says 'papillary carcinoma and transitional cell carcinoma'? If so, what is the meaning of the note under rule H11?

    Rule H12 applies, code to 8130.

    The note under H11 is intended to explain the order of the rules; that is, why the rule to code papillary transitional/urothelial cell carcinoma (H12) follows the rule to code transitional/urothelial cell carcinoma (H11).

    		 2014
    		20110078 MP/H Rules/Histology--Bladder: What is the histology code for "high-grade urothelial carcinoma, plasmacytoid variant"? See Discussion. Per the MP/H Manual, Urinary Equivalent Terms & Definitions, Table 1, plasmacytoid is a specific type of Urothelial/Transitional Cell Tumor. What is the correct histology, and rule used, when a bladder resection pathology report states, "high-grade urothelial carcinoma, plasmacytoid variant"?

    Code the histology to 8082/3 [urothelial carcinoma, plasmacytoid].

    The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology for cases diagnosed 2007 or later. Unfortunately, in this case there is no current rule that directs you appropriately to Table 1 from Rule H7 to find this histology combination. We need to add an example under Rule H7 that instructs you to "See Table 1" for an urothelial carcinoma diagnosis that mentions a more specific cell type (e.g., plasmacytoid). We will add a reference to Table 1 in Rule H7 in the updates to MP/H Rules.

    		2011
    		20130177 MP/H Rules/Histology--Bladder: What rule and histology code apply when a TURB final diagnosis is small cell neuroendocrine carcinoma and high grade urothelial carcinoma? See Discussion.

    The patient has a 6 cm tumor arising in posterior-lateral bladder extending to prostate, obliterates seminal vesicle, and invades pelvic wall.

    TURB final diagnosis: Small cell neuroendocrine carcinoma. High grade urothelial carcinoma involves 10% of tumor.

    Following the current MP/H single tumor rules, it appears Rule H8 applies. Per Rule H8, code the numerically higher code of 8120. By following this rule, it does not seem the histology code fairly represents this tumor.

    There is currently no rule in the urinary site MP/H Rules for this combination of histologies. The best option is to code the histology to 8045/3 [mixed small cell carcinoma], a combination of small cell with other types of carcinoma. The presence of small cell carcinoma drives the treatment decisions for this case.

    This issue will be addressed in the next revision of the MP/H Rules.

    		2013
    		20100108 MP/H Rules/Histology--Brain and CNS: How is histology coded for a left occipital parietal area tumor stated to be a "low grade neuroectodermal neoplasm most consistent with neuronal tumor but lacking classic features of ganglioma" if the pathologist states the tumor is not malignant? Code 9505/0 [Ganglioglioma, benign] is the best option according to our pathology expert. He states, "There recently has been a spate of tumors called low grade glio-neuronal tumors that are not PNETs and have no propensity to become malignant." 2010