Report | Question ID | Question | Discussion | Answer | Year |
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20100029 | MP/H Rules/Histology--Corpus uteri: How should histology be coded and how many primaries should be accessioned for an endometrial primary in which curettings showed malignant mixed mullerian tumor (carcinosarcoma) but hysterectomy specimen showed endometrioid adencarcinoma? See Discussion. | The pathology report COMMENT for the hysterectomy specimen stated that the previous curettage was reviewed. The findings are compatible with malignant mixed mullerian tumor. No residual features of malignant mixed mullerian tumor are found in the current resection, which shows FIGO grade I adenocarcinoma in the wall of the uterus. The malignant mixed Mullerian tumor appears to have been removed with the curettage. There is no information available regarding the number of tumors in these specimens. | For cases diagnosed 2007 or later, abstract a single primary. Rule M1 applies because there is no information on the number of tumors and there is no way to know whether the curettage sample was from a separate tumor or from the tumor in the hysterectomy specimen.
Apply rule H17 and code histology to 8980/3 for malignant mixed Mullerian tumor [Carcinosarcoma, NOS]. |
2010 |
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20110070 | MP/H Rules/Histology--Endometrium: How is histology coded when clear cell adenocarcinoma [8310/3] is stated to involve a "1.5 cm endometrial polyp"? See Discussion. | The CAP formatted pathology report histology field states, "Clear cell adenocarcinoma, NOS 98310/3)" and the tumor size comment field states, "Carcinoma involves a 1.5 cm endometrial polyp." Does rule H11 apply? Is the histology coded to clear cell adenocarcinoma [8310/3] because this is one histologic type identified in the CAP formatted histology field? Or should rule H12 apply and the histology coded as clear cell adenocarcinoma arising in a polyp [8210/3]? Or should we code the higher histology per rule H17 apply because clear cell adenocarcinoma and adenocarcinoma in a polyp are two specific histologies?
For colon primaries, whether or not the tumor arose in a polyp is quite important. Is this also the case for primaries listed in the Other Sites category? |
Code histology to 8310/3 [clear cell adenocarcinoma]. The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology for cases diagnosed 2007 or later.
The following steps are used to determine the histology code:
Open the Multiple Primary and Histology Coding Rules manual. For an endometrial primary, use the Other Sites Histo rules to determine the histology code because endometrium does not have site specific rules.
Go to the SINGLE TUMOR: INVASIVE ONLY module, which starts at Rule H8.
. Code clear cell adenocarcinoma [8310/3] because only one histologic type is identified. |
2011 |
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20091104 | MP/H Rules/Histology--Esophagus: How is histology coded for a biopsy of the esophagus with a pathologic diagnosis of "adenocarcinoma, intestinal type" when there is no evidence of a gastric tumor in scans or EDG? See Discussion. | There is a rule for colon to disregard "intestinal type" and code to adenocarcinoma (8140) but no rule for esophagus. How should histology for this esophageal case be coded? | For cases diagnosed 2007 or later: Follow MP/H Other Sites Rule H11 and code 8144/3 [Adenocarcinoma, intestinal type]. Adenocarcinoma, intestinal type, is called that because it resembles the normal pattern of adenocarcinoma seen in the large intestines. It is not an indication of the location of the adenocarcinoma. We find that it is not uncommon in the sinuses, stomach, lungs, cervix, and many other organs. |
2009 |
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20110121 | MP/H Rules/Histology--Esophagus: Will the AJCC TNM 7 having separate stage groupings for squamous cell carcinoma and adenocarcinoma result in coding histology for a tumor of mixed squamous cell carcinoma and adenocarcinoma to squamous cell carcinoma because it has the poorer prognosis? See Discussion. | Per the CS Esophageal Schema, Note 4, there are now separate stage groupings for squamous cell carcinoma and adenocarcinoma. Should a tumor of mixed histopathologic type be classified as a squamous cell carcinoma?
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Do NOT use the Collaborative Stage Manual to determine the histology code. For CS STAGING purposes only, coding should be based on the squamous cell carcinoma component of this tumor.
The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology. For cases diagnosed 2007 or later, the following steps are used to determine the histology code:
Open the Multiple Primary and Histology Coding Rules manual. For an esophagus primary, use the Other Sites Histo rules to determine the histology code because esophagus does not have site specific rules.
Start at Rule H8 because this is an invasive histology (assuming this is a single tumor). which states that one should code the appropriate combination/mixed code from Table 2 when there are multiple specific histologies.
Find Other Sites for Table 2 under the Terms & Definitions section of manual.
Locate the appropriate mixed code for squamous cell carcinoma and adenocarcinoma in column 1. Per column 3, the correct histology is adenosquamous carcinoma. Per column 4, the correct histology is 8560/3. |
2011 |
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20091015 | MP/H Rules/Histology--Gallbladder: What histology is coded for a tumor described as "90% high grade neuroendocrine ca, large cell type; and 10% low grade adenocarcinoma, conventional type"? | For cases diagnosed 2007 or later: MP/H Rule H17 for Other Sites applies. Code the histology 8140 [adenocarcinoma]. The ICD-O-3 code for large cell neuroendocrine carcinoma is 8013 and the code for adenocarcinoma is 8140. |
2009 | |
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20091012 | MP/H Rules/Histology--Head & Neck: If the final diagnosis states "see microscopic description," can the micro information be used to code the histology? See Discussion. | In regards to coding histology for 2007 and forward cases, we are instructed to use the final diagnosis, and any addenda or comments associated with the final diagnosis. We are not to use the microscopic description. However, we are seeing pathology reports with a final diagnosis that also includes the notation "see microscopic description" or "see description". Example: "Left Parotid: High grade carcinoma involving deep lobe with marginal extension. See description." The microscopic description goes on to describe the carcinoma in more detail, which includes a statement "consistent with the ductal type of primary parotid carcinoma." Can we use this microscopic description or not? | For cases diagnosed 2007 or later: When the final diagnosis indicates that the microscopic section contains the detailed diagnosis, use the microscopic description to code the histology. Otherwise, code from the final diagnosis only and not from the microscopic description. The final diagnosis is usually the pathologist's conclusion after consideration of the various choices listed in the microscopic description. The histology code should represent the pathologist's final conclusion. |
2009 |
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20091019 | MP/H Rules/Histology--Hematopoietic, NOS: Can a diagnosis of multiple myeloma be made if a bone marrow biopsy is negative? See Discussion. | Patient with large mass nasal cavity. Biopsy shows plasmacytoma. Fine needle aspiration of the acetabulum is consistent with multiple myeloma. Skeletal survey shows multiple lytic lesions. Bone marrow biopsy is negative for myeloma. In light of negative bone marrow biopsy can this case be coded as multiple myeloma? | For cases diagnosed prior to 1/1/2010:Code this case as multiple myeloma. The fine needle aspiration of the acetabulum is a biopsy of bone marrow. According to our pathologist consultant, the positive bone marrow biopsy (acetabulum) and the multiple lytic bone lesions confirm multiple myeloma. The negative bone marrow biopsy is likely due to an insufficient sample. For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ. |
2009 |
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20130204 | MP/H Rules/Histology--Kidney, renal pelvis: How is histology coded for a tubulocystic renal cell carcinoma? See Discussion. | Per the resected specimen final diagnosis COMMENT in the pathology report: Tubulocystic renal cell carcinoma is a relatively new renal epithelial neoplasm that has been added to an updated WHO classification of renal tumors. (Srigley et al. The International Society of Urologic Pathology Vancouver Classification of Renal Neoplasia Am J Surg Pathol. 2013;37:1469-1489). The majority of tubulocystic renal cell carcinomas reported in the literature (greater than 90%) have behaved in an indolent manner. | Code the histology to 8312/3 [renal cell carcinoma, NOS] per Rule H3. The term "tubulocystic" is not a specific renal cell histology according to our kidney pathology expert. | 2013 |
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20100107 | MP/H Rules/Histology--Kidney, renal pelvis: How is histology coded for a tumor described as "renal cell carcinoma, clear cell with rhabdoid features"? See Discussion. | Is the statement "with __ features" indicative of a specific type of renal cell carcinoma (that is not represented by a specific histology code) or a second histologic type? Per ICD-O, "malignant rhabdoid tumor" is coded 8963/3. "Rhabdoid" is not listed in Table 1 in the MP/H rules as a specific type of renal cell carcinoma. |
Rhabdoid features occur in about 5% of all renal cell cancers and indicate a more aggressive tumor. Per WHO, these tumors comprise approximately 2% of all pediatric tumors with a median diagnosis age of 1-2 years old. This diagnosis is highly suspect in patients over age 3. Most previously reported rhabdoid tumors over age 5 have subsequently proven to be renal medullary carcinomas.
For cases diagnosed 2007 or later, if the patient in this case is a child, apply Kidney Rule H7 and code histology to 8963/3 [malignant rhaboid tumor]. Otherwise, we strongly suggest you consult with the pathologist to determine if this is truly a rhabdoid rather than a medullary tumor. |
2010 |
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20091009 | MP/H Rules/Histology--Kidney: How do you code histology for a renal cell carcinoma when pathologists disagree as to whether or not the tumor is consistent with thyroid-like follicular carcinoma of the kidney? See Discussion. | Final diagnosis states 'left radical nephrectomy, renal cell carcinoma.' The CAP Histologic Type is listed as: Unclassified, most consistent with primary thyroid-like follicular carcinoma of the kidney.' Because of the unusual histology it was sent for a consult to a genitourinary pathology specialist. His response was: 'histologic features not typical for any of the known subtypes of renal cell carcinoma and are not consistent with primary thyroid-like follicular carcinoma of the kidney, a distinct renal tumor that we have recently published in the literature.' The tumor was TTF-1 negative, arguing against metastasis from a thyroid primary. | For cases diagnosed 2007 or later, assign code 8312 [renal cell carcinoma, NOS]. The diagnosis is renal cell carcinoma, but the specific type is in question. | 2009 |