MP/H Rules/Histology--Breast: How is histology coded when a nipple biopsy shows Paget disease but the mastectomy specimen shows only infiltrating ductal carcinoma in the breast tissue and the nipple is negative for Paget disease? See Discussion.
Biopsy of nipple showed Paget disease. Subsequent mastectomy showed two tumors proven to be infiltrating ductal carcinoma. Nipple is negative. Per MP/H rule M9, this is all counted as a single primary. Do we code histology from the most representative specimen and lose the information about the Paget disease?
For cases diagnosed 2007 or later, code the histology 8541/3 [Paget disease and infiltrating duct carcinoma]. Paget disease of the nipple and infiltrating duct are separate tumors. For each tumor, take the histology from the most representative specimen. The biopsy is the most representative specimen for the Paget disease. The mastectomy is the most representative specimen for the infiltrating duct. According to the multiple primary rules, tumors that are Paget disease and duct are a single primary (M9). According to the histology rules, assign code 8541/3 (H26).
MP/H Rules/Histology--Breast: How is histology coded, and which MP/H rule applies for a diagnosis of ductal carcinoma in situ with clear cell features? See Discussion.
None of the histology rules for in situ breast seem to apply to this case:
Rule H3 doesn't seem to apply because "clear cell" is not a specific intraductal carcinoma.
Rule H6 doesn't seem to apply because there is not a combination of intraductal and 2 or more specific types of intraductal.
Rule H8 wouldn't apply because one of the types is intraductal.
For cases diagnosed 2007 or later:
Code 8523/2 [intraductal carcinoma mixed with other types of in situ carcinoma]. Rule H6 should apply to this case.
The wording in the Rule H6 needs to be clarified to handle a case of intraductal carcinoma with one or more subtypes that are not ductal. This will also require a modification to Table 3. A row needs to be added to the table labeled, "Intraductal and one or more of the histologies in Column 2." The Column 3 text for the newly added row would read, " Intraductal mixed with other types of carcinoma." The appropriate histology code to be reported per Column 4 would be 8523/2. This will be done in the next revision of the rules.
MP/H Rules/Histology--Breast: How is histology to be coded for a breast primary described as "tubular carcinoma (well differentiated invasive ductal carcinoma)"? See Discussion.
How are terms that are modified by parentheses to be interpreted? Do terms in parentheses modify the stated diagnosis and thus have priority over the stated diagnosis? Or would rule H17 apply and histology would be coded as duct and other carcinoma? For this case, the wording of the diagnosis and use of parentheses seem to indicate that tubular is a type of ductal carcinoma. Tubular is not listed as a specific duct carcinoma in the MP/H rules histology tables for breast.
For cases diagnosed 2007 or later, code the histology as tubular carcinoma [8211/3]. This is not a case of tubular AND infiltrating duct. The histology is stated to be tubular. Tubular is not a specific type of duct carcinoma.
MP/H Rules/Histology--Breast: How is the histology coded when a pre-treatment core biopsy showed ductal carcinoma, but the mastectomy specimen following neoadjuvant chemotherapy showed lobular carcinoma? See Discussion.
11/06/2012 Ultrasound-guided biopsy of the left breast and left axilla showed invasive ductal carcinoma. The patient underwent 6 months of chemotherapy. In 05/2013 the patient underwent a mastectomy that showed invasive lobular cancer, pleomorphic type, with 11 axillary lymph nodes negative.
The histology is coded to lobular carcinoma, NOS [8520/3] because the mastectomy (the most representative specimen) showed only lobular carcinoma.
The MP/H Rules state to code the histology from the most representative tumor specimen examined. Although this patient underwent neoadjuvant treatment, there is no indication that the ultrasound-guided biopsy contained more tumor than the mastectomy. The mastectomy is the most representative specimen and should be used to code the histology.
MP/H rules/Histology--Breast: How many primaries and what histologies are coded for a left breast when a bi-lumpectomy path reveals one tumor with a microscopic focus of mucinous adenocarcinoma and extensive DCIS and a second .9 cm mucinous adenocarcinoma with extensive DCIS, and the subsequent mastectomy reveals foci of residual DCIS and Paget's disease of the nipple?
For cases diagnosed 2007 or later:
There are two primaries. Primary 1: The two tumors described on the pathology report from the lumpectomy are a single primary using rule M13. Primary 2: Disregard the foci of residual DCIS. Paget disease of the nipple is a separate primary using rule M12.
Primary 1: invasive mucinous adenocarcinoma and extensive ductal carcinoma in situ: Code the histology as 8480/3 [mucinous adenocarcinoma] using rule H27.
Primary 2: Paget disease of nipple: Code the histology as 8540/3 [Paget disease] using rule H14.
MP/H Rules/Histology--Breast: If the abstractor only has the CAP protocol information from a pathology report and it does not include a "final diagnosis" label, which fields of the protocol are used to determine the histology and whether there is carcinoma in situ present in the specimen?
For cases diagnosed 2007 or later, if the CAP protocol is used in lieu of a final diagnosis, use all of the information in the CAP protocol.
MP/H Rules/Histology--Breast: Patient has single invasive left breast tumor diagnosed in 2008. Final pathology diagnosis is "Invasive solid papillary carcinoma". No mention of ductal in report. What is histology?
For cases diagnosed 2007 or later:
As of July 2010:
Code the histology 8503 [Infiltrating papillary adenocarcinoma].
This is solid papillary, not solid AND papillary carcinoma. Solid is an adjective modifying papillary, in other words, a subtype of papillary. We do not have a code for solid papillary, so we code to the NOS, papillary using rule H14.
MP/H Rules/Histology--Breast: What code is used to represent the histology "ductal carcinoma in situ and invasive lobular carcinoma"? See discussion.
Is the histology coded to the combination code of 8522/3 (ductal and lobular) or to the invasive component 8520/3 (lobular)?
For cases diagnosed 2007 or later:
Assuming ductal carcinoma in situ and invasive lobular carcinoma are present in a single tumor, code 8520/3 [Infiltrating lobular carcinoma, NOS].
Using the 2007 MP/H rules for breast, the single tumor invasive and in situ carcinoma module, start and stop at rule H9 and code the invasive histology.
MP/H Rules/Histology--Breast: What histology code for a diagnosis of pleomorphic lobular carcinoma in situ?
For cases diagnosed 2007 or later, code the histology as lobular carcinoma, in situ [8520/2].
The steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Breast Histo rules because site specific rules exist for this primary.
Start at the SINGLE TUMOR: IN SITU CARCINOMA ONLY module, Rule H1. The rules are intended to be reviewed in consecutive order. Stop at the first rule that applies to the case you are processing. Code the histology to lobular carcinoma in situ [8520/2] because this is the only histologic type identified.
Pleomorphic lobular carcinoma is a variant of lobular carcinoma which does not have an ICD-O-3 code. It is still a lobular carcinoma. The identification of the variants of lobular carcinoma was a relatively recent discovery and the information was not available when the 2007 MP/H Rules were written. All of the lobular variants will be included in the next revision of the MP/H Rules.
MP/H Rules/Histology--Breast: What histology code is used for a single tumor, micropapillary carcinoma with components of mixed ductal and lobular carcinoma?
For cases diagnosed 2007 or later, use rule H16 and assign code 8522 [Duct and lobular carcinoma].
Micropapillary is specific duct type (see Table 1).
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