Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20130192 | MP/H Rules/Histology--Pleura: How is histology coded when the pathology report final diagnosis is "malignant neoplasm, compatible with malignant mesothelioma" if the COMMENT section of the pathology report indicates the tumor has a mixed epithelial and sarcomatoid pattern? See Discussion. | This case was discussed with a pathologist who feels the correct histology should be biphasic mesothelioma (9053/3) because there are both epithelial and sarcomatoid components to this tumor. However, applying the current MP/H Rules, the histology is coded to 9050/3 (mesothelioma, NOS) because the term "pattern" cannot be used to code a more specific histologic type for invasive tumors. If this truly is a biphasic mesothelioma, that data is lost for researchers because the current MP/H Rules fail to capture this information. Should the term pattern be used to code the more specific histology in this case? | Code the histology to malignant mesothelioma, NOS [9050/3]. Apply the MP/H Rules as written until they are revised. The word "pattern" and other terms will be reconsidered for the next iteration of the rules. | 2013 |
|
20071084 | MP/H Rules/Histology--Prostate: How is an "acinar adenocarcinoma with focal large duct adenocarcinoma" coded? | For cases diagnosed 2007 or later: As long as this is NOT urothelial carcinoma extending to the prostatic ducts, code histology to 8140/3 [adenocarcinoma] using rule H10. Do not code histologies designated as "focal." |
2007 | |
|
20071003 | MP/H Rules/Histology--Prostate: If a patient is stated to have prostate "cancer" but a pathology report is not available nor is a specific histology stated in the medical record, can this histology be coded to 8140 [adenocarcinoma] instead of 8000/3 [cancer] because the vast majority of prostate cancers are adenocarcinomas? | For cases diagnosed 2007 and later, the correct histology code is 8000/3 [cancer]. 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 Other Sites Histology rules because no specific rules have been developed for prostate primaries.
To determine the histology, start at the SINGLE TUMOR: INVASIVE ONLY module, rule H8. The rules are intended to be reviewed in consecutive order within a module. Code the histology documented by the physician when there is no pathology/cytology specimen or the pathology/cytology report is not available. Code the histology as 8000/3 [cancer] because that is the only available information. In the absence of a pathology report or any other histologic confirmation, code the histology based on the information available. |
2007 | |
|
20081051 | MP/H Rules/Histology--Prostate: Path said adenocarcinoma of the prostate with an endometroid adenocarcinoma component. What histology code is used? | For cases diagnosed 2007 or later: Assign code 8500 [duct carcinoma]. According to The World Health Organization (WHO), the term endometrioid carcinoma of the prostate is now called Prostate Duct Carcinoma. Using Rule H11 (one type), code 8500 (duct carcinoma) for this rare type of tumor. Do not stop at Rule H10 because this is not acinar. |
2008 | |
|
20010026 | MP/H Rules/Histology--Prostate: What code is used to represent the histology "adenocarcinoma, microacinar type"? | For cases diagnosed 2007 or later:
Assign code 8140 [adenocarcinoma, NOS]. See the MP/H rules for Other Sites, histology coding rule H10. |
2001 | |
|
20071010 | MP/H Rules/Histology--Prostate: While cases of "acinar adenocarcinoma" of the prostate are required to be abstracted with the histology code 8140/3 [adenocarcinoma, NOS] for cases diagnosed 1/1/07 or later, can 8550/3 [acinar adenocarcinoma] be used for cases diagnosed prior to 1/1/07? See Discussion. | The SEER Multiple Primary and Histology manual, effective with 2007 forward diagnosis dates, indicates that this histology should be coded to 8140/3 [adenocarcinoma, NOS]. Does this contradict ICD-O-3? Can acinar adenocarcinoma be coded for other primary sites? | For cases diagnosed 2007 or later, code acinar adenocarcinoma of the prostate as 8140/3. Prior to diagnosis year 2007, code 8550/3 [acinar adenocarcinoma] may be used for prostate cases and for acinar adenocarcinoma of other sites, such as pancreas. |
2007 |
|
20130010 | MP/H Rules/Histology--Skin: How is the histology coded for "infiltrative carcinoma with ductal alterations compatible with squamoid eccrine ductal carcinoma" of the skin? | Code the histology to 8413/3 [eccrine adenocarcinoma]. This is the most specific code available for this diagnosis.
According to our expert pathologist advisor, "The adnexal glands in the skin, sweat (eccrine) glands and apocrine glands, all have ducts which connect the business portion of each gland to the skin surface. Some of the adnexal tumors have features of differentiation which appear to be duct-like, hence the designation 'ductal.'"
In addition, "The 'squamoid' simply indicates some degree of squamous differentiation, but doesn't alter the usefulness of [code 8413/3] because we have no way of coding anything more specific in this case anyway." |
2013 | |
|
20110137 | MP/H Rules/Histology--Skin: How is the histology coded for a "malignant baso-melanocytic tumor" arising in the skin of right shoulder? | Code the histology as melanoma, NOS [8720/3].
This is a malignant skin tumor with both melanoma and basal cell carcinoma histologies. There is no ICD-O-3 code for this entity. Per our subject matter expert, code the histology to 8720/3 [melanoma, NOS] and document the diagnosis of malignant baso-melanocytic tumor in a text field because melanoma is reportable to SEER and basal cell carcinoma is not.
|
2011 | |
|
20110042 | MP/H Rules/Histology--Testis: How is histology coded when the initial biopsies of retroperitoneal mass demonstrated non-seminomatous germ cell tumor, but after neoadjuvant chemotherapy the final diagnosis on the radical orchiectomy specimen demonstrated mature teratoma, NOS (not stated to be malignant)? See Discussion. | A large retroperitoneal mass was found on CT scan. A biopsy demonstrated non-seminomatous germ cell tumor. The biopsy was done at an outside facility. Neither the CT scan nor biopsy pathology report is available for review. Following neoadjuvant chemotherapy, the retroperitoneal mass decreased to 12 cm. Subsequently, the patient had a right radical orchiectomy. The final diagnosis per the pathology reports was a 3.5 cm mature teratoma (NOS, not stated to be "malignant") of right testicle. The patient then had resection of the retroperitoneal mass and biopsies. Pathology showed the "excision" specimen contained 6 benign lymph nodes and two of the "biopsy" specimens showed non-seminomatous germ cell neoplasm with IHC findings suggestive of a mix of embryonal carcinoma and a lesser component of yolk sac tumor. | This is a reportable case. Even though the pathology from the orchiectomy stated mature teratoma, NOS, the presence of lymph node metastases proves that this tumor is malignant. Code the histology as 9065/3 [germ cell tumor non-seminomatous].
The majority of germ cell tumors show the presence of multiple histologies. While the original tumor showed only mature teratoma, there were obviously yolk sac cells that were not detected on the sections taken from the primary tumor. Both teratoma and yolk sac are germ cell tumors. This explains why the pathologist gave you the diagnosis of germ cell tumor. The classification of "non-seminomatous" simply means that there was no seminomas present in the mixture of germ cell histologies. |
2011 |
|
20130149 | MP/H Rules/Histology--Testis: What is the histology code for a testis primary with embryonal carcinoma (70%), yolk sac tumor (30%), and a focus of seminoma (<1%)? See Discussion. | The right orchiectomy specimen showed a mixed histology tumor. The retroperitoneal lymph nodes showed teratoma, NOS only. Does the presence of teratoma in the lymph nodes change the histology coding?
The MP/H Rules for Other Sites, Table 2 (Mixed and Combination Codes) does not include the combination of embryonal carcinoma, yolk sac tumor and seminoma. SINQ 20110013 does state the combination of embryonal carcinoma and yolk sac tumor should be coded to histology 9065/3 [germ cell tumor, nonseminomatous]. In this case, is the focus of seminoma comprising <1% included when coding the histology? If the seminoma is included, Table 2 still does not address this combination. |
Code the histology to mixed germ cell tumor [9085/3] per Rule H16; code the appropriate combination/mixed code when there are multiple specific histologies.
According to the WHO Classification of Tumors of the Male Genital Organs, tumors of more than one histologic type (mixed forms) can occur in any combination of various germ cell histologies including embryonal, yolk sac, teratoma, and choriocarcinoma. Mixed teratoma and seminoma is included under histology code 9085/3 [mixed germ cell tumor] in the ICD-O-3. The revised MP/H rules will expand on these mixed testicular histologies.
Priority for coding histology is using the diagnosis from the primary site (when possible) over the histology from a metastatic site. The presence of teratoma, NOS in the retroperitoneal lymph nodes does not change the histology code. |
2013 |