Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20170039 | Histology--Heme & Lymphoid Neoplasms: How should histology be coded for final bone marrow diagnosis of myelodysplastic syndrome with excess blasts? See Discussion. |
This terminology is not specifically included in either alternate names list for myelodysplastic syndrome, NOS (9989/3) or refractory anemia with excess blasts (9983/3). Example: Bone Marrow Biopsy, Final Diagnosis: Consistent with involvement by myelodysplastic syndrome with excess blasts-2 (MDS EB-2). |
Assign code 9983/3 refractory anemia with excess blasts. Refractory anemia is a type of myelodyplastic syndrome. We will add this to the Heme & Lymphoid database during the next update. |
2017 |
|
20200088 | Histology--Heme & Lymphoid Neoplasms: Is there an inconsistency between the histologies listed as deleted in the ICD-O-3.2 Implementation Guidelines and the obsolete histologies in the Hematopoietic and Lymphoid Neoplasms Database (Heme DB)? See Discussion. |
While we recognize the Heme DB has been the correct source for histology coding for heme and lymphoid neoplasms dating back to 2010, the ICD-O-3.2 Implementation Guidelines appear to provide incorrect coding instructions. Histologies 9670/3, 9728/3, 9729/3 and 9836/3 are listed in Table 3 - Deleted ICD-O codes in ICD-O-3.2. While we recognize these histologies have been included in this Table because they have now been deleted, it is unclear whether the Comments regarding their use listed in the 4th column of the Table is correct. For each of these histologies, the comment states the histology listed in the 1st column (ICD-O-3/3.1) should be used prior to 2021. For example, for histology 9670/3, the comment states: Cases diagnosed prior to 1/1/2021 use code 9670/3. Cases diagnosed 1/1/2021 forward use code 9823/3. However, each of these histology codes have been obsolete for cases diagnosed 1/1/2010 and later. If registrars were following the Heme DB and Heme Manual instructions (the appropriate coding source for these neoplasms), these histologies would not have been used in a decade. Should the Comments column in Table 3 be updated? Or should a Note follow the Table indicating registrars should not use these histology codes for cases diagnosed after 1/1/2010, and these histology codes have been deleted for cases diagnosed 1/1/2021? It seems misleading to indicate any of these are valid histology codes for a 2010-2020 diagnosis when the Heme DB confirms these histology codes only apply to cases diagnosed prior to 2010. |
Follow the Heme DB to determine which codes are obsolete as of 2010. These histologies were made obsolete based on the 2010 WHO Hematopoietic book and confirmation with physicians. The official changes from ICD-O-3 were not implemented until ICD-O-3.2 Also, edits will not allow these histologies to be used for cases diagnosed 2010 and later. The ICD-O tables were based on documentation from IARC ICD-O committee and may differ from practices in North America. |
2020 |
|
20140084 | Histology--Heme & Lymphoid Neoplasms: Should the 1995 diagnosis be changed to plasmacytoma? A 1995 case on the central registry database indicates that MRI and bone surveys revealed a pubic ramus lesion that was biopsied. There are no other bone lesions. A bone marrow biopsy was negative. The pathologist's diagnosis at that time was "Plasma Cell Myeloma". In 2013 there was a positive bone marrow biopsy and a diagnosis of Plasma Cell Myeloma. In 2013, a history of "sequential plasmacytomas since 1995" was mentioned. Since the 1995 diagnosis was only a solitary bone lesion with no marrow involvement, it certainly seems to fit a diagnosis of plasmacytoma better than myeloma. |
Do not change the 1995 diagnosis in this case. It is best to code the histology according to information from the time of the diagnosis. Using information obtained many years later is less reliable. |
2014 | |
|
20230059 | Histology--Heme and Lymphoid Neoplasms: How is histology coded for a diagnosis stated as MDS/AML (myelodysplastic syndrome/acute myeloid leukemia) per the international consensus classification (ICC)? See Discussion. |
The final diagnosis on bone marrow biopsy was high grade myeloid stem cell neoplasm, 17% blasts by differential count. The pathologist further states that this could be classified as “MDS with increased blasts (MDS-IB2) per the WHO 5th edition classification, or MDS/AML per the international consensus classification (ICC).” FISH and cytogenetics revealed a loss of 7q, but no other AML-related genetic abnormalities. The physician confirms the patient has MDS/AML. |
Updated Answer July 2024 Code histology as myelodysplastic neoplasm with increased blasts (9983/3) based on the WHO Classification of Hematolymphoid Tumors, 5th edition, Beta version 2. WHO lists MDS with increased blasts-2 (MDS-IB2) as a subtype of 9983/3. Terms coded to 9983/3 include
When differences exist between WHO and ICC, assign the histology based on the WHO Classification. |
2023 |
|
20230033 | Histology--Heme and Lymphoid Neoplasms: What is the histology code for a final diagnosis of features compatible with EBV-positive nodal T-/NK-cell lymphoma? See Discussion. |
This patient has only nodal involvement for this EBV positive NK/T cell lymphoma. There is no extranodal involvement, specifically no nasal involvement. Additionally, the immunophenotyping does not match the immunophenotyping listed for histology 9719. Therefore, histology 9719 (Extranodal NK/T cell lymphoma, nasal type) does not seem applicable to this case. This patient is an adult, so histology 9724 (Systemic EBV-positive T-cell lymphoma of childhood) also does not seem to be a match. The most recent WHO Classification seems to classify these as 9702. Is this the appropriate histology for an EBV-positive nodal NK/T-cell lymphoma in an adult? |
Assign code 9702/3 for EBV+ nodal T- and NK-cell lymphoma. Primary nodal EBV-positive T- or NK-cell lymphoma is a rare lymphoma type introduced in the 2017 WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (4th Ed.) as a variant of peripheral T-cell lymphoma (PTCL). It presents more commonly in elderly and/or immunodeficient patients, lacks nasal involvement, and is more often of T-cell rather than NK-cell lineage. |
2023 |
|
20180101 | Histology--Kidney: What is the histology code for renal cell clear cell of the kidney with subsequent epithelioid angiomyolipoma PEComa of the liver stated to be metastatic? Case originaly diagnosed in 2016. See discussion. |
This patient was diagnosed in 2016 with renal cell clear cell and was coded to that. In 2018, the patient's liver lesion was resected and pathology revealed epithelioid angiomyolipoma perivascular epithelioid cell tumor (PEComa) (8714/3), a new term as of 2018. This was compared to the kidney slides and it was determined to be metastatic PEComa from the kidney. The physician's note states: The patient had a nephrectomy for a kidney tumor in 2016, excision of cutaneous melanomas, and resection of liver mass in 2018. These three cases were sent in consultation. The diagnosis of cutaneous melanoma was confirmed by a dermatopathologist of our department, (a separate report had been already issued). The kidney tumor is poorly differentiated composed of sheets of discohesive cells with markedly pleomorphic cells with frequent giant and bizarre cells. Most of the cells have abundant eosinophilic to clear cytoplasm. The nuclei are enlarged and pleomorphic. Multinucleated cells are numerous. Some cells have markedly enlarged nucleoli. Multifocal tumor necrosis is noted. Extensive lymphovascular invasion is observed. There are foci at the periphery of the tumor consisting of a proliferation of spindle cells with entrapped adipocytes consistent with minor element of unusual angiomyolipoma (see block A18). The liver tumor has histologic features that are similar to the poorly differentiated component of the kidney tumor. |
Revise the histology code for the 2016 diagnosis based on the review of slides performed in 2018. When new information becomes available, the information in the abstract can be updated. PEComa is a synonym for epithelioid angiomyolipoma (8860/1). These tumors can be malignant with local recurrence and or mets. For a pre-2018 diagnosis, code histology to 8860/3 using the ICD-O-3 Rule F, aka: Matrix principle. |
2018 |
|
20200057 | Histology--Lung: Is there a better code for SMARCA4-deficient malignant neoplasms than 8000/3 that could be used especially given its aggressive nature? This term is not included in the Lung Solid Tumor Rules or ICD-O-3.1 and 3.2. See Discussion. |
Per Mayo consulting pathologist, the final diagnosis on this right lung biopsy is: SMARCA4-deficient malignant neoplasm (see Comment). Comment: Sections show a poorly-differentiated malignant neoplasm without any apparent glandular, squamous, or stromal differentiation. The tumor near totally replaces the underlying lung tissue without recognizable underlying alveolar parenchyma. Immunohistochemical stains performed at Mayo Clinic (Oscar keratin, INSM1, NUT, S100, desmin and BRG1 protein encoded by SMARCA4 gene) demonstrate that the malignant cells are positive for Oscar keratin (rare cells only), synaptophysin (weak/patchy) and p63 (focal) while negative for the remaining antibodies tested. Of note, SMARCA4 stain is negative in the tumor cells. Thus, this tumor can be categorized as a SMARCA4-deficient malignant neoplasm, which is known to be an aggressive malignancy, likely represent a SMARCA4-deficient thoracic sarcoma, a recently described entity. SMARCA4-deficient carcinomas in the lung have been reported to be mostly adenocarcinomas or squamous cell carcinomas, which would not fit for this case. Please refer to a paper published by our group (Sauter JL et al. Mod Pathol 2017;30:1422-32. |
Assign code 8020/3. SMARCA4-deficient malignant neoplasms are newly identified. WHO has not proposed an ICD-O code as of yet. Our pathology experts suggest coding to undifferentiated carcinoma until they are better classified. |
2020 |
|
20220030 | Histology--Lung: Is it acceptable to code histology as 8042/3 for a 2020 lung primary when the pathology report states only "oat cell carcinoma?" See Discussion. |
In the old 2007 Multiple Primaries/Histology rules, Lung Equivalent Terms and Definitions section, oat cell carcinoma (8042) was listed as one of the obsolete terms that was no longer recognized for small cell carcinoma. That note is not in the current 2018 Solid Tumor Manual lung chapter, and ICDO-3.2 lists oat cell carcinoma as the preferred term for code 8042/3. Would rule H4, Note 2 apply -- only one histology present, if not listed in Table 3 use ICD-O and all updates, to code oat cell carcinoma as 8042/3? |
While oat cell carcinoma is an outdated term, if that is all the pathology report states, code histology as 8042/3. Yes, Rule H4 applies: the diagnosis was a single histology. H4 instructs you to refer to the solid tumor H table, and if the term is not found there, check ICD-O and ICD-O updates. All possible histologic types that could occur in the lung may not be included in the table. |
2022 |
|
20031187 | Histology--Lymphoma: What code is used to represent the histology "monomorphic post-transplant lymphoproliferative disorder [diffuse large B-cell lymphoma]"? See Description. |
A 14 year old with a cadaver kidney transplant in 1994 for membranous glomerulonephritis presented in 6/26/03 with a right cervical LN with biopsy showing "lymph node involved by monomorphic post-transplant lymphoproliferative disorder (diffuse large B-cell lymphoma). Staging was done including a bone marrow which was negative, CSF negative. The oncologist on the case reduced the immunosuppression drugs with the final outcome being no sign of the lymphoma. | For cases diagnosed prior to 1/1/2010:Code 9680/36 [Diffuse large B-cell lymphoma]. This post-transplant lymphoproliferative disorder was diffuse large B-cell lymphoma. According to the World Health Organization, there are two types of post-transplant lymphoproliferative disorder. "Regular" post transplant lymphoproliferative disorder is not a neoplasm and is therefore not reportable to a cancer registry. The second type (sometimes called Hodgkin-like PTLD) is classified as a B-cell lymphoma, which means that it IS reportable.
For cases diagnosed 2010 forward, 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. |
2003 |
|
20180015 | Histology--Ovary: What is the correct ICD-O-3 histology code for sertoliform endometrioid carcinoma of the ovary? |
Assign 8380/3. Sertoliform endometrioid carcinoma is a variant of endometrioid carcinoma according to the WHO Classification of Tumors of Female Reproductive Organs, 4th edition. There is no specific ICD-O-3 code for this variant. |
2018 |