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20170065 | MP/H Rules/Histology--Thyroid: How should histology be coded for a single tumor with final diagnosis undifferentiated (anaplastic) carcinoma arising in association with papillary thyroid carcinoma and the Summary Cancer Data states Histologic type: Undifferentiated (anaplastic) carcinoma only? See Discussion. |
The Summary Cancer Data does not seem to describe a more specific histology, but it does describe the tumor histology with the worst outcome and the most extensive tumor. The anaplastic carcinoma grossly extended into skeletal muscle and gave rise to multiple regional lymph node metastases. The more appropriate histology seems to be 8021. However, current MP/H Rules for a single tumor indicate the histology should be coded to the numerically higher histology code (8260). Coding the histology to 8260 does not account for the more aggressive tumor. Should this histology be 8260 or 8021? |
Code the most specific histologic term, 8260, for papillary carcinoma of the thyroid using Multiple Primary/Histology Rule H13 for Other Sites (single tumor, invasive section). Use text fields to describe the complete histology. |
2017 |
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20170041 | MP/H Rules/Histology--Thyroid: How should histology be coded for a thyroidectomy final diagnosis of papillary thyroid carcinoma, favor cribriform-morula variant? See Discussion. |
This specific histology (cribriform-morula variant of papillary thyroid carcinoma) is not found in the ICD-O and is not mentioned in the 2007 MP/H Manual. However, per a web search it appears that this is a distinct type of papillary thyroid carcinoma (http://erc.endocrinology-journals.org/content/24/4/R109.full). Example: Right lobectomy shows thyroid epithelial neoplasm, pending consultation. Consultation: Thyroid gland, right lobe: papillary thyroid carcinoma, favor cribriform-morula variant. Consultation Comment: IHC stains argue against medullary carcinoma. The histologic features of growth patterns and cytologic atypia (with rare grooves and pseudoinclusions) and the immunohistochemical profile support a diagnosis of papillary thyroid carcinoma, favoring the cribriform-morula variant. It is important to note that a significant number of patients with this variant of papillary thyroid carcinoma have been associated with familial adenomatous polyposis syndrome. |
Assign code 8260/3 for papillary carcinoma of thyroid. Cribriform-morula variant is not listed in ICD-O-3 for papillary carcinoma. Multiple Primaries/Histology Rule H14 states to code papillary carcinoma of the thyroid to papillary adenocarcinoma, NOS (8260). |
2017 |
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20170061 | MP/H Rules/Histology--Thyroid: What is the correct histology when final diagnosis of a thyroidectomy includes the descriptor "papillary and follicular architecture?" See Discussion. |
Total thyroidectomy Final Diagnosis: Papillary carcinoma, classical type, with papillary and follicular architecture. The 2007 MP/H rules state that the term architecture is reserved for coding subtype of in situ primaries only. However, SINQ 20130165 appears to indicate this should be coded for invasive thyroid subtypes as well. Can you confirm the addition of the term architecture for determining an invasive histologic subtype for thyroid? |
Assign code 8260/3, papillary carcinoma per Multiple Primaries/Histology Rule H14. Architecture is reserved for coding subtype of in situ primaries only. SINQ 20130165 is not intended to indicate this should be coded for invasive thyroid subtypes. |
2017 |
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20150023 | MP/H Rules/Histology--Thyroid: When is 8341/3, papillary microcarcinoma coded? The code description in ICD-O-3 is followed by (C739), yet there are two SINQ answers that tell us specifically to not use this code for thyroid primaries. Even the first revision of ICD-O-3 still carries the (C739) as part of this code, which goes against SINQ 20110027 and 20081127. |
Per the WHO Tumors of Endocrine Organs, for thyroid primaries/cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult (1cm or less in diameter) and was found incidentally. WHO does not recognize the code 8341 and classifies papillary microcarcinoma of the thyroid as a variant of papillary thyroid and thereby should be coded to 8260. If the primary is thyroid and the pathology states papillary microcarcinoma or micropapillary carcinoma, code 8260 is correct. This information will be included in the upcoming revisions to the MP/H manual. |
2015 | |
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20170007 | MP/H Rules/Histology--Urinary System: How should histology be coded when there are multiple bladder, ureter and renal pelvis urothelial tumors including non-invasive papillary urothelial carcinoma in the left ureter, invasive papillary urothelial carcinoma invading the lamina propria in the bladder, and an invasive sarcomatoid urothelial carcinoma of the renal pelvis that invades the muscularis? See Discussion. |
Per Rule M8, this is a single primary as there are multiple urothelial tumors as outlined in Table 1 (papillary urothelial carcinoma [8130] and sarcomatoid urothelial carcinoma [8122]) simultaneously present in multiple urinary organs (bladder, ureter and renal pelvis). As Rule M8 indicates these are a single primary, despite the histologies differing at the third digit (8130 vs 8122), then Rule H14 (Code the histology of the most invasive tumor) seems to be the most applicable histology rule. Following Rule H14 (in the Text version of the MP/H Rules), the histology would be coded as 8122 (sarcomatoid urothelial carcinoma) since the renal pelvis tumor was the most invasive tumor present. However, in both the Matrix and Flowchart versions of the MP/H Rules, Rule H14 contains a note (missing from the Text version) that states that this rule should only be used when the first three numbers of the histology codes are identical (This is a single primary). Rule M8 clearly tells us these are a single primary, despite the differences at the third digit of the histology. Further defaulting to Rule H15 (Code the numerically higher histology code) in this case would ignore the histology of the tumor with the worse prognosis (the most invasive tumor). Was this note included in the Matrix and Flowchart versions in error? |
Code the histology as 8122 according to the MP/H rules for Renal Pelvis, Ureter, Bladder, and Other Urinary, M8 and H14. Rule M8 states urothelial tumors in two or more of urinary sites including bladder and renal pelvis are a single primary. Rule H14 states code the histology of the most invasive tumors for multiple tumors abstracted as a single primary. |
2017 |
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20140029 | MP/H Rules/Histology-Urinary: 1) What is the correct ICD-O-3 morphology code for conventional renal cell carcinoma? Is this clear cell carcinoma or does conventional refer to the general diagnosis?
2) If a patient was diagnosed with invasive papillary urothelial carcinoma of the bladder in May 2011 and returns in February 2013 with invasive urothelial carcinoma of the bladder, what is the correct ICD-O-3 morphology code? |
1) Clear cell renal carcinoma, code 8310, is often called conventional renal cell carcinoma. It is specific compared to renal cell carcinoma, NOS, code 8312, a general morphology term for the majority of kidney cancers. See kidney rules H5 and H12 and Table 1 on page 57 of the Kidney Terms and Definitions, http://www.seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf
2) Do not change the ICD-O-3 code assigned for the 2011 diagnosis. As you know, the 2013 diagnosis is not a new primary per rule M6. |
2014 | |
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20170060 | MP/H Rules/Histology/Grade--Unknown & ill-defined sites: What is the correct histology and grade of a liver biopsy with metastatic neuroendocrine carcinoma low to intermediate grade if primary site is unknown? See Discussion. |
CT-guided liver biopsy, diagnosis: Metastatic neuroendocrine carcinoma. Diagnosis Comment: Cytology of the tumor appears to be low to intermediate grade. Would this case be coded as an atypical carcinoid tumor (8249/3) based on SINQ 20170033 and the statement of intermediate grade; or should this be 8240/3 (neuroendocrine tumor) per SINQ 20160023 because it is a metastatic site? More clarification is needed on when to code 8249/3 or 8240/3 for a neuroendocrine carcinoma or neoplasm seen in a metastatic specimen only when there is specified grade. |
Assign histology code 8246/3 and assign code 9 for grade. Since the primary is unknown and the type of NEC is not definitively stated, code neuroendocrine carcinoma, NOS based on the diagnosis. Code grade from primary tumor only. Assign grade code 9 when the primary site is unknown. See instruction 2.b. in the Grade Coding Instructions for 2014+. SINQ 20170033 and SINQ 20160023 provide instructions for coding the grade/differentiation field. Using these SINQ questions to code histology could lead to errors. |
2017 |
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20140077 | MP/H Rules/Histology/Multiple primaries--GE junction: How is histology coded for a goblet cell carcinoma in the GE junction? See discussion. |
The patient was diagnosed with GE junction signet ring adenocarcinoma (8490/3) in 5/2012, treated with radiation. GE junction biopsy on 9/20/2012 showed residual signet ring carcinoma. Subsequent biopsies on 7/8/2013 showed GE junction biopsy of invasive adenocarcinoma, signet ring cell type along with “Esophagus, distal and GE junction biopsies” (site not further clarified in available documentation) with Goblet cell carcinoma. The histology code for the goblet cell carcinoma is needed to determine the number of primaries. |
According to our expert pathologist consultant, goblet cell is a descriptive term and not a specific histology in this context. There is no ICD-O-3 code for it. The "goblet cell carcinoma" in this case is not a new primary.
Goblet cell is used to describe some cells containing mucin. In addition to individual tumor cells containing mucin which compresses the nucleus to give the appearance of signet rings, the mucin is present in columnar cells with the nuclei at one end -- this latter is a pattern often seen when glandular structures are formed by the tumor cells. It is also often intermixed with the signet ring cells in the surrounding stroma. |
2014 |
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20160053 | MP/H Rules/Histology: How is the histology coded for an invasive adenocarcinoma arising in a papilloma with high-grade dysplasia? See Discussion. |
Patient has a perihilar bile duct primary with a microscopic focus of invasive moderately differentiated adenocarcinoma arising in a large papilloma. The MP/H Rules do not address adenocarcinomas arising in a papilloma, only adenocarcinomas arising in an adenoma (or polyp). Should the histology be coded as 8140 for the invasive adenocarcinoma component? Or should the matrix principle be applied and the histology coded as a malignant glandular papilloma (8260/3)? |
Assign 8503/3 for invasive adenocarcinoma arising in a papilloma with high-grade dysplasia, perihilar bile duct primary. Neither ICD-O-3 nor the WHO classification have a code for this specific histology; however, our expert pathologist consultant states 8503/3 is the best available choice based on pages 264 and 273 in the WHO Digestive system classification. |
2016 |
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20160025 | MP/H Rules/Histology: What is the correct histology code for a NUT midline carcinoma? |
Code histology to 8010/3.
NUT carcinoma is identified by the NUTM1 gene rearrangement.
NUT midline carcinomas (NMC) are lethal and morphologically indistinguishable from other poorly diff carcinomas. They are epithelial tumors which can range from undifferentiated carcinomas to carcinomas with prominent squamous differentiation.
A new proposed ICD-O-3 code has been suggested for NUT tumors but it is not yet approved for implementation. Do not use the new code until it is approved for use in the United States.
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2016 |
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