Report | Question ID | Question | Discussion | Answer | Year |
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20190067 | Reportability/Histology--Breast: Is a breast mastectomy showing mildly atypical cells within the nipple epidermis which are suspicious for Paget disease of the nipple a reportable malignancy? See Discussion. |
Example: Left breast total mastectomy final diagnosis is incidental microscopic findings suspicious for early Paget disease of the nipple. The diagnosis comment states: The left breast mastectomy shows mildly atypical cells within the nipple epidermis which are suspicious for early Paget disease of the nipple. Additional sampling of the left breast was performed, and no evidence of atypical hyperplasia, in situ carcinoma, or invasive carcinoma within the left breast tissue was identified. Would this case be non-reportable using rationale similar to an early/evolving melanoma per SINQ 20180029? |
Code as 8540/3, Paget disease, based on the use of reportable ambiguous terminology (suspicious) listed in the 2018 SEER Coding Manual. In addition, Rule H8 of the 2018 Breast Solid Tumor Rules says to code Paget disease (8540/3) when the diagnosis is exactly Paget disease when a new tumor with no underlying tumor and the pathology documents invasive or unknown behavior. When two ambiguous terms are used and one is on the reportable list (suspicious) and one is not (early), accept the reportable term and report the case. See #1.b.ii on page 12 in the SEER manual, https://seer.cancer.gov/manuals/2018/SPCSM_2018_maindoc.pdf |
2019 |
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20210019 | Reportability/Histology--Cervix: Is a stratified mucin-producing intraepithelial lesion (SMILE) lesion reportable? Is it reportable if it is invasive SMILE? What is the correct histology? See Discussion. |
Cervix, loop electrosurgical excision procedure: Cervix at transformation zone with stratified mucin-producing intraepithelial lesion (SMILE). SMILE is present at the ectocervical margin. An immunohistochemical stain* for p16 demonstrates strong, diffuse positivity in the lesional epithelium. A mucicarmine stain is also positive in the lesional epithelium, supporting the diagnosis of SMILE. |
Stratified mucin-producing intraepithelial lesion (SMILE) of the cervix is not reportable. SMILE is a variant of adenocarcinoma in situ and is coded 8140/2. In situ neoplasms of the cervix are not reportable. According to the WHO Classification of tumors, p16 is positive and there is a high Ki-67 proliferation index. If SMILE is stated to be invasive, it is reportable, as any other invasive cervical malignancy would be reportable. |
2021 |
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20170024 | Reportability/Histology--Colon: Is tubular adenoma with high grade dysplasia and focal invasion from a pathology report of a colon biopsy reportable?; if so, what is the histology code? |
Tubular adenoma with high grade dysplasia and focal invasion is reportable. Assign the histology code and behavior as 8210/3 (Adenocarcinoma in tubular adenoma). NAACCR Guidelines for ICD-O-3 Implementation discuss the term high grade dysplasia (without invasion). High grade dysplasia and related terms are under review and study for consideration as a reportable neoplasm. Registries should check with their state reporting legislation to see if included in the reporting requirements. |
2017 | |
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20240079 | Reportability/Histology--Conjunctiva: Is low-grade conjunctival melanocytic intraepithelial lesion (LG-CMIL) with focal high-grade features of the conjunctiva (C690) reportable? If reportable, what histology should be assigned? |
Additional comments in this pathology report state "The entire case was sent in consultation to an ophthalmic pathologist. [Pathologist] assigns a conjunctival melanocytic intraepithelial neoplasia (C-MIN) score of 2-3 due to the upward pagetoid migration of small, dendritic melanocytes. A C-MIN score of 2-3 is between low-grade conjunctival melanocytic intraepithelial lesion (LG-CMIL; C-MIN 2) and high-grade conjunctival intraepithelial lesion (HG-CMIL; C-MIN 3). The older terminology for this lesion would be primary acquired melanosis (PAM) with mild to focally moderate atypia." This term does not appear in the SEER Program Coding and Staging Manual (SPCSM), Appendix E1 of the SPCSM, or Solid Tumor Rules (specifically rule H3) . |
Conjunctival melanocytic intraepithelial neoplasia (C-MIN) is reportable; therefore, low-grade conjunctival melanocytic intraepithelial lesion (LG-CMIL) with focal high-grade features of the conjunctiva (C690) is reportable, 8720/2. We will add this to a future edition of the SEER manual. |
2024 |
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20240043 | Reportability/Histology--Digestive Sites: Is a diagnosis of “tubulovillous adenoma with high grade dysplasia” in the duodenum equivalent to a diagnosis of “tubulovillous adenoma, high grade” and, therefore, non-reportable, or is this a reportable non-colorectal high grade dysplasia? See Discussion. |
The 2022 ICD-O-3.2 Implementation Guidelines indicate “Tubulovillous adenoma, high grade” is 8263/2 and is not SEER reportable. However, the 2024 SEER Manual and clarification from recent SINQs (20240021 and 20240025) confirm high grade dysplasia in the esophagus, stomach, and small intestine is reportable (8148/2). Which reportability reference applies to a diagnosis of a tubulovillous adenoma with high grade dysplasia in non-colorectal sites? |
A diagnosis of “tubulovillous adenoma with high grade dysplasia” in the duodenum is not equivalent to a diagnosis of “tubulovillous adenoma, high grade.” Tubulovillous adenoma, high grade (8263/2) is not reportable as of 2022. High grade dysplasia (glandular intraepithelial neoplasia, grade III) is reportable in the esophagus, stomach, and small intestine (8148/2). |
2024 |
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20250001 | Reportability/Histology--Endometrium: Are the following terms and diagnoses synonymous with endometrioid intraepithelial neoplasia (EIN) and therefore reportable? 1. Atypical glandular epithelium 2. Isthmic-type mucosa with focal severe atypia 3. Simple hyperplasia without atypia 4. EIN/complex atypical hyperplasia (EIN/CAH) or focal EIN/CAH (on biopsy but the resection pathology or operative note states no EIN/CAH/atypical hyperplasia) |
We have questions regarding reportability of some terms/diagnoses after a review of EIN cases back to 2021. While some seem synonymous with EIN, others have different terms in the pathology report though the physician is treating as if they have the diagnosis. 1. Atypical glandular epithelium Scenario: Endometrium biopsy with ablation performed at Facility A on 8/7/2024 showed atypical glandular epithelium. Patient was sent to Facility B where the total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAH/BSO) on 9/20/2024 showed other reactive fibrosis and obliterated architecture compatible with history of ablation. Is atypical glandular epithelium synonymous with and coded as EIN? 2. Isthmic-type mucosa with focal severe atypia Scenario: Endometrium biopsy showed isthmic-type mucosa with focal severe atypia. Then Facility B did TAH/BSO that showed no evidence of high grade dysplasia, atypical hyperplasia, or carcinoma. 3. Simple hyperplasia without atypia Scenario: Endometrial biopsy pathology states simple hyperplasia without atypia and the TAH/BSO is either negative or has the same histology; however, the treating physician is stating EIN. 4. EIN/CAH or focal EIN/CAH Scenario: Biopsy showed EIN/CAH but the total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAH/BSO) pathology or the Mirena IUD treatment operative note states no EIN/CAH/Atypical hyperplasia. Are these reportable, similar to an in situ when the re-excision lumpectomy or mastectomy is negative or no residual disease? |
Reportability for EIN became effective in 2021. 1. Do not report atypical glandular epithelium. Atypical glandular epithelium, also referred to as atypical glandular cells (AGC), refers to abnormal looking cells that may be found in the tissue lining the inside of the endometrium or the cervix. While not malignant (in situ or invasive), they can be associated with a range of lesions in the female reproductive system. 2. Do not report isthmic-type mucosa with focal severe atypia. The NCI data dictionary defines atypia as an abnormality in cells in tissue. Report the case when further defined as atypical hyperplasia. 3. Do not report simple hyperplasia without atypia. WHO Classification of Tumors online, Female Genital Tumors (5th ed.), defines endometrial hyperplasia without atypia as a proliferation of endometrial glands of irregular size and shape without significant atypia. There is no ICD-O code for this term. Simple endometrial hyperplasia without atypia is an acceptable related term for endometrial hyperplasia without atypia. Pathology has priority over a physician statement. 4. Report EIN/CAH or focal EIN/CAH (8380/2) based on the biopsy. WHO Classification of Tumors online, Female Genital Tumors (5th ed.), defines EAH/EIN as a simultaneous change of epithelial cytology and an increased number of endometrial glands in a defined region. The preferred term is atypical hyperplasia of the endometrium; terms not recommended include complex atypical endometrial hyperplasia; simple atypical endometrial hyperplasia; endometrial intraepithelial neoplasia.
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2025 |
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20210034 | Reportability/Histology--Endometrium: Is endometrial hyperplasia with atypia equivalent to atypical hyperplasia of the endometrium (8380/2) and thus reportable? |
Endometrial hyperplasia with atypia is equivalent to atypical hyperplasia of the endometrium (8380/2) and thus reportable for cases diagnosed 2021 and later. Our expert pathologist consultant confirmed this for us. |
2021 | |
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20240047 | Reportability/Histology--Endometrium: Is “high grade serous intraepithelial neoplasm” of the endometrium reportable? See Discussion. |
The patient had a 2023 endometrial polypectomy and curettage with final diagnosis of “at least serous intraepithelial neoplasia arising in association with an endometrial polyp.” Diagnosis comment states, “There are multiple tissue fragments with highly atypical glandular lining consistent with a high-grade serous neoplasm. There are focal areas which are suspicious, but not conclusive, for stromal invasion.” Subsequent hysterectomy and BSO showed no residual carcinoma. According to previous SINQ 20210043, serous tubal intraepithelial neoplasm (STIN) is reportable when stated to be high grade. Does the same logic apply to a similar neoplasm in the endometrium and/or endometrial polyp? |
Report high grade serous intraepithelial neoplasm of the endometrium. |
2024 |
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20200044 | Reportability/Histology--Eye: Is conjunctival intraepithelial neoplasia, moderate to severe, reportable and if so, what are the histology and behavior codes? See Discussion. |
Left Eye Conjunctiva, biopsy (01/23/2018): Conjunctival intraepithelial neoplasia moderate to severe. Is intraepithelial neoplasia moderate to severe the same as coding 8077/2? |
Report this case as 8077/2. Our expert pathologist consultant reviewed this and confirmed it is reportable. Here is some of his rationale. The pathologist's designation as "moderate to severe" indicates there are areas of 2/3 of full thickness epithelial change, so the criteria to report are met. |
2020 |
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20220039 | Reportability/Histology--Eye: Is “squamous mucosa with high grade dysplasia” equivalent to a diagnosis of “high grade squamous dysplasia?” See Discussion. |
A conjunctival biopsy final diagnosis is squamous mucosa with moderate to high grade dysplasia. The diagnosis comment states that immunostains were performed and confirm squamous histology. This seems to imply a high grade squamous dysplasia, rather than a non-reportable high grade dysplasia. Does this case meet the criteria for reportable high grade squamous dysplasia? |
Squamous mucosa with high grade dysplasia is the same as high grade squamous dysplasia in the conjunctiva and is coded to 8077/2. |
2022 |