Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20200073 | Solid Tumor Rules (2018)/Histology--Colon: Should the mixed adenoneuroendocrine carcinoma (MANEC) row in Table 1 include the still often used (yet older) terms of adenocarcinoma and carcinoid, adenocarcinoid, etc. for clarity? See Discussion. |
The Terms and Definitions Introduction discusses how these are older terms, but pathologists may still use them. In our region, pathologists do, in fact, still use these terms. Can these terms be added to Table 1? For registrars who do not reference the Introduction every time they code histology but go directly to Table 1, coding consistency would likely improve if such terms were added in the Table. This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The next update to the Solid Tumor rules will include adding the following four terms to Colon Table 1 as synonyms for Mixed adenoneuroendocrine carcinoma 8244
|
2020 |
|
20210004 | Solid Tumor Rules (2018)/Histology--Colon: What is the histology for a 2020 pathology report final diagnosis showing invasive adenocarcinoma, poorly differentiated with signet ring cell features and signet-ring cell carcinoma in the synoptic report? See Discussion. |
Since the synoptic report and final diagnosis are equal in priority, and the Solid Tumor Rules tell us to code the more specific histology, would this be coded to signet ring cell adenocarcinoma, 8490/3, even though the pathologist used features in the final diagnosis? There is no histology adenocarcinoma with signet ring cell features on the CAP Protocol, so the pathologist may check off the next closest histology " signet ring cell carcinoma " which would not be truly representative of the actual histology. Final Diagnosis: Proximal colon, segmental resection: Invasive adenocarcinoma, poorly differentiated, with signet ring cell features. Synoptic Report A: Colon and Rectum - Resection Specimen Procedure: Right hemicolectomy, Tumor Site: Right (ascending) colon, Histologic Type: Signet-ring cell carcinoma, Histologic Grade: G3: Poorly differentiated. |
Code histology to 8490/3 per H6. The December 2020 Solid Tumor Update includes addition of the following instructions to the "Priority Order for Using Documentation to Code Histology" section. Which document to use when there is conflicting information between the final diagnosis, synoptic report, or CAP protocol: When there are discrepancies between the final diagnosis and synoptic report, use the document that provides the more specific histology. This will likely be found in the synoptic report. The CAP Protocol should be used only when a final diagnosis or synoptic report are not available. Definitions for CAP Protocol, final diagnosis, and synoptic report can be found in the Definitions section. |
2021 |
|
20200082 | Solid Tumor Rules (2018)/Histology--Corpus Uteri: How is histology coded for cases of carcinosarcoma/malignant mixed Mullerian (MMMT) tumor diagnosed 2021 and later? See Discussion. |
The ICD-O-3.2 Coding Table includes Mullerian mixed tumor as the preferred term for histology code 8950 (previously malignant mixed Mullerian tumor/MMMT). This table also includes carcinosarcoma, NOS as the preferred term for histology code 8980. Neither the ICD-O-3.2 Coding Table nor the Implementation Guidelines address the long-standing issue of coding histology for diagnoses of carcinosarcoma/malignant mixed Mullerian tumor. These endometrial primaries are frequently diagnosed as both carcinosarcoma and MMMT. The questions regarding histology coding for carcinosarcoma and carcinosarcoma/MMMT of the endometrium date back to before the Multiple Primaries/Histology Rules, with at least three SINQ entries instructing registrars not to use code 8950/3 (MMMT) for diagnoses of MMMT. SINQ has instructed registrars that MMMT is a synonym for carcinosarcoma and these tumors should be coded to 8980 (carcinosarcoma), not to 8950 (MMMT). The most recent SINQ is partly inconsistent with the others, indicating 8950 can be used if the tumor is only described as MMMT. The other SINQ entries state carcinosarcoma should be used as it is the preferred term for MMMT. (See SINQ 20061008, 20100009, 20180071.) The most recent SINQ (20180071) specifically indicates: According to the WHO Classification of Tumors of Female Reproductive Organs, 4th edition, MMMT (8950/3) is now a synonym for carcinosarcoma (8980/3) even though it has a separate ICD-O code. The ICD-O code for MMMT is no longer in the WHO book. However, MMMT is in the ICD-O-3.2 Coding Table and is not stated to be obsolete or a synonym. Which is correct, the clarification in the SINQ or the 2021 ICD-O-3.2 Coding Table? For a 2021 diagnosis of carcinosarcoma/malignant mixed Mullerian tumor, how should registrars code the histology? Follow the previous SINQ entries and Rule H17 to code the histology to 8980 when the diagnosis includes both carcinosarcoma and MMMT? Do these previous SINQ entries still apply to cases diagnosed 2021 and later? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
According to both the 4th and 5th Ed WHO GYN Tumors, carcinosarcoma (8980) is the preferred term and pathologists are encouraged to no longer use Mixed Mullerian Tumor (8950) in their diagnoses. WHO 4th Ed GYN now lists MMMT as synonym for carcinosarcoma. 8950/3 is no longer included in WHO 4th Ed. Until the the Other Sites Rules can be updated with histology tables to assist in coding, use the following to determine histology. Carcinosarcoma (8980/3) and MMMT (8950/3)
|
2020 |
|
20180021 | Solid Tumor Rules (2018)/Histology--Corpus uteri: What is the correct histology code for "Mesophrenic-like adenocarcinoma" of the corpus uteri?" See Discussion. |
The article I read (https://www.ncbi.nlm.nih.gov/pubmed/?term=28984674) makes the distinction between mesophrenic adenocarcinoma and mesophrenic-like adenocarcinoma. The authors propose the term mesonephric-like Mullerian adenocarcinoma. So would this be coded as Mullerian adenocarcinoma? |
Assign code 9110/3, mesonephric adenocarcinoma. These tumors commonly arise in the cervical wall and more commonly involve the lower uterine segment than do other cervical adenocarcinomas. |
2018 |
|
20200023 | Solid Tumor Rules (2018)/Histology--Endometrium: Is the histology for a serous carcinoma, high-grade endometrial primary 8441/3 (serous carcinoma) or 8461/3 (high grade serous carcinoma)? See Discussion. |
Path report reads: 7/15/2019 A. Endometrium, curettings: Serous carcinoma, high grade. B. Endometrial polyp, curettings: Serous carcinoma, high grade. If coded to 8461/3, according to AJCC, this would not be an ideal code (since it is outdated). Also, endometrium is not included in the suggested site codes for 8461/3 according to the 8/22/2018 ICD-O-3 update. |
Code histology for this endometrial primary to serous carcinoma 8441/3. Capture "high grade" in the grade field as instructed in the grade coding manual. "High grade serous carcinoma" has specific clinical and histopathologic features found in ovarian tumors. |
2020 |
|
20200010 | Solid Tumor Rules (2018)/Histology--Head & Neck: How is histology coded for a glossotonsillar sulcus tumor with both squamous cell carcinoma and mucoepidermoid carcinoma? See Discussion. |
Patient had a radical pharyngectomy showing a glossotonsillar sulcus tumor with high grade squamous cell carcinoma and adjacent high grade mucoepidermoid carcinoma. The pathologist commented, the tumor is composed of high grade mucoepidermoid carcinoma and high grade conventional-type squamous cell carcinoma that are immediately adjacent to one another. Given that the tumors are arising so close together and could represent a single neoplastic process with divergent morphologies, they are staged together. Employing Solid Tumor Manual Rule M1 (single primary if unable to determine if there is a single or multiple tumors), it was determined that this should be reported as a single tumor because the pathologist referred to the case as both a tumor singular and tumors pleural. However, the Solid Tumor Manual Histology Rules for a Single Tumor do not appear to have an instruction for coding this histology combination. |
Abstract multiple primaries using 2018 Head and Neck Solid Tumor Rule M8 as these are separate tumors described as arising close together, and are on different rows in Table 3. Code histology separately as squamous cell carcinoma (8070/3) and mucoepidermoid carcinoma (8430/3). This appears to be a collision tumor. Collision tumors are counted as two individual tumors for the purpose of determining multiple primaries. Collision tumors were originally two separate tumors that arose in close proximity. As the tumors increased in size, they merged or overlapped each other. While more common in the colon, they can occur in other sites as well. |
2020 |
|
20180077 | Solid Tumor Rules (2018)/Histology--Head & Neck: How is histology coded for a p16-positive squamous cell carcinoma of the base of tongue? Is p16-positive squamous cell carcinoma equivalent to a diagnosis of squamous cell carcinoma human papilloma virus (HPV)-positive (8085)? See Discussion. |
Table 6 (Tumors of the Oropharynx, Base of Tongue, Tonsils, Adenoids) in the Head and Neck Equivalent Terms and Definitions lists both squamous cell carcinoma HPV-positive and squamous cell carcinoma HPV-negative as subtypes/variants of squamous cell carcinoma (the NOS histology, 8070). Squamous cell carcinoma HPV-positive and squamous cell carcinoma HPV-negative are also listed in the 2018 ICD-O-3 update table. Previous clarification from the standard setters regarding the 2018 ICD-O-3 Update table indicated that histology codes 8085 and 8086 (HPV-positive and HPV-negative squamous cell carcinoma, respectively) included p16+ and p16- squamous cell carcinoma, respectively. Presumably, this clarification was made because p16 is a surrogate marker for HPV, and capturing whether a tumor is HPV-related or not has implications for staging for 2018 and later diagnoses. However, this clarification was not added to the 2018 ICD-O-3 Update table via errata, nor do the Head and Neck Equivalent Terms and Definitions or Histology Coding Rules address this. Is a diagnosis of p16-positive squamous cell carcinoma equivalent to a diagnosis of squamous cell carcinoma HPV-positive (8085)? If so, will this clarification be added to the Head and Neck Solid Tumor Rules? |
HPV-positive is not equivalent to HPV-mediated (p16+). According to the 2018 SEER Manual, HPV-type 16 refers to virus type and is different from p16 overexpression (p16+). HPV status is determined by tests designed to detect viral DNA or RNA. Tests based on ISH, PCR, RT-PCR technologies detect the viral DNA or RNA; whereas, the test for p16 expression, a surrogate marker for HPV, is IHC. HPV testing must be positive by viral detection tests in order to code histology as 8085. |
2018 |
|
20200086 | Solid Tumor Rules (2018)/Histology--Head & Neck: Paraganglioma, NOS is reportable and malignant for cases diagnosed 1/1/2021 and later. Paraganglioma, NOS is listed in the ICD-O-3.2 Coding Table as 8680/3 without synonyms or related terms. Table 4 (ICD-O-3.2 Implementation Guidelines) lists 8693/3 Paraganglioma as a new preferred term. Is this correct? See Discussion. |
Table 4 (Changes in reportable terminology), 2021 ICD-O-3.2 Update, does confirm that the term malignant no longer needs to be used to describe a paraganglioma, but Table 4 includes the histology for extra-adrenal paraganglioma, NOS (8693/3) as the new preferred term for paraganglioma. Paraganglioma, NOS is histology code 8680/3. Which code is correct? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The correct code for extra-adrenal paraganglioma is 8693/3. The preferred term for 8380/3 is Paraganglioma, NOS. Table 4 of the 2021 ICD-O update was based on information from WHO. Table 9 in the Head and Neck ST rules is being revised and formatted differently for ease of coding based on diagnosis year (prior to 2021 and 2021 forward). Not ALL paragangliomas will be included in Table 9. If a term and code are not provided in the rules, refer to ICD-O and updates. |
2020 |
|
20200074 | Solid Tumor Rules (2018)/Histology--Head & Neck: What specific table(s) in the 2021 Head and Neck Solid Tumor Rules if any, apply to tumors of the lip? See Discussion. |
Lip has not been added to any of the site-specific histology tables, nor has any other instruction been provided for coding tumors in this site. Coding histology for lip primaries is difficult because registrars do not know where to look first. The Solid Tumor Rules indicate one should use the tables first, but then do not inform registrars what table to use for a lip primary (i.e., a specific table, any table, no table). This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The tables are based on WHO H&N chapters which do not include lip. There are inherent issues in determining reportability for lip primaries based on site and histology. The decision was made prior to release of the 2018 rules to exclude a histology table for lip. We are consulting both our dermatology and H&N pathology experts to explore adding a lip site-specific table to the rules. |
2020 |
|
20190020 | Solid Tumor Rules (2018)/Histology--Head & Neck: What table in the Head and Neck Solid Tumor Rules applies to tumors of the lip (C000-C009)? The rules apply to all tumors in sites C000-C148, C300-C339, C410, C411, C442 and C479, but none of the histology tables include the lip. See Discussion. |
Example: Patient has a secretory carcinoma of minor salivary gland tissue (mammary analogue secretory carcinoma [MASC]) of the mucosal lower lip; it is unclear which table to use and how to arrive at the correct histology using the H Rules. Rule H1 (code the histology when only one histology is present) states, Note 1: Use Tables 1-9 to code histology. There is no table that includes the lip. The correct histology should be 8502 which is listed in Table 6 (Tumors of Salivary Glands) however this does not correspond to minor salivary glands of the mucosal lip (site C003 per ICD-O-3 coding instruction). The 2018 ICD-O-3 Update table does not include this histology, however Table 6 indicates code 8502 (secretory carcinoma) is a new code that was approved by IARC/WHO. The ICD-O-3 only includes this histology as secretory carcinoma of breast. Therefore, in order to arrive at the correct histology, one must be aware of previous SINQ entries 20160036 and 20130003 that indicate secretory carcinoma (or MASC) is histology 8502. However, these are related to MP/H Rules, so registrars may be hesitant to apply this guideline to cases coded using Solid Tumor Rules. |
Assign 8502/3 using Table 6 of 2018 Solid Tumor Rules for Head and Neck. Table 4 notes that there is no ICD-O site code for minor salivary glands. Many minor salivary glands are located in the lips, inner cheek (buccal mucosa), and there are extensive minor salivary glands in the linings of the mouth and throat. Code to the site in which the salivary gland is located. Mammary analog secretory carcinoma (MASC), also called secretory carcinoma, is a rare, generally low-grade salivary gland carcinoma characterized by morphological resemblance to mammary secretory carcinoma and ETV6-NTRK3 gene fusion. Common sites are of the parotid gland, oral cavity, submandibular gland, and the axilla with rare sites being the face including the lips, trunk, and limbs according to WHO Classification of Head and Neck Tumors, 4th edition and WHO Classification of Skin Tumors, 4th edition. This histology is usually associated with primary site of breast and you may get an edit that you can override. |
2019 |