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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While oat cell carcinoma is an outdated term, if that is all the pathology report states, code histology as 8042/3.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 |
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20220012 | EOD 2018/Regional Nodes--Corpus Uteri: Are lymph nodes found on imaging post-surgery included in Extent of Disease (EOD) Regional Nodes if surgery is already completed? See Discussion. |
11/16/20: Patient diagnosed with endometrial cancer on by MRI of the pelvis; 11.5 cm uterine mass consistent with cancer with no lymphadenopathy. 1/6/21: Patient had a total abdominal hysterectomy/bilateral salpingo-oophorectomy and pelvic lymph node dissection. Operative report stated patient had mildly enlarged bilateral pelvic nodes. Path report: Endometrioid adenocarcinoma with invasion of the serosa. Five bilateral pelvic nodes were sampled and negative. Originally, staging had patient as node negative. 1/22/21: Patient had post op imaging done that showed metastatic retroperitoneal, aortocaval, and possibly left iliac lymph nodes. Physician changed staging to include the lymph node involvement. |
EOD includes all information available within four months of diagnosis in the absence of disease progression or upon completion of surgery(ies) in first course of treatment, whichever is longer. Since the imaging was within the four-month window, and the nodes could have been positive during surgery but not assessed by the surgeon, use the information from the imaging. Assign code 600 for EOD Regional Nodes for involvement of the aortocaval and retroperitoneal nodes (para-aortic nodes), size unknown. |
2022 |
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20220035 |
Solid Tumor Rules/Histology--Bladder: How is histology coded for a transurethral resection of the bladder (TURB) diagnosis with multiple components? See Discussion. |
Examples: Bladder TURB: Invasive high grade urothelial carcinoma with poorly differentiated (40%), lipoid (5%), and sarcomatoid (55%) components. Bladder tumor base TURB: Invasive high grade urothelial carcinoma with poorly differentiated (65%) and sarcomatoid (30%) components. The Urinary Sites Solid Tumor Rules, histology coding rules, say to code the most specific histology or subtype/variant, regardless of whether it is described as majority, minority, or component. Poorly differentiated (8020) and sarcomatoid (8122) are both urothelial subtypes, but there is no rule to instruct how to code a tumor/tumors with multiple urothelial subtypes. |
Code histology as 8120/3 in the two examples using Note 1 in the Urinary Sites Solid Tumor Rules, instruction 1 of the Coding Histology section. The subtypes/variants or components must describe a carcinoma or sarcoma in order to code a histology described by those terms. |
2022 |
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20220003 | Reportability/Histology--Anus: Are 2021 diagnoses of anal intraepithelial neoplasia (AIN) II or AIN II-III reportable in patients with a known history of AIN II or AIN II-III diagnosed prior to 2021? See Discussion. |
Patient has a history of AIN I/low-grade squamous intraepithelial lesion (LSIL) dating back to at least 2015, was diagnosed with AIN II-III in 12/2019, and then diagnosed again with AIN II-III in 08/2021. There is no indication of treatment or a disease-free interval for this patient. SINQ 20210015, while not an exact match to this case, implies there is no clear disease-free interval for these AIN diagnoses, so it is the same non-reportable neoplasm diagnosed prior to reportability (12/2019). However, there was a diagnosis of a reportable neoplasm in 2021, so it also seems possible this would be accessioned as a reportable tumor based on a diagnosis of reportable tumor diagnosis in 2021. With the reportability changes for these intraepithelial neoplasia II/II-III tumors, these situations will arise more frequently. |
Report AIN II and AIN II-III cases when initially diagnosed in 2021 or later. Do not report retrospective cases; that is, cases with diagnoses prior to 2021 with continuation of AIN II or AIN II-III extending into the reportable period. |
2022 |
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20220005 | Reportability--Ambiguous Terminology: Can the term “at most” preceding a statement of a reportable diagnosis be used to accession a case? See Discussion. |
A January 2022 endometrium biopsy and curettage both show final diagnosis of “mild cytologic atypia and glandular crowding, at most endometrioid intraepithelial neoplasia.” Any subsequent surgery path is unlikely to provide clarification. |
Do not report the case in this scenario based on the diagnosis alone of mild cytologic atypia and glandular crowding, at most endometrioid intraepithelial neoplasia. "At most" is not an ambiguous term for reportability. It appears that "at most" in this case refers to the worst possible option within other possible options (differential diagnosis). Differential diagnoses are "educated guesses" or hypotheses and are usually not reportable unless proven otherwise. As there is no clear statement of the diagnosis in this case, we recommend that you seek additional information, for example, clinical diagnosis, treatment, and patient care. |
2022 |
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20220017 | Histology--Thyroid: What is the correct histology code for a thyroid resection showing papillary carcinoma, tall cell variant with oncocytic features with 30% of largest tumor (right) is tall cell variant and both foci contain benign multinucleated giant cells? See Discussion. |
There is an ICD-O histology code for papillary carcinoma, tall cell (8344/3) as well as papillary carcinoma, oxyphilic cell (8342/3). Per SINQ 20150045, the term oncocytic is synonymous with oxyphilic in this context. The term “variant” can be used for the Other Sites (non-updated STR sites) primaries when the ICD-O-3.2 (or ICD-O-3 for older cases) includes the term “variant” in the histology name. The MPH General Instructions did not include the term “variant” as a term that can be used to code histology. |
Code papillary carcinoma, tall cell variant with oncocytic features to papillary carcinoma, tall cell (C73.9) (8344/3). The WHO Classification of Endocrine Organs states that this variant is composed of cells that are as tall as they are wide, and show abundant eosinophilic (oncocytic-like) cytoplasm. Tall cells must account for greater than or equal to 30% of all tumor cells. |
2022 |
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20220007 | Histology: Is there any guidance on using STRATA Oncology testing (molecular tumor profiling tests), such as StrataNGS and StrataEXP, to code SSDIs, histology, etc? I do not see anything in STR, SEER Program Manual, SINQ, or CAnswerForum. We are seeing the testing with our 2021 paths. |
We recommend that you do not use information from these molecular tumor profiling tests until they become a standard diagnostic tool. If/when that happens, we will add information to the various manuals. |
2022 | |
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20220010 | EOD 2018/Heme & Lymphoid Neoplasms--Myeloid Sarcoma: How is Extent of Disease (EOD) Primary Tumor coded for a myeloid sarcoma with multifocal skin involvement? See Discussion. |
Patient has a diagnosis of myeloid sarcoma presenting as multiple erythematous papules and nodules on back, chest, right arm & shoulder. Oncologist did not mention any evidence or suspicion of an associated AML diagnosis. HemeRetic schema EOD Primary Tumor Note 1 states that myeloid sarcoma can be coded as localized (code 100) or systemic (code 700). It is not clear what would qualify as systemic disease for myeloid sarcoma. |
Assign code 100, localized, using the 2018 EOD Primary Tumor, HemeRetic schema, for the myeloid sarcoma with skin involvement since only the skin is involved. Use code 700, distant or disseminated, when multiple organs are involved. |
2022 |
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20220043 | First Course Treatment/Neoadjuvant Therapy--Melanoma: How are the three Neoadjuvant Therapy data items (Neoadjuvant Therapy, Neoadjuvant Therapy--Clinical Response, Neoadjuvant Therapy--Treatment Effect) coded when a patient is diagnosed with melanoma in the lymph nodes with no primary skin site identified? The physician gives immunotherapy as neoadjuvant therapy with planned and carried out surgical resection of involved lymph nodes following completion of immunotherapy. There is no "planned definitive surgical resection of the primary site" as no primary site was found, |
Assign code 0 to each of the three Neoadjuvant Therapy data items in this situation. We will add an example to the coding instructions for these data items in the next release of the manual. |
2022 | |
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20220029 | Histology/Behavior--GI Tract: What is the difference between high grade dysplasia and severe dysplasia for tumors in the cervix and gastrointestinal (GI) tract? Are these terms synonymous with in situ/behavior code /2? See Discussion. |
In the WHO Classification of Female Genital Tumors, 5th edition, for the uterine cervix squamous intraepithelial lesions, there is related terminology for high grade squamous intraepithelial lesion HSIL (CIN3) 8077/2 and it is severe squamous dysplasia; squamous cell in situ. However, in the online WHO Classification of Digestive System Tumors, 5th edition, there is no related terminology for esophageal high-grade squamous dysplasia, 8077/2. Can you collect cases of severe dysplasia the same as cases of high grade dysplasia? |
According to a leading GI pathologist, severe dysplasia is equivalent to high grade dysplasia in the GI tract. |
2022 |
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