MP/H Rules--Brain and CNS: Are stigmata of neurofibromatosis in the brain reportable neurofibromatosis lesions? See Discussion.
Reference: SINQ 20051108; SINQ 20061018 Three year old patient with history of neurofibromatosis 1. 3/05 MRI of the brain showed right optic nerve glioma. It also showed heterogeneous high t2 signal in the middle cerebellar peduncles and near the genu of the internal capsules bilaterally are stigmata of neurofibromatosis type I. 3/08 MRI showed new mass suspicious for glioma in the hypothalamus. Clinical diagnosis is benign glioma secondary to diagnosis of neurofibromatosis. How many primaries are to be accessioned for this patient? Should the matrix principle be invoked for the second glioma? Should the behavior code for the glioma be 0?
For cases diagnosed 2007 through 2017
Accession NF (9540/1) when there is CNS tumor -- a glioma or some other intracranial/intraspinal tumor. Stigmata of NF are reportable when the stigmata themselves are reportable tumors. For example, glioma, or another intracranial/intraspinal tumor. Do not report sitgmata that are only termed "stigmata seen on MRI," for example, without other reportable terminology.
Do NOT accession NF (9540/1) when there is only peripheral nerve/nervous system involvement.
Accession the neurofibromatosis itself only once per patient. Accession any initial neoplasm in the CNS separately. Abstract and code any subsequent CNS neoplasms according to the multiple primary brain rules.
Accession three primaries for the case described above.
Neurofibromatosis (C729 9540/1)
Optic nerve glioma (C723 9421/3)--> see below.
Hypothalamus glioma (C710 9380/0)
--> Optic nerve gliomas associated with NF are pilocytic astrocytomas. Code pilocytic astrocytoma as 9421/3 in North America.
For cases diagnosed 2018 or later
See the 2018 Solid Tumor Rules for Non-Malignant CNS tumors.
MP/H Rules/Histology--Rectum: When not specifically mentioned as part of the histology, is the adenoma a second histologic type, or just a further physical description of the tumor? See Discussion.
Rectal tumor resection (APR) path report final dx: "mucinous carcinoma, see comment". The comment is the CAP-format tumor summary, which states "histologic type: adenocarcinoma with extensive mucin production (mucinous or colloid carcinoma). Additional pathologic findings: adenomas - tumor arises in a tubulovillous adenoma".
If you follow the rules and only use the final dx, you would code a different histology than if you use the 'additional path findings.'
For cases diagnosed 2007 or later
Other Sites histology rule H12 applies in this case. Assign histology code 8263 [adenocarcinoma in tubulovillous adenoma].
Use information from the CAP protocol and from comments associated with the final diagnosis to code histology.
The fact that the malignancy arose in a polyp can be taken from anywhere in the medical record; not limited to the final diagnosis.
Based on the information provided for this case, the histology is adenocarcinoma with extensive mucin production (mucinous or colloid carcinoma) arising in a tubulovillous adenoma.
MP/H Rules--Bladder: Is a TURBT in 4/07 that demonstrates papillary carcinoma (8130/3) followed two weeks later with biopsies that demonstrate high grade flat dysplasia/carcinoma in situ (8010/2) two primaries?
For cases diagnosed 2007 or later, rule M6 applies and this is a single primary.
Flat transitional cell carcinoma and carcinoma in situ of the bladder are synonymous. See the definition of "Flat Tumor (bladder)/Noninvasive flat TCC" in the Urinary Terms and Definitions section of the 2007 MP/H manual.
Date Multiple Tumors--Prostate: For a prostate biopsy done 10/20/08, both lobes involved with tumor, unknown how many tumors, what would be coded in date of multiple tumors?
In this case, code the date of the biopsy in Date of Multiple Tumors [10202008]. When the number of tumors is unknown, code the date of diagnosis as the Date of Multiple Tumors. This is the date on which it was determined that there were an unknown number of tumors. This instruction will be added to next edition of the MP/H manual.
Multiple primaries--Lymphoma: Is a splenectomy done for non-Hodgkin lymphoma diffuse large B-cell of the spleen a composite histology and a single primary if a perihilar lymph node with Hodgkin lymphoma classic type is found at the time of this surgery?
For cases diagnosed prior to 1/1/2010:This is two primaries -- Non-Hodgkin lymphoma (NHL) in the spleen and Hodgkin lymphoma (HD) in a lymph node.
Composite lymphoma is NHL and HD both in a single lymph node.
For cases diagnosed 1/1/10 and later, 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.
Multiplicity Counter--Ill-defined sites: How is this field coded for Ill-Defined sites (C760-C768)?
Code the number of tumors present if known. If the number of tumors present is not known, code 99 [unknown number of tumors, unknown if multiple tumors].
MP/H Rules/Date of Diagnosis/Behavior--Brain and CNS: How many primaries would be reported when a December 2004 MRI shows a pineal region mass with the major differential consideration being pineocytoma; a November 2007 MRI that shows the mass has almost tripled in size; and the December 2007 resection final diagnosis is consistent with pineoblastoma? How would diagnosis date[s] and behavior code[s] be coded? See Discussion.
Dec. 2004 MRI of brain: Pineal region mass. The major differential consideration given patient's gender, age group, and imaging characteristics is pineocytoma. The differential includes pineoblastoma or germ cell line tumor. These are felt less likely.
Nov. 2005 MRI brain: stable exam since last MRI. No change in size.
Nov. 2007 MRI studies: pineal mass has almost tripled in size.
Dec. 2007 Surgical resection of pineal tumor: High grade (WHO Grade IV) pineal parenchymal neoplasm consistent with pineoblastoma.
For cases diagnosed 2007 or later:
Abstract as separate primaries:
12/2004 pineocytoma (9361/1)
12/2007 pineoblastoma (9362/3)
Complete two abstracts when a previously diagnosed non-malignant tumor transforms or progresses to a malignancy. Refer to the CDC/NPCR guidelines for Data Collection of Primary Central Nervous System Tumors, 2004. Malignant transformation is discussed on page 50.
MP/H Rules/Histology--Breast: What is the histology code for the following?
4/21/03 Left breast: infiltrating ductal carcinoma, grade 3 micropapillary type. Tumor size: 3.5 cms; deep margin negative. Skin, nipple & areola positive for invasive ductal carcinoma. Dermal lymphatic invasion by carcinoma breast. Extensive intraductal component absent. 6+/6. See Discussion.
How should histology be coded for a 2003 diagnosis and also for the same diagnosis in 2007 or later?
For a case diagnosed in 2003, code 8507/3 [Duct micropapillary carcinoma]. See Coding Complex Morphologic Diagnoses, revised August 2002, 3rd example on page 5 and page 3, #4.
For cases diagnosed 2007 or later, code 8507/3 [Duct micropapillary carcinoma]. Use rule H12.
MP/H Rules--Breast: For tubulolobular carcinoma, do we use 8522? See Discussion.
Path comment: This mixed variant of ductal and lobular carcinoma has been called in the past tubulolobular carcinoma, however, more recently is a mixed pattern of ductal and lobular carcinoma and not a variant of lobular carcinoma.
For cases diagnosed 2007 or later, use rule H18 and assign code 8524 [lobular mixed with other types of carcinoma]. According to the MP/H rules, tubular is not a specific type of duct or lobular. This is based on the latest WHO classification of breast tumors.
The combination histology of tubular and lobular will be reviewed during the upcoming revision of the MP/H rules.
Reportability: Is a case reportable if a benign diagnosis is obtained on a resection that follows a positive needle aspiration? See Discussion.
Fine needle aspiration of the thyroid diagnosis was "positive for malignant cells, favor medullary carcinoma." Subsequent thyroidectomy was reported as benign.
This case is reportable. The cytology is positive. Report as medulary carcinoma of the thyroid.
An official website of the United States government
Home