Report | Question ID | Question | Discussion | Answer | Year |
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20140089 | Multiple primaries--Heme & Lymphoid Neoplasms: Should the 2014 diagnosis be abstracted as a new primary since it is not mantle cell lymphoma and all of the types listed in the differential diagnosis would be a new primary? See discussion. |
Mantle cell lymphoma diagnosed in 1997 which was treated with chemotherapy. Now in 2014 a 'relapse' of non-Hodgkin lymphoma. They do a biopsy of the pericardium, which is called low grade B cell non Hodgkin lymphoma. See comment. The comment says histochemical stains are reviewed and findings are consistent with involvement by a CD5 positive low grade B cell lymphoma. Lack of cyclin D1 and SOX-11 positivity as well as negative IGH-CCND1 FISH analysis essentially rule out mantle cell lymphoma. The morphologic and immunophenotypic features of this disorder are not specific for any lymphoma subtype. The differential includes CLL, marginal zone lymphoma, and lymphoplasmacytic lymphoma. If this is coded NHL, NOS (9591) it is the same primary as seq. 1 and would not be abstracted. |
This is the same primary, the mantle cell lymphoma.
Differential diagnoses cannot be used to assign histology. For the 2014 diagnosis, the only histology that can be assigned is 9591/3 for non-Hodgkin lymphoma, NOS. (CLL, mantle cell lymphoma and lymphoplasmacytic lymphoma are all NHL's.)
Compare the 1997 diganosis of mantle cell lymphoma with the 2014 diagnosis of non-Hodgkin lymphoma. Start with Rule M1. The first rule that applies is Rule M15, which instructs you to use the multiple primaries calculator. Enter 9673/3 and then 9591/3 and then calculate. The result is same primary.
If at a later time one of the differential diagnoses is confirmed, apply the rules again.
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2014 |
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20140086 | MP/H Rules/Multiple primaries--Colon: Does rule M7 apply here (A frank malignant or in situ adenocarcinoma and an in situ or malignant tumor in a polyp are a single primary)? Can the frank malignant adenocarcinoma be any specific type of adenocarcinoma for this rule to apply?
A patient has 2 synchronous tumors in the ascending colon. The first is grade 3 adenocarcinoma with signet ring differentiation and focal mucinous features (8255/3). The second is grade 2-3 adenocarcinoma in a tubulovillous adenoma (8263/3). |
M7 applies to this case. The frank adenocarcinoma can be a specific type of adenocarcinoma. |
2014 | |
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20140001 | Grade--Brain and CNS: How should grade be coded for a pineal parenchymal tumor of "intermediate differentiation"? See discussion. | Per a web search, the term "pineal parenchymal tumor of intermediate differentiation" refers to a pineal tumor with the histology/behavior that falls somewhere between the category of pineocytoma (9361/1) and pineoblastoma (9362/3). In other words, it is a malignant tumor that is a WHO grade II/III neoplasm because it's histologic features and behavior are not quite equivalent to a pineoblastoma (WHO grade IV). Thus, it appears the expression "intermediate differentiation" is actually referring to a type of WHO classification system rather than the grade field. Should the type of documentation provided in pathology report be used to imply the grade field is being referenced and thus be coded to 2 for "intermediate differentiation" or should grade be coded to 9 based on the information found during the web search? |
Code the grade as 2 based on instruction #8 in the revised grade instructions for 2014.
Do not use WHO grade to code the grade field for CNS tumors. |
2014 |
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20140051 | Reportability/Histology: Is this reporatable? If so, what is the correct histology?
2012 duodenal nodule biopsy, pathology positive for well differentiated neuroendocrine neoplasm. |
Report this case as 8240/3. In this context, well differentiated neuroendocrine neoplasm seems to be a synonym for neuroendocrine tumor (NET) G1 (carcinoid). According to the WHO classification, "Neuroendocrine neoplasms of the duodenum comprise NETs..." |
2014 | |
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20140040 | Reportability/Primary Site--Lip: Is a right lower lip (NOS) squamous cell carcinoma reportable when the microscopic description states the tumor arises from the epidermis and extends through the dermis? See discussion. |
We are having difficulty determining whether the primary site is lip, NOS (C009) or skin of lip (C440). Usually we look for a statement of “skin” or “mucosa” in the microscopic description if the specimen label is only lip, NOS as instructed by the previous SINQ 20051049. Is a statement of "epidermis" or "dermis" in the microscopic description enough to indicate carcinoma is arising in the skin of the lip (C440) and thus not reportable? |
This case is interpreted as skin of lip and not reportable. According to our expert pathologist consultant, the pathologist in this case "is specifically saying "epidermis" and "dermis" and I would have to think it is skin, and thus not reportable." |
2014 |
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20140054 | MP/H/Multiple primaries--Stomach: How should I report this case? I reviwed both the MP/H and the Heme Rules and could not determine whether or not this case is multiple primaries in a single site but two histologies and therefore needing two separate abstracts.
Path Diagnosis: Gastric Mass Biopsy: 1) Signet Ring Cell Carcinoma. 2) Extranodal Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT Lymphoma). 3) Mild Intestinal Metaplasia and Marked Fundic Gland Atrophy, Negative for H Pylori. Comments: Biopsy shows presence of both signet ring carcinoma and MALT Lymphoma. |
Report two primaries: MALT lymphoma and signet ring carcinoma. Use the 2007 MP/H rules and the Heme rules for this case.
This case could be an example of a "collision tumor" - two separate tumors that grow together into one mass. Collision tumors are a rare exception to rule M2 in the MP/H rules. |
2014 | |
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20140027 | MP/H Rules/Histology--Bladder: What is the correct histology for the following bladder case and how do you determine? See discussion. |
8/1/10 CYSTOSCOPY -- MULTIPLE BLADDER TUMORS INVOLVING POSTERIOR WALL, DOME & BLADDER NECK AREA. LARGEST WOULD BE MORE THAN 5 CM IN SIZE. 8/17/10 path -- BLADDER TUMORS:PAPILLARY TRANSITIONAL CELL CARCINOMA OF urinary bladder, GRADE III. ONE FRAGMENT OF TISSUE SHOWS NECROTIC CHANGE WITH APPARENT TRANSFORMATION TO A HIGH GRADE SARCOMATOID VARIANT W ITH EXTENSIVE SUBMUCOSAL INVASION & FOCAL AREA SUGGESTIVE OF ANGIOLYMPHATIC INVASION NOTED. MAJORITY OF TUMOR APPEARS CONFINED TO MUCOSAL SURFACE W ITH NO OTHER AREAS OF DEFINITIVE SUBMUCOSAL INVASION FOUND. |
Code 8122/3 (UC/TCC, Sarcomatoid). Rule H5 and Table 1 apply.
This is based on the information provided: Transitional Cell Carcinoma with sarcomatoid variant, and Table 1 in Terms and Definitions for "Ureter/Renal Pelvis/Bladder". |
2014 |
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20140026 | Histology: Are all well differentiated neuroendocrine carcinomas (carcinoid) tumors coded to 8240 or 8246? When do you use code 8246? |
Code 8246 is correct when the mass/lesion is referred to as neuroendocrine "carcinoma" or NEC. Use code 8240 when the mass/lesion is referred to as a neuroendocrine "tumor" or NET G1. The difference is the word tumor versus carcinoma. Carcinoid is most often used interchangeably with neuroendocrine tumor and not with neuroendocrine carcinoma. |
2014 | |
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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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20140038 | MP/H Rules/Multiple Primaries--Urinary: How many primaries are there and which MP rules apply in this scenario? See discussion. |
Patient has 2 tumors in the left ureter; one is transitional cell (8120) and one is papillary transitional cell (8130). Rule M6 says BLADDER tumors with any combination of the following histologies ... are a single primary. But this is not a bladder case. Rule M8 says urothelial tumors in 2 or more of the following sites are a single primary... but this is not in 2 or more sites. Rule M9 then says histologies different at the 1st, 2nd, or 3rd digit are separate primaries. That makes this 2 primaries, but I do not think this should be 2 primaries. |
Rule M9 applies. Abstract 2 primaries.
We will evaluate this scenario for the next version of the multiple primary rules. |
2014 |