Behavior--Breast: Is behavior for encapsulated papillary carcinoma (EPC) of the breast coded as noninvasive or invasive?
The pathologist has the final say on behavior. Code behavior based on the pathologist's final diagnosis. See Rule F in ICD-O-3.
According the WHO Classification of Breast Tumors, encapsulated papillary carcinoma of the breast is in situ, /2. Encapsulated papillary carcinoma with invasion is assigned /3. WHO describes "frank invasive carcinoma" for this histology as "neoplastic epithelial elements infiltrate beyond the fibrous capsule of encapsulated papillary carcinomas." WHO cautions that true infiltration should be "differentiated from entrapment of neoplastic epithelial cells in the fibrous capsule and from epithelial displacement into the biopsy site, which is frequently encountered following needle-core procedures of papillary lesions."
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.
Primary site--Bladder: What is the primary site for bladder tumor biopsy: invasive adenocarcinoma, enteric type favor urachal origin, stage III
Based on the information provided, code the primary site to urachus (C677). Primary adenocarcinoma of the bladder accounts for less than 1% of all bladder malignancies. Of these, 20–39% are urachal in origin.
MP/H--Bladder: Are 8130 and rule H12 correct for this case? Bladder with papillary urothelial carcinoma with squamous cell differentiation.
Rule H8 applies, code the histology with the numerically higher ICD-O-3 code which is papillary transitional cell carcinoma, 8130.
Based on the information provided, there is a single bladder tumor, papillary urothelial carcinoma with squamous cell differentiation. Urinary sites rule H12 does not apply because this is a single tumor, not multiple tumors. In the single tumor H rules, H3 does not apply as this rule does not include papillary transitional cell carcinoma. Rule H4 is papillary carcinoma or papillary transitional cell carcinoma and refers you to Table 1. Table 1 does not list papillary urothelial carcinoma with squamous cell differentiation because there is no ICD-O-3 code for this histology. Table 1 does list transitional cell carcinoma with squamous differentiation as code 8120, however, the papillary transitional cell carcinoma is the higher code, 8130. We will review this situation for the next version of the rules.
Primary site: If text supports a pancreatobiliary primary with no other information what primary site code would be assigned? C249 biliary tract NOS, or C269 GI tract nos, or C809 unknown?
Assign C269 in the absence of any additional information.
MP/H Rules/Histology--Endometrium: What is the correct histology code for an endometrial cancer described as "Adenocarcinoma with areas of squamous differentiation?"
Assign 8570/3 to adenocarcinoma with squamous differentiation of the endometrium. The most recent WHO classification does not list "adenocarcinoma" for tumors of the uterine corpus. WHO does state that "endometroid carcinoma of the usual type is a glandular neoplasm..." Further, WHO states "Endometroid carcinoma typically displays a glandular or villoglandular architecture..." Based on the WHO classification, the use of the term "adenocarcinoma" in this context can be interpreted as endometroid carcinoma.
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.
MP/H Rules/Histology-Urinary: 1) What is the correct ICD-O-3 morphology code for conventional renal cell carcinoma? Is this clear cell carcinoma or does conventional refer to the general diagnosis?
2) If a patient was diagnosed with invasive papillary urothelial carcinoma of the bladder in May 2011 and returns in February 2013 with invasive urothelial carcinoma of the bladder, what is the correct ICD-O-3 morphology code?
1) Clear cell renal carcinoma, code 8310, is often called conventional renal cell carcinoma. It is specific compared to renal cell carcinoma, NOS, code 8312, a general morphology term for the majority of kidney cancers. See kidney rules H5 and H12 and Table 1 on page 57 of the Kidney Terms and Definitions, http://www.seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf
2) Do not change the ICD-O-3 code assigned for the 2011 diagnosis. As you know, the 2013 diagnosis is not a new primary per rule M6.
MP/H Rules/Multiple Primaries--Lung: Does lung MP/H Rule M6 apply to synchronous tumors only, metachronous tumors only, or both? See discussion.
How many primaries should be reported when a patient has a history of RLL adenocarcinoma diagnosed on 10/8/2009 followed by diagnoses of LUL adenocarcinoma on 10/5/2012 and a RUL adenocarcinoma on 3/26/2014?
We applied Rule M6 to the 10/5/2012 diagnosis of LUL adenocarcinoma and reported an additional primary. However, we are unsure how to apply the MP/H rules for the 3/26/2014 RUL adenocarcinoma.
Should we apply Rule M8 because the RUL adenocarcinoma was diagnosed more than 3 years after the original RLL adenocarcinoma and then apply M6 because the RUL and LUL indicate a single tumor in each lung (resulting in a third primary); or does Rule M12 apply because there has been more than a single tumor in each lung (no new primary)?
Assuming each of the three diagnoses is a single tumor and there are no other tumors in either lung, abstract two primaries: 1 in the RLL diagnosed on 10/8/2009 and 1 in the LUL diagnosed on 10/5/2012. Do not abstract the 3/26/2014 diagnosis as a new primary.
Rule M6 applies to the 2009 and 2012 diagnoses. Rule M12 applies to the 2012 and 2014 diagnoses. Do not compare the 2014 diagnosis to the 2009 diagnosis. Always compare the latest diagnosis to the most recent previous diagnosis in cases like this.