MP/H Rules/Histology--Brain and CNS: What is the code for Rosette-forming glioneural tumor from a pathology report of a brain tumor biopsy for a date of diagnosis in 2015? See Discussion.
Assign 9505/1 for Rosette-forming glioneuronal tumor. The new code, 9509/1, has not been implemented in the United States. 9505/1 is to be used until the new code is implemented. See page 7 of the NAACCR Guidelines for ICD-O-D Implementation, effective January 1, 2014, http://www.naaccr.org/LinkClick.aspx?fileticket=u7d3sB71t5w%3d&tabid=126&mid=466.
Grade/Sarcoma--Breast: Is the correct grade for high grade angiosarcoma of the breast a code 3 or 4? The breast usually uses a three grade system but sarcoma is not a typical histologic type of the breast.
Assign grade code 4 using the sarcoma table. Nottingham or Bloom-Richardson (BR) Score/Grade does not apply to angiosarcomas. This is a good question and points out needed clarification of the grade rules.
MP/H/Histology--Breast: What MP/H Rule, histology, and behavior code for a breast primary apply to the following?
2 foci DCIS, solid, high grade (Grade 3) w/microca++
Apply the Multiple Primaries/Histology, Breast Rule H3: DCIS and a more specific in situ are coded to the more specific histology term which in this case is solid. Code the histology to ductal carcinoma in situ, solid type (8230/2). Based on the information provided, there is no invasive component. The term "microca ++" means micro-calcifications are present, not micro carcinoma.
MP/H Rules/Histology--Skin: What histology code and MP/H Rule apply to a skin primary with the final diagnosis, ? See Discussion.
The patient had an upper arm shave biopsy with final diagnosis of basaloid carcinoma with squamous and neuroendocrine differentiation. The pathologist also comments: Further resection was negative for residual malignancy.
Would SINQ 20150033 apply, thus resulting in final histology of carcinoma with neuroendocrine carcinoma (8574/3)?
Assign 8574/3 according to Other Sites rule H17 for basaloid carcinoma with squamous and neuroendocrine differentiation.
There is no combination code that includes basal cell, squamous, and neuroendocrine. We can combine basal cell with squamous, 8094/3, or carcinoma with neuoendocrine differentiation, 8574/3. Rule H17 directs us to assign the higher code, 8574/3.
Reportability/MP/H Rules/Histology--Ovary: What is the histology code for an ovarian tumor described as a mucinous borderline tumor, intestinal type?
Mucinous borderline tumor, intestinal type, of the ovary is not reportable. The behavior is /1. There is no applicable histology code for this histology when it ocurs in the ovary.
First course treatment/Date 1st surgical procedure--Colon: Should the date of a polypectomy be recorded in the Date of First Surgical Procedure field when the entire tumor is not removed by polypectomy? See Discussion.
The patient underwent a polypectomy. The endoscopy report noted the "single piece polypectomy" only partially removed the polyp/mass as the remainder of the mass was more fixed to the wall. The margins were not noted on the pathology report, but were presumably positive given the endoscopy report and the subsequent low anterior resection (LAR) that proved macroscopic residual tumor. Should the date of the polypectomy be recorded in Date of First Surgical Procedure field? Or would the date of the subsequent LAR be recorded since macroscopic residual tumor was present following polypectomy?
Record the date of the polypectomy as the date of first surgical procedure. Polypectomies are surgery for the purposes of cancer registry data collection regardless of whether or not there is residual tumor after the polypectomy.
Reportability--Carcinoid: Is a diagnosis of carcinoid heart disease, based solely on clinical information and no pathology, reportable?
Carcinoid heart disease is not reportable but this diagnosis indicates that the patient likely has a carcinoid tumor which may be reportable. Obtain further information.
Radiation Therapy--Breast: Are iodine 125 (I-125) seed implants for breast cancer coded as brachytherapy or as a localization technique similar to wire localization? See Discussion.
We are seeing many I-125 seed implants for breast cancer. Many of my associates are coding them as brachytherapy. I think they are the newest of the localization technique like wire localization but with greater accuracy. Most are done the same day as the surgery so brachytherapy does not make sense. Which is correct?
I-125 seeds could be used for brachytherapy for breast cancer or as a localization technique for nonpalpable breast tumors. If the seeds were in place a short time and removed as part of a breast surgical procedure, they were likely used for tumor localization. Radioactive seed localization (RSL) is thought to be more precise than the wire implantation technique for localizing lesions.
MP/H/Histology--Sarcoma: How should Ewing Sarcoma/primitive neuroectodermal tumor (PNET) be coded for a 2012 case? See Discussion.
SEER SINQ 20031051 applies to cases diagnosed before 2007 and advises: Code histology as 9260/3, Ewing sarcoma. Ewing sarcoma is a specific histology on the continuum of primitive neuroectodermal tumors. Code Ewing sarcoma as it is more specific than PNET, NOS.
For tumors diagnosed 2007 or later, refer to the MP/H rules.
Apply 2007 MP/H rule H6 and assign the numerically higher ICD-O-3 code that reflects PNET (9364/3).
According to the WHO Tumors of Soft Tissue and Bone, though Ewing sarcoma ICD-O-3 code is 9260/3, Ewing sarcoma with a higher degree of neuroectodermal differentiation present is classically termed peripheral neuroectodermal tumors (PNET). WHO does not offer guidance how to classify tumors stated to be Ewing sarcoma PNET.
Histology code 9364/3 is assigned for a Ewing/PNET that arises outside of the brain/CNS. Peripheral neuroectodermal tumor (PNET) and peripheral primitive neuroectodermal tumor (PPNET) are Ewing family tumors.
Histology code 9473/3 (PNET, primitive neuroectodermal tumor, central primitive neuroectodermal tumor, or supratentorial PNET) is only used for tumors arising inside the brain/CNS.
MP/H Rules/Histology--Brain and CNS: What is the histology code for a tumor originating in the cerebellum and extending into the fourth venrticle described as a glioblastoma with primitive neuroectodermal tumor component (WHO Grade IV)?
The WHO Classification of CNS tumours lists glioblastoma with primitive neuroectodermal tumor component as a subtype of glioblastoma and assigns 9440/3. Also referred to as glioblastoma with a primitive neuronal component.