Reportability/Histology-Gallbladder: Is high grade biliary intraepithelial neoplasia of the gallbladder reportable?
High grade biliary intraepithelial neoplasia of the gallbladder is reportable. Assign code 8148/2. It is also known as biliary intraepithelial neoplasia grade 3, or BilIN-3.
Reportability--Lung: Is a case of pulmonary metastatic leiomyoma (favored) vs. low grade leiomyosarcoma reportable, and if so, what is the primary site and histology code? See Discussion.
Patient presents with an abnormal chest x-ray. PET reveals 4.6 cm left lower lobe mass and several additional bilateral nodules measuring up to 1.6 cm. Biopsy was recommended and is positive for metastatic histologically benign smooth muscle neoplasm. ER/PR are positive. Mayo consult on biopsy agrees with histology. The differential diagnosis includes benign metastasizing leiomyoma and low grade leiomyosarcoma. Comment: If these nodules remain small and do not progressively grow would consider this metastasizing leiomyoma. Physicians state bilateral pulmonary metastatic leiomyoma (favored) vs low grade leiomyosarcoma. Tamoxifen was started. Patient has a history of uterine fibroids. Several months later, imaging reveals stable bilateral multi pulmonary nodules and left lower lobe mass but persistent. Surgery was recommended but cancelled due to insurance.
This case is not reportable based on the information provided. The histologic diagnosis is "metastatic histologically benign smooth muscle neoplasm." The physicians seem to agree with the histologic diagnosis, benign metastasizing leiomyoma (BML). The WHO classification and ICD-O-3 assign 8898/1 to "metastasizing leiomyoma." WHO states "This resembles a typical leiomyoma but it is found in the lungs of women with a history of typical uterine leiomyomas." A recent article states "Because of the hormone-sensitive characteristics of BML, treatments are based on hormonal manipulation along with either surgical or medical oophorectomy." Tamoxifen treatment is in keeping with the BML diagnosis.
MP/H Rules/Histology--Lung: What histology code and MP/H Rule applies to the Histologic Type described as adenocarcinoma, mixed invasive mucinous and non-mucinous which involves multiple lung tumors present in a single lobe? See Discussion.
The patient had a lower lobectomy with final diagnosis of adenocarcinoma with the following features: Tumor Focality: Multiple separate tumor nodules in same lobe; Tumor Size: 2.6 cm, 0.7 cm, 0.3 cm and 0.1 cm in greatest dimension; Histologic Type: Adenocarcinoma, mixed invasive mucinous and non-mucinous adenocarcinoma; Histologic Grade: Moderately differentiated.
Assign histology code 8254/3.
The 2007 MP/H Lung rules do not include coding guidelines for mixed mucinous and non-mucinous tumors. Lung Table 1 (in the Terms and Definitions, pages 37-38, http://seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf ) is very specific about which histologies can be coded to mixed adenocarcinoma (8255/3). Mucinous is not included per the note at the end of Table 1. Per WHO 3rd and 4th Ed Tumors of the Lung, mixed mucinous and non-mucinous tumors of the lung are classified as 8254/3. Mixed invasive mucinous and non-mucinous adenocarcinoma is a synonym for BAC, mucinous and non-mucinous.
Would this situation be 2 primaries - 1993 Renal pelvis and 1994 Bladder with the 2015 being the same primary as 1993 Renal pelvis? Or 3 primaries - 1993 Renal pelvis, 1994 Bladder, 2015 Bladder?
Abstract four primaries, 1993 renal pelvis, 1994 bladder, 2013 bladder, and 2015 bladder.
For the remaining diagnoses, the 2007 MP/H rules apply. The 2013 bladder diagnosis is a new primary per rule M7. The 2014 bladder diagnosis is not a new primary per rule M6. The 2015 bladder diagnosis is a new primary per rule M5.
Reportability--Breast: Is mammary fibromatosis reportable and if so, what histology code is assigned? See discussion.
The pathologist completed a CAP protocol using soft tissue. Pathology revealed a 2.5 cm tumor with invasion of skeletal muscle with deep margins positive for tumor.
Mammary fibromatosis is not reportable. The WHO classification for breast tumors assigns mammary fibromatosis a behavior code of /1. According to WHO, mammary fibromatosis "is a locally infiltrative lesion without metastatic potential…"
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.
MP/H Rules/Histology--Bladder: Can the histology for a high grade urothelial carcinoma described as having "extensive sarcomatoid dedifferentiation" be coded to sarcomatoid transitional cell carcinoma (8122/3)?
Example; TURBT, Final Diagnosis - Urothelial carcinoma, high grade. Type/grade comment: Extensive sarcomatoid dedifferentiation is present (40-50% of tumor volume).
Code high grade urothelial carcinoma described as having "extensive sarcomatoid dedifferentiation" to sarcomatoid transitional cell carcinoma (8122/3).
SEER Summary Stage 2000--Melanoma: Can Clark's level classification still used to Summary Stage melanoma? It was previously used by AJCC TNM, but was not included in the 7th edition. I see it is still listed in the CAP protocols for melanoma.
Clark's level can be used to assign in situ, localized or regional summary stage.
If there is a discrepancy between the Clark’s level and the pathologic description of extent, use the higher Summary Stage code.
Surgery of Primary Site--Melanoma: Please further explain the SEER Note under Melanoma surgery codes 30-36 for these two examples. Are both examples coded 31?
1. Shave bx: +melanoma in situ, +microscopic margins Wide excision: no residual melanoma in situ
2. Shave bx: melanoma, +microscopic margin Wide excision: Melanoma, margins negative (margin status negative but distance not stated)
Revised answer: Assign surgery code 30 for both examples based on the SEER Note on the top of page 2 in the Surgery of Primary Site Codes for Skin: If it is stated to be a wide excision or reexcision, but the margins are unknown, code to 30.
Reportability--Melanoma: Please explain how a CTR is to interpret the guideline in the MP/H rules (Cutaneous Melanoma): Evolving melanoma (borderline evolving melanoma): Evolving melanoma are tumors of uncertain biologic behavior. Histological changes of borderline evolving melanoma are too subtle for a definitive diagnosis of melanoma in situ. Is this to mean that evolving melanoma in situ is not reportable? Or should we follow the guidelines in SEER Question 20130022 that states the reportability terms for melanoma and melanoma in situ.
Follow the guidelines in SINQ 20130022 for now. When the MP/H rules are revised, new instructions will be implemented.
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