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Report Produced: 02/20/2026 00:09 AM

Report Question ID Question Discussion Answer Year
20160053

MP/H Rules/Histology: How is the histology coded for an invasive adenocarcinoma arising in a papilloma with high-grade dysplasia? See Discussion.

Patient has a perihilar bile duct primary with a microscopic focus of invasive moderately differentiated adenocarcinoma arising in a large papilloma. The MP/H Rules do not address adenocarcinomas arising in a papilloma, only adenocarcinomas arising in an adenoma (or polyp). Should the histology be coded as 8140 for the invasive adenocarcinoma component? Or should the matrix principle be applied and the histology coded as a malignant glandular papilloma (8260/3)?

Assign 8503/3 for invasive adenocarcinoma arising in a papilloma with high-grade dysplasia, perihilar bile duct primary. Neither ICD-O-3 nor the WHO classification have a code for this specific histology; however, our expert pathologist consultant states 8503/3 is the best available choice based on pages 264 and 273 in the WHO Digestive system classification.

2016
20160002

MP/H Rules/Histology--Breast: Which is the correct histology code to use and which MP/H rule applies in the case of a single lumpectomy specimen that demonstrates two separate tumors with the following histologies.

1) Invasive lobular carcinoma

2) Invasive ductal carcinoma with tubular features

See discussion.

Does ductal carcinoma with tubular features qualify for Breast MP/H Rule H28? Or, is it more appropriate to strictly follow Table 2 (not a type of ductal tumor) and apply Rule H29, thus losing the lobular component?

Abstract a single primary using Rule M13. Assign 8523/3 using rule H29. The code for  invasive ductal carcinoma with tubular features (8523/3) is higher than the code for invasive lobular carcinoma (8520/3). H28 does not apply because 8523/3 is not included as a type of duct carcinoma on Table 2.

2016
20160049

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.

2016
20160060

Mets at diagnosis fields--Heme & Lymphoid Neoplasms (Lymphoma): How are Mets at Diagnosis -- Bone, Brain, Liver, Lung, Lymph Node, and Other -- to be coded for lymphomas in 2016? Are they always 0 if the TNM Stage is I, II, or III? How is bone marrow involvement coded -- in which Mets at Diagnosis field?

Note: Answer verified Sept. 2019, still valid for current cases.

Code all mets at diagnosis fields to 0 when the Stage is I, II, or III.

When the lymphoma is Stage IV, one of the mets at dx fields (other than Mets at Dx-Distant lymph nodes) needs to be coded to 1. Stage IV indicates that there is multiple extralymphatic organ involvement, diffuse involvement of an organ; liver, brain, lung or bone involvement, or bone marrow involvement.

For bone, brain, liver, and lung, code these as 1 when these sites are involved and they are not the primary site. This is the same instruction for solid tumor neoplasms.

For mets at dx-distant lymph nodes, always code to 0. For lymphomas, lymph node involvement is included in stage and not based on whether they are regional or distant.

For mets at dx-other, code to 1 for bone marrow involvement or if there is multi extralymphatic organ involvement.

 2016
20160028

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.

2016
20160025

MP/H Rules/Histology: What is the correct histology code for a NUT midline carcinoma?

Code histology to 8010/3.

NUT carcinoma is identified by the NUTM1 gene rearrangement.  

NUT midline carcinomas (NMC) are lethal and morphologically indistinguishable from other poorly diff carcinomas. They are epithelial tumors which can range from undifferentiated carcinomas to carcinomas with prominent squamous differentiation.

A new proposed ICD-O-3 code has been suggested for NUT tumors but it is not yet approved for implementation. Do not use the new code until it is approved for use in the United States.

                           

2016
20160042

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.

2016
20160045

Neoadjuvant treatment/Grade--Prostate: How should the grade/differentiation field be coded when hormone therapy is given prior to radiation for metastatic prostate cancer? Is hormone treatment "neoadjuvant treatment" in this situation? Per NCCN guidelines, neoadjuvant hormone therapy is strongly discouraged outside of a clinical trial for localized disease. However for metastatic disease, hormone is recommended (gold standard). See discussion.

8/1/15 CT Exam showed enlarged prostate and left seminal vesicle with multiple enlarged pelvic LNs. Findings: suspicious for prostate cancer with invasion of seminal vesicle. Bone scan findings: positive bone mets in multiple sites. PSA 169.0 (elevated). Patient was started on casodex 8/12/15. A prostate biopsy was performed on 9/16/15 to confirm diagnosis, adenocarcinoma Gleason 4+5. Patient's treatment continued with radiation to bone.

For cases diagnosed prior to 2018

Code the grade/differentiation field from the biopsy for this situation. According to experts consulted, hormone therapy does not alter the grade in this case and grade should be coded based on information after hormone therapy when that is the only grade information available.

 2016
20160012

Reportability--Brain and CNS:  Is a thalamic amyloidoma reportable if so what histology code is used?

Thalamic amyloidoma is not reportable. Amyloidoma (tumoral amyloidosis, amyloid tumor) is a tumor-like deposit of amyloid. It is not neoplastic. Amyloid is a protein derived substance deposited in various clinical settings.

2016
20160065

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.

2016