Report | Question ID | Question | Discussion | Answer | Year |
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20170052 | MP/H Rules/Histology--Bladder: Is urothelial carcinoma, high-grade, predominantly solid type, coded as 8120/3 or 8230/3? See Discussion. |
Urinary bladder: Invasive urothelial carcinoma, high-grade, 4.5cm, predominantly solid type, arising in background of carcinoma in-situ, carcinoma grossly extends into perivesical adipose tissue; lymph-vascular invasion is seen. |
Assign histology code 8120/3, urothelial carcinoma, NOS. Solid type is not a recognized variant of urothelial tumors and likely represents the appearance of the urothelial cells within the tumor and not a specific histologic type. |
2017 |
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20170068 | MP/H Rules/Histology--Lung: What is the histology of a lung tumor described as solid predominant with mucin production, 8230/3 (Multiple Primaries/Histology (MP/H) Rule 5) or 8255/3 (MP/H Rule 6)? See Discussion. |
Pathology report: Left lower lobe lung, Tumor Size: Greatest dimension: 3.0 cm Additional dimensions: 2.5 x 2.0 cm; Tumor Focality: Unifocal; Histologic Type: Invasive adenocarcinoma Solid predominant with mucin production; Histologic Grade: G3: Poorly differentiated. Is the correct histology for this case 8230/3 (rule H5) or 8255/3 (rule H6)? |
Code histology as 8230/3, solid adenocarcinoma with mucin formation, using MP/H Rule H3 as one histologic type is identified. All of the histologic terms (solid, mucin production) are covered by 8230/3. Therefore, rule H3 applies. Use the first rule that applies, and stop. |
2017 |
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20170072 | Reportability--Heme & Lymphoid Neoplasms: Is the diagnosis of large granular lymphocyte syndrome or large granular lymphocyte disorder a reportable synonym for T-cell large granular lymphocytic leukemia? See Discussion. |
The physician consult in this case further specifies that the large granular lymphocyte disorder represents an autoimmune disease of autoimmune T-cell mediated mechanism. Is this a reportable diagnosis? |
Report large granular lymphocyte disorder (9831/3). Alternate names for T-cell large granular lymphocytic leukemia (9831/3) listed in the Hematopoietic and Lymphoid Neoplasms Database include but are not limited to Chronic large granular lymphocyte lymphoproliferative disorder, large granular lymphocytosis, NOS, and T-cell large granular lymphocytosis. |
2017 |
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20170074 | Reportability--Kidney: Is a renal cell neoplasm stated to be multilocular clear cell renal cell neoplasm of low malignant potential a reportable tumor if the physician refers to the tumor as renal cell carcinoma in a follow-up note after surgery? If reportable, how is histology coded? See Discussion. |
The partial nephrectomy final diagnosis is renal cell neoplasm. The College of American Pathologists (CAP) Summary lists histology as: multilocular clear cell neoplasm of low malignant potential. The diagnosis comment adds: This neoplasm currently termed multilocular clear cell renal cell neoplasm of low malignant potential (WHO 2016), was previously termed cystic renal cell carcinoma. |
For now, report the case and code to 8310/3. In the 3rd Ed WHO Tumors of the Urinary System, multilocular clear cell RCC is coded as 8310/3, however the recent 4th Ed WHO Tumors of Urinary System notes this term is obsolete and a synonym for multilocular cystic renal neoplasm of low malignant potential (8316/1) which would be non-reportable. Per WHO 3rd Ed these tumors never recur or metastasize which may be why the behavior code is shown as /1. The standard setters must review this terminology change in relation to reporting the case as it may impact incidence rates. |
2017 |
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20170028 | MP/H Rules/Histology--Kidney: How should histology be coded for a clear cell renal cell carcinoma when the CAP protocol indicates sarcomatoid features are present? See Discussion. |
Sarcomotoid (8318) is listed as a specific renal cell subtype in the MP/H manual, but it is not listed as a renal cell subtype in the most recent WHO blue book for Urinary Organs. We are wondering if sarcomatoid features, as listed in the CAP protocol format in the following example, should be ignored when coding histology? Left kidney, radical nephrectomy: Clear cell renal cell carcinoma, with the following features: Tumor size: 8.5 X 6 cm. Tumor focality: Unifocal. Macroscopic extent of tumor: Tumor limited to kidney. Sarcomatoid features: Present (<20% of tumor shows sarcomatoid features). Histologic grade: G4. Microscopic tumor extension: Tumor limited to kidney. Margins: All margins negative for invasive carcinoma. Lymph-vascular invasion: Not identified. |
Code 8255 (adenocarcinoma with mixed subtypes). The Multiple Primaries/Histology Rule H6 applies as there are two or more specific renal cell carcinoma types, clear cell and sarcomatoid (Spindle cell), as listed in Table 1 of the kidney Terms and definitions. |
2017 |
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20170020 | Size of tumor--Breast: Please clarify guideline #7 if the only size you have is from a CORE biopsy specimen and imaging only states nonspecific sizes, like "architectural distortion" or "calcifications" and a core biopsy pathology reports invasive tumor spans 5mm. Do you use the core biopsy size, or use 999 for clinical tumor size? See discussion. |
SEER Program Coding and Staging Manual 2016 states: Record size in specified order using a. The largest measurement of the primary tumor from physical exam, imaging, or other diagnostic procedures before any form of treatment. See Coding Instructions 7-9 below. b. The largest size from all information available within four months of the date of diagnosis, in the absence of disease progression when no treatment is administered. #7 Priority of imaging/radiographic techniques: Information on size from imaging/radiographic techniques can be used to code clinical size when there is no more specific size information from a biopsy or operative (surgical exploration) report. It should be taken as a lower priority, but over a physical exam. |
Do not code size of tumor based on the size of the core biopsy. If the statement "invasive tumor spans 5mm" from the core biopsy report represents the surgeon's assessment of tumor size, use this information to code tumor size when no other information is available. |
2017 |
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20170025 | MP/H Rules/Multiple primaries--Breast: Is this the same primary per MP/H Rule M10? Ductal carcinoma of the left breast in 2013, treated with a lumpectomy. New tumor with ductal and lobular carcinoma in the same breast in 2016. |
The 2016 diagnosis is the same primary. MP/H Rule M10 for breast cancer applies. Do not change the original histology code. Use text fields to document the later histologic type -- duct and lobular. |
2017 | |
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20170008 | MP/H Rules/Histology--Colon: Is the code for invasive adenocarcinoma in a serrated adenoma 8213/3? The NAACCR Guidelines for ICD-O-3 Update Implementation, effective 1/1/14, provides new terms including 8213/0 for sessile serrated adenoma/sessile serrated polyp and 8213/3 for serrated adenocarcinoma. This would cause Site/Type and Histology overrides to be set. Coding 8210/3 would allow the case to be reported without overrides. See Discussion. |
Pathology report 1/13/15, Histology - Transverse colon resection pathology = Invasive moderately differentiated adenocarcinoma. The invasive adenocarcinoma arises in a sessile serrated adenoma. |
Assign 8213/3 to invasive adenocarcinoma arising in a sessile serrated adenoma. The instruction in SINQ 20120089 is still valid. The 2014 ICD-O-3 Update does not change this SINQ answer. |
2017 |
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20170076 | MP/H Rules/Histology--Brain and CNS: Is meningioma with atypical features coded as meningioma (9530/0) or atypical meningioma (9539/1)? See Discussion. |
Pathology report microscopic description: The tumor is a meningothelial neoplasm (EMA+; BCL-2 and CD34 negative) with prominent collagen deposition. Necrosis and prominent nucleoli are present; no other atypical features are seen. Mitoses are present, up to 2 per 10 high-powered fields. Final Diagnosis: Dura, bicoronal craniotomy (specimen A): Meningioma with atypical features. There is no rule in benign brain and CNS section of Multiple Primary/Histology (MP/H) Rules stating to code the most specific histologic term when the diagnosis is (something less specific, i.e., adenocarcinoma). This rule is in other site chapters of MP/H but appears missing in the benign brain and CNS section. |
Code as meningioma, NOS (9530/0). This lesion has some of the features of an atypical meningioma (necrosis and prominent nucleoli), but it does not fit the definition of atypical meningioma in WHO Classification of Tumors of the Central Nervous System. Use text fields to document the details. |
2017 |
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20170019 | MP/H Rules/Histology--Testis: How should histology be coded for a mixed germ cell tumor that also includes choriocarcinoma now that non-seminomatous mixed germ cell tumors (9065) and seminomatous mixed germ cell tumors (9085) are collapsed for analysis? See Discussion. |
The MP/H Rules (Other Sites Terms and Definitions, Table 2) currently lists a separate mixed germ cell tumor code (9101) for germ cell tumors with choriocarcinoma plus teratoma, seminoma or embryonal carcinoma. Is this separate mixed germ cell tumor code still to be used now that all mixed germ cell tumors (9065 and 9085) have been collapsed into code 9085 for analysis per SINQs 20160056 and 20110013? The current WHO Classification for testis tumors does not list code 9101, but also collapses all seminomatous and nonseminomatous mixed germ cell tumors of more than one histologic type under code 9085. |
While WHO 4th Ed Tumors of Urinary and Male Genital System does not include 9101/3, this code has not been made obsolete. Follow the 2007 MP/H rules and code histology to 9101/3 per Other sites rule H16, Table 2. |
2017 |