MP/H Rules/Multiple primaries--Lung: How many primaries should be accessioned if patient has a LUL lung biopsy with squamous cell carcinoma and subsequently a station 4L node biopsy with small cell carcinoma? See Discussion.
Patient has only a LUL tumor on imaging. The tumor board initially states, possibly a mixed tumor, likely IIIA SCC and/or IIIA or B small cell. Later, the physician refers to it as "Stage III lung cancer, mixed histology with small cell in the lymph node and squamous cell in the LUL mass." Patient has no further workup and has declined therapy.
Accession the case as a single lung primary since there is only a mixed tumor noted by the tumor board. Code the histology as 8045, combination/mixed small cell carcinoma and squamous cell carcinoma, per Table 1 of the Multiple Primaries/Histology Rules.
Histology/Behavior--Brain and CNS: How are histology and behavior coded for a diagnosis of pineal anlage tumor in an infant? See Discussion.
Patient is an 11 month old with brain biopsy showing final diagnosis of pineal anlage tumor. How are behavior and histology coded for this rare tumor?
Assign 9362/3 for pineal anlage tumors. According to the WHO Classification of Tumors of the Central Nervous System, 4th edition, pineal anlage tumors, while extremely rare, share features with pineoblastoma. Although they have a distinct morphology, there is no other ICD-O-3 code for pineal anlage tumors.
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.
Grade--Appendix: What is the code and term to use for the grade/differentiation field for well differentiated, Grade 2 neuroendocrine tumor (NET)? See Discussion.
Diagnosis: Fragmented appendix with: Goblet cell carcinoid tumor (typical goblet cell carcinoid): WELL DIFFERENTIATED neuroendocrine tumor; INTERMEDIATE GRADE (GRADE 2 NET). Size 3.5 cm according to surgical pathology report. Tumor infiltrates through appendiceal wall to subserosa. Tumor is present in what appears to be the wall of the appendix near the perforation site or in hemorrhagic tissue on the surface of the appendix. MAXIMUM MITOTIC RATE IS TWO (2) FIGURES PER 10 HIGH POWER fields (2/10hpf). (4/10 hpf according to report).
WD indicates a 3- grade system (code 1 for WD) Intermediate grade indicates a 3- grade system (code grade 3 for intermediate grade), Grade 2 indicates a 2- grade system (code 2 for grade 2). Please advise.
See SINQ 20160023 for NET grade coding instructions. Coding grade for NETs is slightly different from coding grade for other solid tumors.
Since this diagnosis includes "Well differentiated" and "Grade 2," assign grade code 2, the higher grade. According to our expert pathologist consultant, "intermediate" fits best with grade 2.
Reportability--Bone: Are giant cell tumors (GCT) of the bone that metastasize to the lung reportable? See Discussion.
Patient had radical resection of pelvic giant cell tumor of bone in August 2012. Final diagnosis clarified that no features to suggest a frankly malignant giant cell tumor were identified.
July 2013 left upper lobe nodules were removed and found to be consistent with multifocal metastatic lung involvement with a previous pelvic giant cell tumor of bone. However, the pathology report comment specifies there are no histological high-grade features to suggest a malignancy:
While SINQ 20091087 may apply, these metastases clearly arrived in the lung by hematogenous spread. The previous SINQ note refers to a case where the implants/metastases can seed the surrounding pelvic and abdominal structures by rupture of the tumor or intraoperative tumor spillage. That type of spread is not quite the same as the current case showing tumor cells leaving the primary tumor/site and travelling through the blood to implant in the lungs.
This case is not reportable. According to the WHO Classification of Bone Tumors, pulmonary metastases from GCTs are "very slow-growing and are thought to represent pulmonary implants that result from embolization of intravascular growths of GCT. Some of these benign pulmonary implants can regress spontaneously. A small number, however, exhibit progressive enlargement and can lead to the death of the patient." The pathologist for this case is very clear that no malignancy was found in the lung or in the bone.
MP/H Rules/Histology--Brain and CNS: What is the code for an embryonal tumor with multilayered rosettes. WHO shows the code as 9478/3, but this code is not available for use in the United States.
Assign ICD-O-3 code 9392/3 until code 9478/3 is implemented in 2018. Per our expert neuropathologist, embryonal tumor with multilayered rosettes was previously called ependymoblastoma.
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.
MP/H Rules/Histology--Thyroid: What is the correct histology when final diagnosis of a thyroidectomy includes the descriptor "papillary and follicular architecture?" See Discussion.
Total thyroidectomy Final Diagnosis: Papillary carcinoma, classical type, with papillary and follicular architecture.
The 2007 MP/H rules state that the term architecture is reserved for coding subtype of in situ primaries only. However, SINQ 20130165 appears to indicate this should be coded for invasive thyroid subtypes as well. Can you confirm the addition of the term architecture for determining an invasive histologic subtype for thyroid?
Assign code 8260/3, papillary carcinoma per Multiple Primaries/Histology Rule H14.
Architecture is reserved for coding subtype of in situ primaries only. SINQ 20130165 is not intended to indicate this should be coded for invasive thyroid subtypes.
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