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20180010 | Diagnostic confirmation--Heme & Lymphoid Neoplasms: Is Diagnostic Confirmation coded as 5 (positive laboratory test/ marker study) or code 8 (clinical diagnosis only) for a case that has a positive JAK2 mutation, and based on the results of the JAK2, the physician diagnosed the patient with polycythemia vera? There were no blood smears or bone marrow biopsies done. |
Assign diagnostic confirmation code 5 for a positive laboratory test/marker study. A note was added to the Hematopoietic manual to state that code 5 now includes cases with no histological confirmation but there is positive immunophenotyping or genetic studies. |
2018 | |
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20180107 | Solid Tumor Rules (2018)/Histology--Lung: If the pathology states non-small cell carcinoma of the lung (NSCLC), consistent with squamous cell carcinoma, is the code non-small cell carcinoma according to the Solid Tumor Rules? The Medical Oncologist states that the tumor is a squamous cell carcinoma. In these instances would you code the squamous cell carcinoma since you have a definite physician statement? |
Code the histology to SCC 8070/3. Based on registrar feedback on the NSCLC rule, we added a rule that specifically addresses when ambiguous terminology can be used to code histology other than NSCLC. The lung rules were update 10/12/2018 so please make sure you are using the currently posted rules. The new rule is: Rule H3-Code the specific histology when the diagnosis is non-small cell lung carcinoma (NSCLC) consistent with (or any other ambiguous term) a specific carcinoma (such as adenocarcinoma, squamous cell carcinoma, etc.) when: * Clinically confirmed by a physician (attending, pathologist, oncologist, pulmonologist, etc.) * Patient is treated for the histology described by an ambiguous term * The case is accessioned (added to your database) based on ambiguous terminology and no other histology information is available/documented Example 1: The pathology diagnosis is NSCLC consistent with adenocarcinoma. The oncology consult says the patient has adenocarcinoma of the right lung. This is clinical confirmation of the diagnosis, code adenocarcinoma. Your case meets the criteria in bullet 1. |
2018 | |
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20180089 | Reportability--Appendix: Is disseminated peritoneal adenomucinosis (DPAM) reportable when it is being referred to as if the primary tumor is a low-grade appendiceal mucinous neoplasm (LAMN)? See Discussion. |
Example 1: 8/23/2017 debulking path diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) with involvement of intrapelvic mucin, left ovarian mass, uterine serosa and pelvic tumor, consistent with disseminated peritoneal adenomucinosis, that may also be called low-grade mucinous carcinoma peritonei. 8/8/2018 resection of sigmoid and rectum, path diagnosis of peri-colorectal fibroadipose issue with low-grade mucinous carcinoma compatible with the prior diagnosis of pseumomyxoma peritonei with low-grade mucinous carcinoma histology. Example 2: Path diagnosis of low-grade appendiceal mucinous neoplasm in association with low grade mucinous carcinoma peritonei involving the serosa of the small intestine and mesentery. Also, there is involvement of serosal lined soft tissue of peritoneum, omentum, stomach, falciform ligament, gallbladder, diaphragm and spleen. Some pathologists in our area are referring to DPAM as mucinous carcinoma peritonei, which is causing confusion because the term carcinoma is being used. One would assume that because the pseudomyxoma peritonei/underlying tumor itself is low-grade (LAMN), then the case is not reportable, but we would like clarification. |
For cases diagnosed prior to 1/1/2022 Disseminated peritoneal adenomucinosis (DPAM) is not reportable when the primary tumor is a low-grade appendiceal mucinous neoplasm (LAMN). The term disseminated peritoneal adenomucinosis (DPAM) is discouraged by the WHO Digestive System monograph (page 123, section on pseudomyxoma peritonei (mucinous carcinoma peritonei)), since it does not clarify whether the process is low grade or high grade carcinoma. When used, the term should be referring back to the histology of the defining process and in both of these examples this appears to be LAMN, and therefore not reportable. The only exception to this might be if the peritoneal implants were invasive; that is, they contained adenocarcinoma invading into the underlying peritoneum, bowel serosa, etc., rather than simply being present within the surface mucinous material. The pathologist would make this clear if this was, in fact, believed to be invasive carcinoma. |
2018 |
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20180113 | Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of a 2018 lung cancer case with invasive non-mucinous adenocarcinoma? For non-mucinous carcinoma/adenocarcinoma, the Solid Tumor Rules have codes for microinvasive, minimally invasive, preinvasive, and in situ. Do we default to the microinvasive/minimally invasive code? |
Code histology to adenocarcinoma, NOS (8140/3). The World Health Organization and the College of American Pathologists no longer recognize non-mucinous carcinoma/adenocarcinoma, NOS. Pathologists are discouraged from using this term. Microinvasive/minimally invasive lung tumors have very specific criteria and these criteria do not apply to non-mucinous carcinoma, NOS. |
2018 | |
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20180096 | Reportability/Histology--Small intestine: Is a neuroendocrine microtumor of the duodenum a reportable tumor? See Discussion. |
This comment was added to the pathology report by the pathologist: A focus of neuroendocrine microtumor measured 350 micrometers, qualifying as a neuroendocrine microtumor. Focus was immunohistochemically positive for chromogranin and synaptophysin and negative for gastrin. The Ki-67/CD45 immunostain showed <1% positivity in microtumor. |
Neuroendocrine microtumor of the duodenum is reportable as 8240/3. "Microtumor" pertains to the size/amount of NET and not to a histologic type. |
2018 |
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20180006 | MP/H Rules/Histology--Breast: Should encapsulated papillary carcinoma of the breast with a separate focus of ductal carcinoma in situ be coded as 8050/2 (papillary carcinoma) and staged as in situ? See Discussion. |
Pathology--Right breast, lumpectomy with needle localization: Encapsulated papillary carcinoma of the breast. A separate focus of ductal carcinoma in situ is present. Sentinel lymph node, right breast, biopsy: One lymph node, negative for malignancy. No metastatic carcinoma is seen on slides stained with immunostain for cytokeratin (AE1/AE3). Specimen laterality: Right. Tumor size: 1.2 cm. Histologic type: Encapsulated papillary carcinoma. Nuclear grade: Grade 1 (low). Mitotic rate: Score 1. Ductal carcinoma in situ (DCIS): DCIS is present. Estimated size (extent) of DCIS: 3 mm. Architectural patterns: Cribriform and papillary. Nuclear grade: grade 1 (low). Necrosis: Not identified. Margins: Margins uninvolved by encapsulated papillary carcinoma. Distance from closest margin: 8 mm, superior Margins uninvolved by DCIS. Distance from closest margin: 11 mm, superior Lymph nodes: Total number of lymph nodes examined (sentinel and nonsentinel): 1. Number of sentinel lymph nodes examined: 1. Number of lymph nodes with tumor cells: 0. Pathologic staging: Primary tumor: See comment. Regional lymph nodes: pN0(i-). Comment: In the WHO Classification of Tumours of the Breast (2012), it is stated that "there is no universal agreement on how to stage encapsulated papillary carcinomas. In the absence of conventional invasive carcinoma, the consensus of the WHO Working Group was that such lesions should be staged and managed as Tis disease." |
For cases diagnosed prior to 2018 Code as encapsulated papillary carcinoma, 8504/3; this is a synonym for intracystic carcinoma (WHO Classification of Tumors of the Breast). Stage this case as invasive. |
2018 |
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20180095 | Solid Tumor Rules (2018)/Histology--Lung: How is histology coded when the term "predominant" is used to describe solid adenocarcinoma, acinar adenocarcinoma, etc.? Pathology reports often say "See Synoptic" (also known as the College of American Pathologists (CAP) protocol) included in the Final Diagnosis rather than including all the detail. Based upon the new Solid Tumor Rules for lung, predominant/predominantly is no longer a subtype/variant and should not be coded unless there is a specific code/subtype-variant for the NOS in Table 3, e.g., adenocarcinoma, lepidic predominant. See Discussion. |
Examples Example #1: CAP histology type: Adenocarcinoma, solid predominant, Final diagnosis states that Adenocarcinoma, poorly differentiated, solid predominant (80%) and cribriform (20%) subtype (see lung carcinoma synoptic report) Example #2: CAP histology type : Invasive adenocarcinoma, solid predominant, Other Subtypes Present (specify subtype(s), may also include percentages): acinar (45%) and micropapillary (5%) Final diagnosis : adenocarcinoma of the lung, please see Synoptic Report Example #3: CAP histology type: Adenocarcinoma, acinar predominant , Adenocarcinoma, solid predominant Final diagnosis: Adenocarcinoma, poorly differentiated, solid predominant (60%), papillary (30%) and acinar (10%) subtype (see lung carcinoma synoptic report) |
The lung H rules and tables have been updated to include histologies that CAP identifies using the term "predominant" in the diagnosis. Example: Code adenocarcinoma, lepidic predominant, to 8250/3 rather than 8140/3. When the final pathology diagnosis includes more than one "predominant" adenocarcinoma subtype such as acinar, solid, or lepidic, then code the type with the greatest percentage according to Lung Solid Tumor Rule H7. |
2018 |
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20180026 | Solid Tumor Rules (2018)--Breast: How many primaries are accessioned when a prophylactic mastectomy reveals a final diagnosis of invasive tubular carcinoma, but the College of American Pathologists (CAP) Protocol includes ductal carcinoma in situ (DCIS) sized separately and it is not clear if these are different tumors? See Discussion. |
The patient was incidentally diagnosed with cancer on a prophylactic mastectomy, so there are no positive imaging findings to correlate the number of tumors/masses. The final diagnosis was invasive tubular carcinoma, and referred to the CAP Protocol. The CAP notes: However, it does not specify whether the single contiguous focus also includes the in situ component. The CAP goes on to note DCIS was present: The gross description does not provide any indication of either a single or multiple tumors/masses/lesions, though it was referred to as "Lesion 1" in the gross description with no indication of other lesions. The format of the CAP Protocol frequently does not specify whether the DCIS is a separate measured tumor, or if it is a component of the invasive tumor. This makes it difficult to determine whether the DCIS should be a separate primary when the invasive tumor is not also a type of ductal carcinoma. Per both the 2007 MP/H and 2018 Solid Tumor Rules, an invasive tubular carcinoma and a ductal carcinoma in situ would be multiple primaries if they were multiple tumors. Should we default to Rule M1: Abstract a single primary when it is not possible to determine if there is a single or multiple tumors? Or should we assume these are separate tumors because they were both sized, the focality only described a single invasive tumor, and the tumors are not both ductal carcinomas? |
Accession a single primary using Solid Tumor Rule M3. Based on the information provided, this was described as "Lesion 1' with no other lesions noted in the gross description. If the DCIS was a separate tumor, this would have been noted by the pathologist. Reminder, the breast CAP protocol is a checklist for pathologists to note their findings while reviewing the slides and/or specimen. The findings and notes should be consolidated into a final/synoptic report. |
2018 |
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20180109 | Date of diagnosis/Ambiguous terminology--Cervix Uteri: Is the date of diagnosis of a cervical pap smear done in December 2017, that states high-grade squamous intraepithelial lesion with features suspicious for invasion, followed by a cervical biopsy in 2018 positive for squamous cell carcinoma, in 2017? Is the ambiguous term used in the cytology in 2017 (suspicious for invasion) to determine diagnosis as the SEER manual states to use the ambiguous cytology as the date of diagnosis if confirmed later. |
Updated for cases diagnosed 2022 or later For cases diagnosed in 2022 or later, see the instructions in the SEER manual under Reportability and Date of Diagnosis for ambiguous cytology. |
2018 | |
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20180066 | Solid Tumor Rules (2018)/Laterality--Brain and CNS: How is laterality coded for bilateral non-malignant central nervous system (CNS) or malignant CNS tumors now that laterality is no longer used to identify these tumors as multiple primaries? See Discussion. |
The Equivalent Terms and Definitions sections in the Solid Tumor Rules for these schemas identify which sites must have laterality coded, but there is no instruction for coding laterality when bilateral tumors are a single primary. The SEER Manual currently only indicates code 4 (bilateral) is seldom used (e.g., bilateral ovarian tumors, Wilms tumors, etc.) but does not indicate laterality code 4 should be used for CNS tumors. Is this note going to be updated or should a non-bilateral code be applied? Example: MRI demonstrates multiple left-sided dural-based meningiomas including a 4.4 cm left posterior fossa meningioma, a 0.8 cm left frontal-parietal meningioma and a right posterior frontal meningioma. The large left posterior fossa meningioma was resected and proved atypical meningioma. Should the laterality be 4 (bilateral) as the patient had both left and right-sided meningiomas confirmed to be a single primary? Or should the laterality be coded as 2 (left) since only the large left-sided meningioma was proven to be a borderline tumor (atypical meningioma, 9539/1) and the others were benign? |
Determine whether the CNS tumors are single or multiple primaries. Multiple cerebral meningiomas are a single primary according to the non-malignant CNS Solid Tumor Rules. Assign laterality using the 2018 SEER Manual for select invasive, benign, and borderline primary intracranial and CNS tumors using codes 1-9 for all sites listed in the Sites for Which Laterality Codes Must Be Recorded table. In the example, assign code 4, bilateral involvement at time of diagnosis, lateral origin unknown for a single primary. The solid tumor rules are not a one-stop-shop for all coding. Refer to the appropriate coding manual for laterality. We removed laterality for determining multiple primaries in meningiomas as they were being over-reported according to CBTRUS. |
2018 |
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