Report | Question ID | Question | Discussion | Answer | Year |
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20180014 | Reportability/Histology--Brain and CNS: Is multinodular and vacuolating neuronal tumor of the cerebrum reportable, and if so, is the histology coded as 9492/0? See Discussion. |
Patient diagnosed with multinodular and vacuolating neuronal tumor of the cerebrum. My research shows: Multinodular and vacuolating neuronal tumor of the cerebrum is a recently reported benign, mixed glial neuronal lesion that is included in the 2016 updated World Health Organization classification of brain neoplasms as a unique cytoarchitectural pattern of gangliocytoma. There is no code in ICD-O-3 for it, so do I report it and use 9492/0 or not ? |
Do not report multinodular and vacuolating neuronal tumor of the cerebrum. At this time, WHO is undecided about whether this is a neoplastic or a hamartomatous/malformative process. If WHO makes a determination that this is a neoplastic process, we will update reportability instructions and ICD-O-3 guidelines for registrars. |
2018 |
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20180081 | Reportability--Corpus uteri: Is endometrial atypical complex hyperplasia/borderline endometrial adenocarcinoma (FIGO 1), (mucinous type), (no invasion of myometrium) reportable? |
Do not report this case based on the information provided. The actual diagnosis is somewhere between atypical hyerpplasia and carcinoma in situ. Do not report until/unless a more definitively reportable diagnosis is made. |
2018 | |
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20180078 | Solid Tumor Rules (2018)/Histology--Breast: How is histology coded and which rule applies for a single in situ tumor that is described as an encapsulated papillary carcinoma (EPC) with conventional ductal carcinoma in situ (DCIS)? See Discussion. |
Patient had a breast excision that proved a single tumor with no evidence of invasive carcinoma. The final diagnosis stated: Size (extent) of EPC DCIS: Spanning approximately 1.3 cm. The pathologist did not describe separate foci of DCIS; only one tumor comprised of both encapsulated papillary carcinoma and DCIS. The encapsulated papillary carcinoma was not described as invasive. The pathology noted: This case is best classified as EPC conventional DCIS. No conventional stromal invasion is identified. Solid Tumor Rule M2 confirms a single tumor is a single primary. However, there does not appear to be an H Rule that instructs how to code histology. The Single Tumor: In Situ Only module, has only three H Rules and none of them apply to this case. The patient does not have Paget disease (H1), does not have a single histology (H2, there are multiple histologies present as DCIS and EPC are listed on different rows in Table 3) and does not have DCIS and LCIS (H3). How does one arrive at the correct histology for this case? |
Code histology to 8500/2. Per April 2019 update: Rule H5 applies: Code DCIS 8500/2 when there is a combination of DCIS and any other carcinoma in situ. The 4th Ed WHO Tumors of the Breast states that tumors with encapsulated papillary carcinoma in situ in the absence of DCIS in the surrounding tissue have a very favorable prognosis. Only tumors without DCIS should be coded to 8504/2. The component of DCIS will determine treatment. |
2018 |
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20180079 | Solid Tumor Rules/Multiple primaries--Breast: How many primaries should be abstracted when papillary carcinoma is identified in two biopsies and a subsequent lumpectomy identified invasive ductal carcinoma with multifocal ductal carcinoma in situ (DCIS)? See Discussion. |
The right breast ultrasound shows a 1.4 cm mass at 8 o'clock and a separate mass .6 cm at 7 o'clock (site code for both C50.5). Pathology report: Right 8 o'clock core needle biopsy fragments of intracystic noninvasive papillary carcinoma (8504/2), right 7 o'clock core needle biopsy fragments of intracystic noninvasive papillary carcinoma (8504/2). Then, another facility performs a right breast lumpectomy (operative note not available). Outside Facility: Right breast lumpectomy pathology shows invasive ductal carcinoma .6cm (8500/3) multifocal DCIS .5cm greatest dimension tumor site right breast NOS. Should we use Rule M12-Abstract multiple primaries when separate/non-contiguous tumors are on different rows in Table 3 in the Equivalent Terms and Definitions. Timing is irrelevant. Note: Each row in the table is a distinctly different histology. So would this be two primaries C50.5 (8504/2) and C50.9 (8500/3)? |
Abstract as multiple primaries using Breast Solid Tumor Rule M12 as these are separate, non-contiguous tumors on different rows in Table 3. |
2018 |
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20180033 | Reportability--Corpus uteri: Is smooth muscle tumor with uncertain malignant potential (STUMP) reportable? See Discussion. |
Spindled cell lesion of smooth muscle origin (desmin and SMA are positive, CD34, S100, pancytokeratin, Pax8, MDM2 and CDK4 are negative). Many of the cells have hyperchromatic, bizarre-shaped nuclei. Mitotic activity is inconspicuous. There are no areas of necrosis. The overall findings in this biopsy is best classified as a "STUMP"; however, a leiomyosarcoma cannot be excluded. |
STUMP (smooth muscle tumor of uncertain malignant potential) is not reportable. According to the WHO classification of uterine corpus tumors, the behavior code for STUMP is /1. |
2018 |
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20180038 | Multiple Primaries--Heme & Lymphoid Neoplasms: How many primaries should be reported when a 10/10/2017 skin biopsy identified myeloid sarcoma with monocytic differentiation, clinically stated to be leukemia cutis is followed by an 11/2/2017 BM biopsy showing an evolving high grade myelodysplastic process with atypical monocytes, likely an early evolving acute myeloid leukemia (AML), clinically stated to be a therapy-related AML (9920/3)? See Discussion. |
Code 9920/3 is not included under rule M3. However, disease process knowledge would indicate that because the patient has an underlying AML subtype, the leukemia cutis is due to the AML cells that have migrated into the skin tissue. This appears to be a single advanced disease process essentially diagnosed simultaneously. |
The leukemia cutis is secondary to leukemia that is already present. This is multiple disease processes going on at the same time. Look for more information on this case. Is there any previous diagnosis of MDS, leukemia, or some other disease that would result in a treatment related AML? If no further information can be found, abstract one primary with 9920/3. |
2018 |
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20180008 | MP/H Rules/Multiple primaries--Thyroid: Is medullary carcinoma of the right lobe of the thyroid, with foci of papillary microcarcinoma in both lobes, one primary with mixed histology (8347/3) or two separate primaries? |
For cases diagnosed prior to 2018 Abstract two primaries, Medullary (8510/3) and papillary microcarcinoma (8260/3). Other sites rule M17 applies. |
2018 | |
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20180056 | Primary Site--Ovary: How should primary site be coded for a previously diagnosed ovarian cancer which is now being reclassified as fallopian tube? See Discussion. |
There is a group of patients diagnosed within the past few years with ovarian cancers who are now enrolled in a clinical trial and are being screened as potential patients for a particular protocol. The screening for these particular cases is being done by a pathologist who has a particular interest in GYN pathology. As the pathologist is screening the cases, there are some which the pathologist is reclassifying as being fallopian tube primaries rather than ovarian primaries. This is apparently due to newly emerging findings and literature. The problem for me is that these cases have been entered into the registry as ovarian primaries, which was correct as of the time of the initial diagnosis. Should the abstracts remain as they were initially coded, since the diagnosis was ovarian cancer at the time they were diagnosed, or should these cases be updated to reflect the current pathologist's interpretation that these are fallopian tube primaries? |
Do not change the primary site in this situation. Since the review was done for a clinical trial and the change was not officially made in the patient's medical record, the primary site remains ovary for the cancer registry. Add an explanatory note in a text field for future reference. |
2018 |
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20180102 | Solid Tumor Rules 2018/Histology--Brain and CNS: What code should be used for high grade neuroepithelial tumor with BCOR Alteration? See Discussion |
A recent molecular study of PNET tumors at NCI (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139621) seems to indicate the discovery of four new CNS tumor entities, of which HGNET-BCOR is one. The article suggests that these are not primitive neuroectodermal tumors tumors (PNET), but something different. |
This question was reviewed by an expert neuropathologist. He recommends coding these tumors to malignant tumor, clear cell type 8005/3. He states: these tumors are extremely rare. In summary, CNS HGNET-BCOR represents a rare tumor occurring in young patients with dismal prognosis. Whether CNS HGNET-BCOR should be classified among the category of "embryonal tumors" or within the category of "mesenchymal, nonmeningothelial tumors" remains to be clarified. Because CNS HGNET-BCOR share pathologic features and characteristic BCOR-ITD with clear cell sarcoma of the kidney, these tumors may represent local variants of the same entity. |
2018 |
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20180037 | Date of Diagnosis--Colon: If a patient has a positive Cologuard test, is the date of diagnosis the date of the cologuard test or the date of the biopsy? |
Do not use the date of a positive Cologuard test as the date of diagnosis. |
2018 |