Report | Question ID | Question | Discussion | Answer | Year |
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20180103 | Histology/Grade--Small intestine: For a 2017 diagnosis, is the grade/differentiation field coded 1 or 9 when the diagnosis is well-differentiated neuroendocrine tumor (NET) (carcinoid)? It seems as though the term well-differentiated defines type of neuroendocrine tumor so they can diagnosis the carcinoid. See Discussion. |
5/15/17 Duodenal bulb, biopsy: Fragments of duodenal mucosa with well differentiated neuroendocrine tumor (carcinoid), extending to the edge of specimen and peptic duodenitis in the submitted tissue. No significant intraepithelial lymphocytosis. |
Assign grade code 1 for well-differentiated NET (8240/3). Well-differentiated is synonymous with NET, grade 1, according to WHO Classification of Tumors of the Digestive System. |
2018 |
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20180105 | 2018 Solid Tumor Rules/Histology--Lung: What is the appropriate histology code for the case below in the Discussion section? Is there a difference between adenocarcinoma in situ (bronchioloalveolar carcinoma), non-mucinous type (8252/2) and adenocarcinoma in-situ, mucinous? See Discussion. |
Procedure: Wedge, resection specimen, Laterality: Right, Tumor site: Right upper lobe, Tumor size: 1.0 cm in greatest dimension, Histologic type: Adenocarcinoma in-situ, mucinous, Histologic grade: N/A, Visceral pleura invasion: Not identified, Tumor extension: N/A, Margins: Uninvolved, Lymphocytosis. |
Assign 8253/2 for adenocarcinoma in situ, mucinous. New codes were added in 2018 for mucinous adenocarcinoma in situ for lung cancer only as all cases were not invasive. Pathologist are discouraged from using the term BAC. In-situ lung tumors can now be identified as either mucinous or non-mucinous and the appropriate ICD-O code should be assigned based on diagnosis. |
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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20180064 | Solid Tumor Rules (2018)/Recurrence--Breast: Does any recurrence within the multiple primaries-stated timeframe count, not those just in the primary site? See Discussion. |
A patient has a left breast cancer diagnosed in 2011; then has a "recurrence" in her lymph nodes in 2017. In 2018, she has a new left breast mass that is the same histology and behavior as the 2011 cancer. Based on the 2017 "recurrence" in the lymph nodes, this is not a new breast primary, is that correct? |
This is a single primary using 2018 Breast Solid Tumor Rule M11. Rule M8 does not apply because the patient was not clinically disease free for 5 years. We are interpreting the 2017 diagnosis as lymph node metastasis from the 2011 breast cancer diagnosis. |
2018 |
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20180016 | Primary site--Pancreas: Is the uncinate process of the pancreas coded to C259, C250, or C257? |
Assign C250 to the uncinate process of the pancreas. The uncinate process is part of the head of the pancreas. |
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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20180050 | Reportability/Heme & Lymphoid Neoplasms: Is monoclonal B-cell lymphocytosis reportable? See Discussion. |
We noticed this term was added to the most recent version of the Heme Database (DB) as an alternate name for chronic lymphocytic leukemia/small lymphocytic lymphoma; however we do not recall being notified that this was a new reportable term for code 9823 and the term was not included in the 2018 ICD-O-3 Histology updates. The Definition in the Heme DB for Chronic lymphocytic leukemia/small lymphocytic leukemia (CLL/SLL) includes information that the term was added in the 2016 WHO revision, thus would be reportable back to 2016, is that correct? In addition, the Definition seems to be describing it as a precursor condition to CLL and may never actually evolve into CLL, so it is unclear if this term should really be reportable. Example: 09/08/2016 Onc Note: A/P: monoclonal B-cell lymphocytosis of undetermined significance (MBL): I reviewed with him the results of the bone marrow biopsy. Interestingly, there is no evidence of abnormal plasma cell population by flow cytometry and immunohistochemistry. Nevertheless, flow cytometry does demonstrate a very small population of abnormal and monoclonal B-cell lymphocyte population with immunophenotype consistent with CLL/SLL. Given the very low number of the abnormal B cells, this can be categorized as monoclonal B-cell lymphocytosis (MBL). I recommend surveillance visit in one year. 9/12/2017 Onc note: A/P: Monoclonal B-cell lymphocytosis of undetermined significance (MBL) and IgM MGUS. No symptoms concerning for active disease or progression. Explained that MBL is a very indolent process. Patients with CLL-phenotype MBL progress to CLL at a rate of ~1-2 percent per year. Follow-up in 1 year. Is this case reportable? |
Monoclonal B-cell lymphocytosis is not a reportable condition. This term will be removed from 9823/3 since it is a /1 (has it's own code). This will become much more clear once we get the new WHO Heme terms into the database. |
2018 |
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20180111 | Reportability/Histology--Appendix: Is high grade appendiceal mucinous neoplasm (HAMN) diagnosed in 2018 reportable? See Discussion. |
Example: Initial CT scan impression is large appendiceal mucocele with a moderate amount of right-sided abdominal ascites. Faint mural enhancement suggesting an underlying appendiceal neoplasm (mucinous adenoma or adenocarcinoma). Appendectomy follows two days later with final diagnosis of high-grade appendiceal mucinous neoplasm, see comment. Histologic grade: Grade G2 of 4 (based on the CAP protocol) . . . Ascites fluid (ThinPrep(r) and cell block preparations): Mucin, fragments of debris, and macrophages. No diagnostic neoplastic cells are identified . . . Pathologic stage: pT4a, pNX, pM1a (AJCC 8th ed). Diagnosis Comment states, We feel that there are areas of this tumor where the cytologic atypia is beyond what one would expect in low-grade appendiceal mucinous neoplasm. While mitotic figures are not strikingly increased, there are focal nuclear changes that would support classification of this tumor as high-grade appendiceal mucinous neoplasm. Approximately two weeks later the patient has an Oncology assessment stating new diagnosis of T4a, NX, M1a, Stage IVA high-grade mucinous adenocarcinoma of the appendix with mucinous ascites. Patient has had an appendectomy but no further surgery so far. However, anecdotally, the best reported case series has been with surgical debulking followed by HIPEC chemotherapy In that instance I have recommended surgery with intraperitoneal chemotherapy. Is this a reportable malignancy? If so, what is the best histology for the diagnosis? |
2022 and later HAMN is reportable. Assign 8480/2. |
2018 |
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20180082 | Summary Stage Manual 2018 "Lymphoma: SEER Summary Stage 2000 states: For lymphomas, any mention of lymph nodes is indicative of involvement and is used to determine the number and location of lymph node chains involved (see lymphoma scheme). This statement is not in SEER Summary Stage 2018. Does that mean we follow rules #4-7, pages 14-15, under Code 3: Regional Lymph Nodes only, for every site, including lymphoma? |
The following statement "Any mention of the terms including fixed, matted, mass in the hilum, mediastinum, retroperitoneum, and/or mesentery, palpable, enlarged, shotty, lymphadenopathy are all regarded as involvement for lymphomas when determining appropriate code," is included in EOD Primary Tumor and is applicable to Summary Stage 2018. The statement will be added as note 4 to the Lymphoma Summary Stage chapter. This will be included in the 2019 update (estimated release January 2019). |
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 |