Reportability--Head & Neck: Is dentinoameloblastoma reportable, and if so, what is the correct histology code? See Discussion.
Mixed odontogenic tumor consistent with dentinoameloblastoma, 9.5 cm, See Note: Tumor involves maxillary bone including hard palate, alveolar ridges, nasal cavities and maxillary sinuses bilaterally and buccal soft tissue. Lymphovascular invasion not identified. Perineural invasion not identified. Margins: Tumor involves right posterior bone (alveolar) margin. All other margins negative. Note: This is a rare hybrid tumor showing features of ameloblastoma producing pre-dentin/osteodentin matrix. Submucosal tumor is seen in the nasal cavities and palate. A congo red stain shows that the acellular dentin-like matrix fluoresces similar to collagen after polarization. Immunohistochemistry shows that the tumor cells are diffusely and strongly positive for p63, focally positive for CK19, and negative for CK5/6, SOX10, S100 and calretinin.
Dentinoameloblastoma is not reportable. It is a variant of ameloblastoma which produces dentin and/or osteoid. It is benign. It can extend locally in a rather aggressive fashion, but is not given a malignant designation unless it metastasizes.
First Course of Treatment/Surgery of Primary Site--Melanoma: How do you code UVB therapy treatment for melanoma?
Code UVB therapy for melanoma as photodynamic therapy under Surgery of Primary Site for skin. Assign code 11 [Photodynamic therapy (PDT)] if there is no pathology specimen. Assign code 21 [Photodynamic therapy (PDT)] if there is a pathology specimen. Use text fields to document details.
Reportability/Primary Site--Skin: Is vulvar intraepithelial neoplasia III (VIN III) or associated invasive squamous cell carcinoma reportable when stated to be of the or or ? See Discussion.
Example: Operative report states, partial simple vulvectomy, anoscopy with normal-appearing clitoris, clitoral prepuce, bilateral labia majora, and labia minora. There is a 1.5 x 1 cm raised, hyperpigmented lesion which appears consistent with VIN 3 on the perineal body, just to the right of midline, and not touching the midline. It goes quite close to the anus but is not touching the anus.
Final diagnosis on resection is, Invasive squamous cell carcinoma arising in a background of high-grade squamous intraepithelial neoplasia (VIN III) with the following features: Location: perineum. Focal invasion arising in setting of 1 cm area of VIN III.
Squamous carcinoma and squamous intraepithelial neoplasia III arising in the skin of the perineum (C445) are not reportable. Even though the abreviation "VIN III" is used in this example, this lesion does not involve the vulva. Since it involves the perineum, and skin of perineum is coded to C445, it is not reportable.
Neoplasms arising in skin (C44) with the following histologies are not reportable.
--Malignant neoplasm (8000-8005)
--Epithelial carcinoma (8010-8046)
--Papillary and squamous cell carcinoma (8050-8084)
--Squamous intraepithelial neoplasia III (8077) arising in perianal skin (C445)
Reportability--Ovary: Is an ovarian serous borderline tumor with microinvasion with serous tumor aggregates (3 mm in greatest dimension) in 2 of 10 pelvic lymph nodes reportable? See Discussion.
SINQ 20170043 is a similar question about an ovarian mucinous borderline tumor with microinvasion, but the answer seems to be specifically referencing mucinous tumors only. It is unclear if that SINQ could be applied to this case. In addition, we were not sure how to interpret the nodal involvement. The physician assessment after surgery was low grade serous carcinoma, chemo not recommended and letrozole started.
Ovarian serous borderline tumor with node implants is not reportable; it is a borderline neoplasm. However, if the oncologist believes he or she is dealing with a low grade serous carcinoma rather than a borderline tumor, this case is reportable. We recommend that you determine whether the diagnosis of low grade serous carcinoma, chemotherapy not recommended, is based on the pathological findings or on something else before reporting this case.
Reportability--Prostate: According to the 2018 SEER Program Manual, a prostatic intraepithelial neoplasia (PIN) III is not reportable, but is an atypical small acinar proliferation (ASAP) PIN 4 reportable?
ASAP is not reportable. Patients with ASAP found on needle biopsy will likely undergo another biopsy.
Solid Tumor Rules (2018)/Histology--Head & Neck: Where does cytology rank on the Priority Order for Using Documentation to Identify Histology for Head and Neck primaries? See Discussion.
Cytology is not listed in the Priority Order for Using Documentation to Identify Histology (Histology Coding Rules) in the Head and Neck schema. Other schemas do include cytology in the hierarchy below tissue from a biopsy or resection. Cytology is often less specific than histology, so one would expect cytology to be listed below tissue in this hierarchy. Was this an oversight? Or would cytology be equivalent to histology if it provided the most specific histology for the case?
Instruction #5 in the Priority Order for Using Documentation to Identify Histology of the Head and Neck Solid Tumor Rules, Item 5.B., refers to cytology in the documentation though cytology is not listed before this. In H&N tumors, cytology is usually performed on lymph nodes and seldom on a primary tumor. Cytology will be added to H&N in the next update.
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.
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.
Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of a 2018 lung case whose pathology states adenocarcinoma, acinar predominant?
The Solid Tumor Rules for Lung rule H4 applies. Per Table 3, page 12, third column on adenocarcinoma row, adenocarcinoma, acinar predominant is coded to 8551/3.
Reportability--Ambiguous terminology: Are the following terms reportable: almost certainly and until proven otherwise? See Discussion.
Example 1: Physician states patient has an almost certain melanoma. Due to the patient's age, there is no plan to for any treatment or further workup. Almost certain is not listed as a reportable phrase, so typically we would not accession this case.
Example 2: Imaging states a diagnosis of renal cell carcinoma until proven otherwise. No additional workup is available at this facility. This terminology is also not seen on the ambiguous reportable terminology list but we are seeing it more often and wanted confirmation.
Use the ambiguous terminology list as a last resort. Consult with the physician and search for further information to assist with the decision. If no further information can be obtained, use the ambiguous terms list to decide; in this case, the terms are not on the list and these examples would not be reportable.