Report | Question ID | Question | Discussion | Answer | Year |
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20200083 | Reportability/Histology--Kidney: Is hybrid oncocytic chromophobe tumor reportable for cases diagnosed 2021 and later? If so, how is the histology coded? See Discussion. |
The ICD-O-3.2 Coding Table includes hybrid oncocytic chromophobe tumor as a related term for histology code 8317 (Renal cell carcinoma, chromophobe type). However, this related term is not discussed in the implementation guidelines as being a new term/reportable tumor. The Solid Tumor Rules do not indicate a hybrid oncocytic chromophobe tumor is reportable; however, if a registrar only looked at the ICD-O-3.2 Coding Table, it may seem as though this histology should be collected. The term hybrid oncocytic chromophobe tumor was not included in the Solid Tumor Rules as a subtype/variant of RCC, or as an equivalent term for chromophobe RCC. There is a SINQ (20180047) that states not to report renal hybrid oncocytic tumor, despite the fact these tumors exhibit mixed features of both oncocytoma and chromophobe RCC. For cases diagnosed 2021 and later, should the clarification in the SINQ apply? Or should the ICD-O-3.2 Coding Table be used which indicates this is a reportable diagnosis? If the standard setters decided not to implement use of hybrid oncocytic chromophobe tumor for 2021, can clarification be added to the Solid Tumor Rules or Implementation Guidelines? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
Hybrid oncocytic chromophobe tumor is listed in ICD-O-3.2 as 8317/3 which indicates it is reportable if diagnosed in 2021 or later. For cases diagnosed 1/1/2021 and later, use ICD-O-3.2 for reportability. See page 16 of the NAACCR 2021 Implementation Guidelines. Between publication of ICD-O-3.2 and updates made to solid tumor histology tables, additional terms were added based on review by the IARC ICD-O committee. These changes were not made available in time to correct the tables. All related terms or synonyms may not be included in the histology tables and ICD-O-3.2 should be used in tandem with the solid tumor rules. |
2020 |
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20200078 | Solid Tumor Rules (2018)/Histology--Brain and CNS: Should the new malignant term pituitary blastoma be added to Table 3 of the 2018 Malignant Central Nervous System (CNS) and Peripheral Nerves Solid Tumor Rules? See Discussion. |
Pituitary blastoma was not added to Table 3 (Specific Histologies, NOS, and Subtypes/Variants) of the 2018 Malignant CNS and Peripheral Nerves Solid Tumor Rules as part of the December 2020 update. This is a new malignant CNS histology for 2021 and later. Not including this histology in Table 3 results in the registrars being required to check another source to correctly code this histology. If this histology cannot be used for cases diagnosed prior to 2021, should that diagnosis year clarification be included in the STR? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The Solid Tumor Malignant CNS tables do not list pituitary specific histologies at this time. Registrars will need to refer to ICD-O and/or updates until the decision to add malignant pituitary neoplasms is made. Pituitary blastoma is a rare tumor which occurs in children. |
2020 |
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20200034 | Solid Tumor Rules (2018)/Histology--Breast: How should histology be coded for 2020 breast lumpectomy final diagnosis of invasive ductal carcinoma? Summary Cancer Data and CAP Summary states: Invasive carcinoma with the following features: Histologic type: Tubular adenocarcinoma. See Discussion. |
Per the 2018 Solid Tumor Rules instructions, Final Diagnosis and Staging Summary (synoptic report) have equal coding priority. However, it is unclear which takes priority, or if this should be a combination of components, when the histologies are two different specific histologic types per Table 3 of the Breast Solid Tumor Rules Manual. |
In this case, the pathologist states two different histologies. Per the H rules, when there are different histologies, code the histology which comprises the majority of tumor. Use H16 and code histology stated to be more than 50% of tumor OR H17, code 8523 when percentage is not stated or unknown. |
2020 |
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20200082 | Solid Tumor Rules (2018)/Histology--Corpus Uteri: How is histology coded for cases of carcinosarcoma/malignant mixed Mullerian (MMMT) tumor diagnosed 2021 and later? See Discussion. |
The ICD-O-3.2 Coding Table includes Mullerian mixed tumor as the preferred term for histology code 8950 (previously malignant mixed Mullerian tumor/MMMT). This table also includes carcinosarcoma, NOS as the preferred term for histology code 8980. Neither the ICD-O-3.2 Coding Table nor the Implementation Guidelines address the long-standing issue of coding histology for diagnoses of carcinosarcoma/malignant mixed Mullerian tumor. These endometrial primaries are frequently diagnosed as both carcinosarcoma and MMMT. The questions regarding histology coding for carcinosarcoma and carcinosarcoma/MMMT of the endometrium date back to before the Multiple Primaries/Histology Rules, with at least three SINQ entries instructing registrars not to use code 8950/3 (MMMT) for diagnoses of MMMT. SINQ has instructed registrars that MMMT is a synonym for carcinosarcoma and these tumors should be coded to 8980 (carcinosarcoma), not to 8950 (MMMT). The most recent SINQ is partly inconsistent with the others, indicating 8950 can be used if the tumor is only described as MMMT. The other SINQ entries state carcinosarcoma should be used as it is the preferred term for MMMT. (See SINQ 20061008, 20100009, 20180071.) The most recent SINQ (20180071) specifically indicates: According to the WHO Classification of Tumors of Female Reproductive Organs, 4th edition, MMMT (8950/3) is now a synonym for carcinosarcoma (8980/3) even though it has a separate ICD-O code. The ICD-O code for MMMT is no longer in the WHO book. However, MMMT is in the ICD-O-3.2 Coding Table and is not stated to be obsolete or a synonym. Which is correct, the clarification in the SINQ or the 2021 ICD-O-3.2 Coding Table? For a 2021 diagnosis of carcinosarcoma/malignant mixed Mullerian tumor, how should registrars code the histology? Follow the previous SINQ entries and Rule H17 to code the histology to 8980 when the diagnosis includes both carcinosarcoma and MMMT? Do these previous SINQ entries still apply to cases diagnosed 2021 and later? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
According to both the 4th and 5th Ed WHO GYN Tumors, carcinosarcoma (8980) is the preferred term and pathologists are encouraged to no longer use Mixed Mullerian Tumor (8950) in their diagnoses. WHO 4th Ed GYN now lists MMMT as synonym for carcinosarcoma. 8950/3 is no longer included in WHO 4th Ed. Until the the Other Sites Rules can be updated with histology tables to assist in coding, use the following to determine histology. Carcinosarcoma (8980/3) and MMMT (8950/3)
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2020 |
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20200044 | Reportability/Histology--Eye: Is conjunctival intraepithelial neoplasia, moderate to severe, reportable and if so, what are the histology and behavior codes? See Discussion. |
Left Eye Conjunctiva, biopsy (01/23/2018): Conjunctival intraepithelial neoplasia moderate to severe. Is intraepithelial neoplasia moderate to severe the same as coding 8077/2? |
Report this case as 8077/2. Our expert pathologist consultant reviewed this and confirmed it is reportable. Here is some of his rationale. The pathologist's designation as "moderate to severe" indicates there are areas of 2/3 of full thickness epithelial change, so the criteria to report are met. |
2020 |
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20200004 | Solid Tumor Rules (2018)/Multiple primaries--Lung: How are Primary Site and EOD Primary Tumor coded when a patient is diagnosed with four invasive tumors in the right lung that represent three separate primaries, but the not otherwise specified (NOS) tumor and one of the specific subtype/variants are in separate lobes? See Discussion. |
There are four invasive tumors in the right lung: Large cell undifferentiated carcinoma in the right lower lobe (8012/3, C343); Adenocarcinoma, acinar-predominant in the right lower lobe (8551/3, C343) that was 0.7 cm in size and limited to the lung; Mucinous adenocarcinoma in the right upper lobe (8253/3, C341) that was 0.9 cm and limited to the lung; Adenocarcinoma, NOS also in the right upper lobe (8140/3, C341) that was 1 cm and limited to the lung. The Lung M Rules confirm the large cell undifferentiated carcinoma is a separate primary from the three adenocarcinoma tumors (Rule M8). The acinar adenocarcinoma and mucinous adenocarcinoma tumors are separate primaries (Rule M6). The adenocarcinoma, NOS tumor is the same primary as both the acinar and mucinous are adenocarcinomas (Rule M7). How is Primary Site coded for both the acinar and mucinous adenocarcinomas if they represent multiple tumors reported as a single primary (when compared to the adenocarcinoma, NOS tumor)? Should the adenocarcinoma, NOS tumor also be included when coding EOD Primary Tumor for both the right lower lobe acinar adenocarcinoma and right upper lobe mucinous adenocarcinoma primaries? Further follow-up with the physician is not possible. |
Abstract three primaries using 2018 Lung Solid Tumor Rules, Rule M6 and M8 as these are multiple synchronous tumors. M6 (Subtypes in Column 3 of Table 3): Adenocarcinoma, acinar predominant: Primary Site: C343 (RLL) EOD Primary Tumor: 300 Mucinous adenocarcinoma Primary Site: C341 (RUL) EOD Primary Tumor: 300 M8 (Separate rows in Table 3): Large cell undifferentiated carcinoma: Primary Site: C343 (RLL) EOD Primary Tumor: 300 Note: The adenocarcinoma, NOS, along with the other subtypes, is on a different row than the large cell undifferentiated carcinoma and is already accounted for in Rule 6 as multiple synchronous tumors. Do not include the adenocarcinoma, NOS in EOD Primary Tumor for the reportable primaries. |
2020 |
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20210077 | First Course Therapy/Neoadjuvant Treatment: How are Neoadjuvant Therapy--Clinical Response and Neoadjuvant Therapy--Treatment Effect coded when the neoadjuvant therapy was not completed? Does the entire course of neoadjuvant therapy need to be completed before we can code these fields? See Discussion. |
Example: The neoadjuvant therapy was started, the patient progressed, the treatment plan was altered, and a new course of systemic therapy was started; surgery was cancelled. 01/25/21 Bile duct brushing: Malignant cells present, adenocarcinoma 01/26/21 Surgical oncology consult: Currently unresectable; recommend neoadjuvant chemo 02/22/21-3/29/21 Neoadjuvant Gemzar & Abraxane, two cycles, discontinued due to disease progression 04/17/21 Surgical oncology re-eval: CT positive for disease progression, need to change Rx 04/26/21 Second change of treatment due to progression: Irinotecan, Oxaliplatin, and 5FU 07/16/21 Surgical oncology re-eval: Unresectable, advise 4-6 months of chemo followed by radiation |
Assign code 3 (Progressive disease (PD)(per managing/treating physician statement) for Neoadjuvant Treatment--Clinical Response and code 7 (Neoadjuvant therapy completed and planned surgical resection not performed) for Neoadjuvant Treatment--Treatment Effect. These are the best choices under the circumstances. Use text fields to record the details. |
2021 |
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20210065 | Solid Tumor Rules (2018/2021)/Histology--Lung: Should there be an exception to the Solid Tumor Rules for Lung to allow coding a more specific histology described by ambiguous terminology, when the only pathologic workup done is a cytology report? Due to the unique nature of lung cases which are often diagnosed on imaging and cytology without more definitive pathology, we are seeing many cases where the existing Solid Tumor guidelines result in very generic NOS histology codes. For example, lung mass found on imaging with a fine needle aspirate of a lymph node, final diagnosis "positive for malignancy" and comment "consistent with squamous cell carcinoma." See Discussion. |
The Solid Tumor histology coding guideline #3 for Lung states that an ambiguous histology can only be coded over an NOS when a physician clinically confirms it or the patient receives treatment based on the ambiguous histology; similar instructions exist in rules H3 and H12. We are in a central registry and don't typically have access to physician notes or treatment plans; unfortunately our hospital abstracts rarely document physician confirmation of ambiguous histology and we are uncertain if we should accept their coding of the more specific histology, assuming they did find clinical confirmation that was not documented. If not, our understanding of the Solid Tumor rules is that the histology in such a case would have to be coded as malignancy NOS (8000/3) per the non-ambiguous final diagnosis, and that we cannot use the more specific but ambiguous squamous cell carcinoma since we don't have definite clinical confirmation. We also have a fair number of cytology-only lung cases without any hospital information to clinically confirm an ambiguous histology. |
Code histology as squamous cell carcinoma, NOS (8070/3) using Lung Solid Tumor Rules, Rule H3 if no other information is available. Rule H3 states: If the case is accessioned (added to your database) based on a single histology described by ambiguous terminology and no other histology information is available/documented, code that histology. |
2021 |
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20210016 | Solid Tumor Rules (2018, 2021)/Histology--Kidney: What is the correct histology code for a kidney primary described as clear cell papillary renal cell carcinoma"? Should we use H2 and code 8312/3 or H3 and code 8323/3? |
Assign 8323/3, clear cell papillary renal cell carcinoma using the 2018 Kidney Solid Tumor Rules, Rule H1, as this is a single histology, a variant of renal cell carcinoma NOS. |
2021 | |
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20210068 | Mets at Diagnosis Fields/Primary Site--Lymph Nodes: How are the Mets at Diagnosis fields coded when the metastatic adenocarcinoma involves only one lymph node area and the primary site is unknown? See Discussion. |
In 2018, patient has lymph node metastasis confined to left retroperitoneal area; core biopsy was done which showed metastatic adenocarcinoma, unknown primary site. There are no other sites of disease found. Should I code Mets at Diagnosis--Distant Lymph Node(s) as 1, and the others such as bone and lung as 0? |
In a situation like this with one area of metastatic involvement and an unknown primary, if there is no further information, we advise that the metastasis are "regional" until/unless proven otherwise. With this in mind, code the Mets at Diagnosis fields as 0, including the Mets at Diagnosis--Distant Lymph Node(s). This case should continue to be worked up to identify the primary site. If a primary site is identified later, update the abstract accordingly. In the meantime, use text fields to describe the situation. |
2021 |