Report | Question ID | Question | Discussion | Answer | Year |
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20220029 | Histology/Behavior--GI Tract: What is the difference between high grade dysplasia and severe dysplasia for tumors in the cervix and gastrointestinal (GI) tract? Are these terms synonymous with in situ/behavior code /2? See Discussion. |
In the WHO Classification of Female Genital Tumors, 5th edition, for the uterine cervix squamous intraepithelial lesions, there is related terminology for high grade squamous intraepithelial lesion HSIL (CIN3) 8077/2 and it is severe squamous dysplasia; squamous cell in situ. However, in the online WHO Classification of Digestive System Tumors, 5th edition, there is no related terminology for esophageal high-grade squamous dysplasia, 8077/2. Can you collect cases of severe dysplasia the same as cases of high grade dysplasia? |
According to a leading GI pathologist, severe dysplasia is equivalent to high grade dysplasia in the GI tract. |
2022 |
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20220001 | Solid Tumor Rules (2022)/Histology--Bladder: Can the term configuration be used to code the more specific histology for bladder primaries diagnosed 2022 and later? See Discussion. |
In the September 2021 Urinary Sites Solid Tumor Rules update, the term configuration was removed from the “DO NOT CODE histology when described as” list. However, it was not added as a term that can be used to code the more specific histology for urinary tumors. Can configuration be used to code the more specific histology 8130 (papillary urothelial carcinoma) when the diagnosis is urothelial carcinoma, tumor configuration: papillary? |
Beginning with cases diagnosed 1/1/2022, the term "configuration" can be used to code histology for urinary sites only. At the request of the AJCC urinary experts, the instructions were changed to allow configuration to be used to code histology. |
2022 |
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20220010 | EOD 2018/Heme & Lymphoid Neoplasms--Myeloid Sarcoma: How is Extent of Disease (EOD) Primary Tumor coded for a myeloid sarcoma with multifocal skin involvement? See Discussion. |
Patient has a diagnosis of myeloid sarcoma presenting as multiple erythematous papules and nodules on back, chest, right arm & shoulder. Oncologist did not mention any evidence or suspicion of an associated AML diagnosis. HemeRetic schema EOD Primary Tumor Note 1 states that myeloid sarcoma can be coded as localized (code 100) or systemic (code 700). It is not clear what would qualify as systemic disease for myeloid sarcoma. |
Assign code 100, localized, using the 2018 EOD Primary Tumor, HemeRetic schema, for the myeloid sarcoma with skin involvement since only the skin is involved. Use code 700, distant or disseminated, when multiple organs are involved. |
2022 |
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20220038 | Solid Tumor Rules/Histology--Thyroid: What is the histology code for sclerosing mucoepidermoid carcinoma with eosinophilla in the left thyroid and papillary thyroid carcinoma in the right thyroid? See Discussion. |
The left thyroid lobectomy/isthmusectomy returned a diagnosis of sclerosing mucoepidermoid carcinoma with eosinophina, 6.5 cm, replacing nearly the entire left lobe of the thyroid. The patient has a completion thyroidectomy of the right lobe and returned the diagnosis of papillary thyroid carcinoma, 0.5 mm, in maximum dimension. The endocrinologist describes it as "co-exsisting" and states the tumor is iodine non-avid. |
Abstract two primaries and assign code 8260/3 (papillary adenocarcinoma, NOS) to the right thyroid using Solid Tumor Rules, Other Sites, Rule H14, and 8430/3 (mucoepidermoid carcinoma) to the left thyroid as these are separate tumors with different histology types according to WHO Classification of Tumors of Endocrine Organs, 4th edition. |
2022 |
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20220041 | Primary Site/Histology--Intrahepatic Duct: How are primary site and histology coded for cholangiocarcinoma cases when the pathology only shows a liver tumor and other involvement. See Discussion. |
A common scenario is a patient has a positive CT of the abdomen/pelvis for liver mass only. Biopsy of the liver mass is positive for cholangiocarcinoma. The physician is also calling the liver tumor the primary site with histology of cholangiocarcinoma. There is no evidence of intrahepatic bile duct (C221) or gallbladder (C240) involvement which are sites specific to this histology. The hematology/oncology consult stages this as Stage IIIA, T3N0M0 intrahepatic cholangiocarcinoma. Can we code cholangiocarcinoma with site code C220 (liver) or should we assume that C221 (intrahepatic bile ducts) would be a better code to reflect this histology? |
Assign C221 (intrahepatic bile duct) as the primary site for cholangiocarcinoma (8160/3). Our expert GI pathologist confirms that even when intrahepatic bile ducts are not specifically mentioned, intrahepatic cholangiocarcinoma originates in the intrahepatic bile ducts. |
2022 |
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20220049 | Solid Tumor Rules/Multiple Primaries--Lung: How many cases should be abstracted for a patient with 2022 wedge biopsy of right upper lobe acinar predominant lung adenocarcinoma and wedge biopsy of right lower lobe lepidic predominant adenocarcinoma if there is concern for diffuse spread throughout the lungs secondary to the lymphangitic carcinomatosis and possible diffuse pneumonic type of adenocarcinoma? See Discussion. |
Acinar predominant adenocarcinoma measures at least 12 mm and involves wedge biopsy margins, while the lepidic predominant adenocarcinoma measures 11 mm and does not involve the margins of that separate specimen. Pathologist also notes, “CT findings of diffuse coarse reticular nodular opacity, these findings may represent pneumonic type adenocarcinoma/diffuse pulmonary involvement or intrapulmonary metastasis. Both of these scenarios have the corresponding stages of pT4 (if thought to be ipsilateral) or M1a (if thought to also involve the contralateral lobe).” Patient declined any further treatment and transitioned to hospice before expiring less than 1 month after wedge biopsies. It is unclear if Rule M6 would apply to these two specimens with different subtypes since this scenario is not specifically addressed in the M rule definitions. |
Abstract two separate primaries when separate/non-contiguous tumors are two or more different subtypes/variants in Column 3 of Table 3 using Rule M6 in the Solid Tumor Rules (September 2021 Update). They represent two subtypes/variants of the same NOS histology. When coding histology, tissue from pathology takes precedence over imaging, including when stated as differential diagnoses based on the CT scan, as noted by the pathologist in this example. |
2022 |
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20220020 | Histology--Thyroid: What is the correct histology code for a thyroidectomy with final diagnosis of “Right lower lobe: papillary microcarcinoma, conventional type, 0.8 cm. Isthmus: papillary microcarcinoma, follicular variant, 0.2 cm. Left lobe: Papillary carcinoma, conventional, unencapsulated.” See Discussion. |
We were previously told that papillary microcarcinoma is coded to 8260 (papillary thyroid carcinoma) and not papillary microcarcinoma (8341). That is an area of confusion. |
Based on the information provided, code histology to follicular variant of papillary thyroid carcinoma (8340/3). The tumor is a mix of papillary and follicular variants. |
2022 |
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20220019 | Solid Tumor Rules/Histology--Thyroid: What is the correct histology code for a papillary carcinoma, encapsulated with columnar cell features? See Discussion. |
There is an ICD-O histology code for papillary carcinoma, columnar cell (8344/3) as well as papillary carcinoma, encapsulated (8343/3). Per Rule H13, the terms “with features of” may be used to identify a subtype. Considering these two subtypes, and knowing there is no specific histology code for this combination, is the first rule that applies H17 (code the numerically higher histology code)? |
Code to papillary carcinoma, encapsulated (C73.9) (8343/3) using Solid Tumor Rules, Other Sites, Rule H11, code the histology when only one histologic type is identified. The usage of features is describing the cellular architecture of the encapsulated papillary carcinoma and does not necessarily indicate a specific histologic type. We consulted with our endocrine specialist pathologist who agrees and indicated terminology used in thryoid neoplasms is inconsistent. |
2022 |
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20220035 |
Solid Tumor Rules/Histology--Bladder: How is histology coded for a transurethral resection of the bladder (TURB) diagnosis with multiple components? See Discussion. |
Examples: Bladder TURB: Invasive high grade urothelial carcinoma with poorly differentiated (40%), lipoid (5%), and sarcomatoid (55%) components. Bladder tumor base TURB: Invasive high grade urothelial carcinoma with poorly differentiated (65%) and sarcomatoid (30%) components. The Urinary Sites Solid Tumor Rules, histology coding rules, say to code the most specific histology or subtype/variant, regardless of whether it is described as majority, minority, or component. Poorly differentiated (8020) and sarcomatoid (8122) are both urothelial subtypes, but there is no rule to instruct how to code a tumor/tumors with multiple urothelial subtypes. |
Code histology as 8120/3 in the two examples using Note 1 in the Urinary Sites Solid Tumor Rules, instruction 1 of the Coding Histology section. The subtypes/variants or components must describe a carcinoma or sarcoma in order to code a histology described by those terms. |
2022 |
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20220004 | First Course Treatment/Cancer-directed Treatment: What information can registrars use to determine disease progression and whether treatment counts as first course treatment? See Discussion. |
Is a physician’s statement of progressive disease adequate to determine disease progression in coding first vs. second course treatment? Can an increase in tumor burden (i.e., a change in overall stage) be used by the registrar to determine disease progression? Often, determining disease progression is difficult as there are no guidelines in the SEER Manual related to this topic. It seems a physician’s statement of progressive disease should always be accepted. However, that statement is not always available. While it seems an increase in tumor size alone would not be “progressive disease” as tumors will continue to grow, can registrars use an increase in tumor burden to make this determination? The instructions for coding first vs. second course treatment are clear when a treatment plan is changed, but determining whether there has been disease progression, recurrence, or treatment failure can be difficult without a physician’s assessment. For example, a patient was diagnosed with a newly diagnosed resectable pancreatic cancer; the documented treatment plan was for upfront chemotherapy, followed by repeat staging, followed by pancreatectomy. The patient completed 3 cycles of FOLFIRINOX, but the physician noted that the CT scan shows progressive disease, and the plan was to start a new treatment regimen with Abraxane, Gemzar, and stereotactic body radiation (SBRT) (Cyberknife). The patient completed the additional chemotherapy, radiation, and proceeded to the initially planned surgery. The pathologist staged this as yp disease, but the surgery appears to be second course treatment, and we would not code the surgery, or collect the staging (yp staging) since the physician stated this was progressive disease. The classification as yp staging can be misleading, since the resection is technically after neoadjuvant treatment, but is not collected per our guidelines. In this case, is it correct to code first course treatment as FOLFIRINOX only? |
Determining first course treatment is based on knowing the treatment plan and its course as to whether it was completed as initially planned. Read the medical record, scans, labs, and physician notes. First course of therapy ends when the treatment plan is completed as planned. Alternatively, first course of therapy ends when there is documented disease progression, recurrence, or treatment failure. A change to a drug in a different group or a change to a different treatment modality indicates the end of the first course of treatment. While a physician/clinician statement of progression, additional imaging, or other procedures that assess treatment efficacy, or increase in tumor burden can be used to denote progression, recurrence, or failure, a change to the initial treatment plan is a signal to to the registrar to suspect the end of first course of therapy. Once the initial treatment plan is changed, everything after the change is subsequent treatment. In the scenario provided, code FOLFIRINOX as first course of treatment. Based on the information provided, the Abraxane, Gemzar, and SBRT are second course and everything that followed that is second or subsequent course. The physician noted progressive disease and a new treatment regimen was started -- this is a clear indication of the end of the first course of treatment. The planned treatment course was FOLFINOX and surgery. Once that initial treatment plan is changed, everything after the change is no longer first course of treatment. Use text fields to document the details. |
2022 |