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Assign 8083/3, basaloid squamous cell carcinoma (BSCC), in both examples. It is more important to capture the variant than to code 8085 or 8086.

WHO Classification of Head and Neck Tumors, 5th ed., states that BSCC is a distinctive form of SCC, characterized by prominent basaloid morphology, squamous differentiation, and aggressive behavior.  Some primary sites capture p16 status as a Site Specific Data Item; you may record the p16 results when that is the case.

Based on the information provided, code the tumor size as 035.  We asked an expert pathologist to review this question and she said to use the larger measurement.  She also said "the pathologist usually cuts the anus and rectum open like a tube; the “circumference” would be measured flat."

We recommend that you do not use information from these molecular tumor profiling tests until they become a standard diagnostic tool. If/when that happens, we will add information to the various manuals.

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.

Assign code 0 to each of the three Neoadjuvant Therapy data items in this situation.

We will add an example to the coding instructions for these data items in the next release of the manual.

Code this multifocal thyroid carcinoma, single primary, as papillary thyroid carcinoma, follicular variant (8340/3) using Solid Tumor Rules, Other Sites, Rule H13 that says to code the most specific histologic term. We consulted with our endocrine specialty pathologist and when there is a mix of papillary and follicular variants, assign 8340.

Non-invasive follicular thyroid neoplasm with papillary-like nuclear features is coded as 8349/1 beginning in 2021.  According to the WHO Classification of Endocrine Organs, 4th edition, it was formerly classified as non-invasive encapsulated follicular variant of PTC (FVPTC) (8343/2) but was reclassified based on extremely low malignant potential.

Report papillary renal neoplasm with reverse polarity as 8260/3. According to the WHO Classification of Urinary and Male Genital Tumors, 5th edition, this is a distinctive pattern of papillary renal cell carcinoma that has been recently recognized. These tumors have recurrent mutations of KRAS, differing from typical papillary renal cell carcinoma. We recommend that you include with reverse polarity in your histology text to differentiate this entity from others classified in 8260/3.

Code Cixutumumab as Other Therapy.  Cixutumumab is still in clinical trials and not approved by FDA yet. Though it is classified as an immunotherapy agent, it is not approved.

Assign code 8000/0.  This is an emerging histology and not yet recognized by the World Health Organization. Document the details in text fields. It might also be useful to document this SINQ question in text.

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.