MP/H Rules/Multiple Primaries/Laterality--Brain and CNS: How many primaries are to be abstracted and how is laterality to be coded for two meningiomas, one occurring at the midline and the other in the right termporal region? See Discussion.
MRI of the brain shows two meningiomas: One is stated to be 'midline' (laterality code 9) and one is stated to be in the 'right' temporal region. The rules state if same site (C700), same histology & laterality is same side or one side unknown, then abstract as single primary. Based on this, the MRI findings would be one primary, but how should laterality be coded?
For cases diagnosed 2007 or later, abstract two primaries. The lateralities of both meningiomas are known. Right (code 1) and midline (code 9) are different lateralities.
MP/H Rules/Histology: In the absence of a tissue diagnosis, should the histology field be coded based on the findings of a suspicious cytology or a CT scan that clinically confirmed the diagnosis? See Discussion.
Cytology (brushings at ERCP) which are highly suspicious of adenocarcinoma. A CT of the abdomen performed the next day shows a mass, most likely Klatskin tumor. Can the histology be coded to Klatskin tumor [8162/3] based on the CT findings?
For cases diagnosed 2007 or later, code the histology to 8162/3 [Klatskin tumor] using the histology from the CT. This case is confirmed clinically based on the CT. It cannot be accessioned based on suspicious cytology.
Rule H8 in the 2007 Histology Coding Rules for Other Sites provides instructions for coding histology when the pathology report and cytology report are not available.
MP/H rules/Histology--Lung: How is histology coded for a path diagnosis of "pleomorphic carcinoma with adenocarcinoma, squamous, clear cell and spindle components"? Please see discussion.
Path diagnosis of lung tumor is pleomorphic carcinoma, with adenocarcinoma, squamous, clear cell, and spindle cell components. Path comment states: "While the majority of tumor displays usual adenocarcinoma-type features, elsewhere the tumor shows varying differentiation, including squamous, clear cell and spindle cell differentiation. Therefore the tumor is best categorized as pleomorphic carcinoma."
This tumor is best described by a non-specific histology. However, the MP/H rules guide the abstractor to identify a more specific histology. If we work through the lung rules, would we end up using rule H7 and code the histology with the numerically highest ICD-O-3 code?
For cases diagnosed 2007 or later, assign histology code 8022 [pleomorphic carcinoma] based on the pathologist's assessment and rule H3. He/she reviewed all of the histologic components and rendered a final diagnosis of pleomorphic carcinoma.
"Components" is not a term indicative of a more specific histology. See note under rule H5.
Histology--Corpus uteri: Because coding a pathology final diagnosis of "serous carcinoma" for an endometrial primary to 8441/3 triggers the site/histology error in the SEER Edits, should histology be coded to 8010/3 [Carcinoma, NOS] instead?
Assign histology code 8441 [serous carcinoma] and override the edit. Endometrium with serous carcinoma is NOT one of the "impossible" site / histology combinations.
Type of Multiple Tumors--Lung: Is this field coded to 40 [Multiple invasive] or 80 [Unk in situ or invasive] when only one nodule is biopsied of multiple existing nodules for a reported single lung primary? See Discussion.
The right lung has 4 tumor nodules in the upper lobe. Biopsy of one tumor is positive for moderately differentiated adenocarcinoma. No other work up performed.
Should code 40 be used because we dont know the behavior of the other nodules?
The best code to use in this case is 40 [multiple invasive]. For lung only, it is assumed that all of the tumors are the same histology and that all are invasive.
MP/H Rules/Histology--Colon: If a tubulovillous (TV) adenoma is in situ and other polyp(s) have an invasive component, does the in situ TV adenoma still have priority and should rule H18 be applied?
For cases diagnosed 2007 or later, always give precedence to coding the invasive. Rule H18 applies UNLESS the adenocarcinoma in the TV is in situ and the others are invasive. In this case, code the histology of the invasive adenocarcinoma.
This clarification will be added when the MP/H manual is revised.
Histology (Pre-2007)--Breast: How is "invasive lobular carcinoma with signet ring cell features (95%) and ductal features (5%)" coded for a single tumor diagnosed prior to 2007?
For cases diagnosed 1/1/04-12/31/06, code histology to 8524 [Lobular mixed with other types of carcinoma]. Assuming there is no mention of in situ, Histology Coding Rule 3 applies: Use a mixed histology code if one exists
For cases diagnosed 2007-2014, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Ambiguous Terminology/Date of Conclusive Terminology: If there is an unknown date of diagnosis, should the Ambiguous Terminology field always be coded to 9 and the Date of Conclusive Terminology be coded to 99999999? See Discussion.
Scenario: Mammogram is suspicious for carcinoma, unknown date in 2007. A biopsy prior to admission to reporting facility is positive for carcinoma. Patient seen at reporting facility in June 2007 for treatment.
The purpose of the data item "Ambiguous Terminology" is to flag cases entered into the registry based on a diagnosis with ambiguous terminology. Because the case above was entered into the registry based on conclusive terminology, code Ambiguous Terminology to 0 [Conclusive term] and code Date of Conclusive Terminology to 88888888 [not applicable].
Histology--Pancreas: How is a "gastrin and somatostatin producing endocrine neoplasm" coded that has lymph node metastasis?
The best code available for this situation is 8153/3 [Gastrinoma, malignant].
Many pancreatic endocrine tumors produce more than one peptide, such as gastrin and somatostatin in this case. ICD-O-3 does not provide a code for pancreatic endocrine tumors which produce more than one peptide. According to the WHO Classification of Tumours of Endocrine Organs, there is a distinct hormonal syndrome associated with gastrin producing tumors, and not with many of the somatostatin producing tumors. Therefore, our pathologist consultant advises us to code to gastrinoma in this case.
Reportability/Ambiguous Terminology--Esophagus: Is a case with a biopsy diagnosis of "... focal areas suspicious for adenocarcinoma in situ change" reportable if the diagnosis on the partial esophagectomy specimen only includes the phrase "... with foci of high grade dysplasia; no invasive carcinoma identified"?
The case is not reportable.
The biopsy with a suspicious result (suspicious for adenocarcinoma) was disproven by the esophagectomy.
An official website of the United States government
Home