MP/H Rules/Histology--Brain and CNS: Is it generally correct that the code for PNET [9473/3] should be used to code tumors arising in the brain and spinal cord, and the code for pPNET [9364/3] should be used to code tumors arising in the bone and soft tissue? See Discussion.
The terms and definitions for "Brain" in the 2007 MP/H rules distinguish between pPNET and PNET. Is it correct even when the diagnostic terminology alone would lead to other coding, such as "PNET" used to diagnose a soft tissue mass in the chest and "neuroectodermal tumor" used to diagnose a brain mass?
Should additional rules be added to both "Brain" and "Other Sites" to enforce this distinction?
For cases diagnosed 2007 or later:
Yes. Assign code 9473/3 for tumors arising in the brain and spinal cord and assign code 9364/3 for tumors arising in the bone and soft tissue.
Clarification and reinforcement of this distinction will be added to the "Other sites" terms and definitions with the first revision to the MP/H rules.
Reportability--Brain and CNS: Does a neurofibroma actually arise in peripheral nerve roots like a schwannoma even if it is referred to as a "C6-T1 intradural spinal cord tumor" and is therefore not reportable?
Schwannomas and neurofibromas of the peripheral nerves are not reportable. Schwannomas of the nerve root or spinal dura are reportable.
MP/H Rules/Histology--Colon: How is histology coded when the final pathology diagnosis is "adenocarcinoma with extensive mucinous features" and the percent of mucinous features is not stated?
Code 8140 using rule H6. Rule H6 applies because the percent of mucinous is not specified.
MP/H rules/Histology--Breast: How many primaries and what histologies are coded for a left breast when a bi-lumpectomy path reveals one tumor with a microscopic focus of mucinous adenocarcinoma and extensive DCIS and a second .9 cm mucinous adenocarcinoma with extensive DCIS, and the subsequent mastectomy reveals foci of residual DCIS and Paget's disease of the nipple?
For cases diagnosed 2007 or later:
There are two primaries. Primary 1: The two tumors described on the pathology report from the lumpectomy are a single primary using rule M13. Primary 2: Disregard the foci of residual DCIS. Paget disease of the nipple is a separate primary using rule M12.
Primary 1: invasive mucinous adenocarcinoma and extensive ductal carcinoma in situ: Code the histology as 8480/3 [mucinous adenocarcinoma] using rule H27.
Primary 2: Paget disease of nipple: Code the histology as 8540/3 [Paget disease] using rule H14.
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.
Grade, Differentiation--Bladder: Can grade be coded from the pathology report for a recurrent bladder cancer specimen? See Discussion.
In 2006 a TURB was done for bladder carcinoma diagnosed 10 years ago. Is grade always coded 9 on class 3 cases unless the original slides were reviewed?
Code grade from the original tumor; do not code grade from recurrence.
If the grade of the original primary tumor is specified, code it, regardless of class of case.
MP/H Rules/Multiple Primaries/Histology--Colon: How many primaries should be reported and how is the histology field(s) coded if the left colon contains two adenocarcinomas and one mucinous adenocarcinoma arising in a villous adenoma and each has a different level of invasion? See Discussion.
A patient had three tumors in the left colon including an 1) invasive well differentiated mucinous adenocarcinoma arising in tubulovillous adenoma with pericolonic subserosal fat invasion 8.5cm, 2) An infiltrative moderately differentiated colonic adenocarcinoma with invasion of muscularis propria 4cm and 3) an invasive moderately differentiated adenocarcinoma with invasion of muscularis propria, 1/69 nodes positive. The case was coded using rule M8 for one primary, but M10 contradicts; and H13 coding rule for histology 8263/3.
For cases diagnosed 2007 or later:
Assuming that all tumors are in the left colon, there are three tumors:
Mucinous adenocarcinoma arising in a villous adenoma
Colonic adenocarcinoma
Colonic adenocarcinoma
Multiple Primary Determination
In the colon MP rules go to the multiple tumors module. Start with M3. Stop at M7 and abstract as a single primary.
Histology Code
Go to the histology coding rules, multiple tumors module, and start with H15. Stop at H20 which tells you to code the most invasive tumor. Tumor 1 is the most invasive according to the definition of most invasive in the 2007 SEER Manual, page C-271. Code 8263/3 [Adenocarcinoma in tubulovillous adenoma].
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.
MP/H Rules/Histology--Colon: Regarding histology rule H21, is there a hierarchy or do you code the higher histology if there is an adenocarcinoma arising in a polyp and an adenocarcinoma in a villous adenoma?
For cases diagnosed 2007 or later:
If you arrive at H21 and have an additional decision to make regarding the use of 8210, 8261 or 8263, you must make another pass through the histology rules. The second pass will determine which of the two or three histology codes to assign. The answer will vary depending of the specifics of the case.
Example:
Transverse colon: Adenocarcinoma in an adenomatous polyp involving muscularis propria and adenocarcinoma in a villous adenoma involving subserosa of transverse colon. Start with rule H15 because there are multiple tumors. Stop at H21 -- code either 8210 or 8261. To decide between 8210 and 8261, make a second pass through the histology rules, starting again with H15. Stop at H20. Code the histology of the most invasive tumor, 8210 [Adenocarcinoma in adenomatous polyp].
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