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The path report reads: COMMENT: There is multifocal involvement throughout both bowel segments which combined represent a subtotal colectomy procedure. There are at least 11 tumors, all of which are histologically similar. Given the unusual gross appearance, a representative portion of the largest mass (hepatic flexure) was forwarded to _____ for flow cytometric evaluation. There is chronic active colitis in the background suggestive of idiopathic inflammatory bowel disease, specifically ulcerative colitis. However, no dysplasia is seen in multiple random sections of grossly benign large bowel. ADDENDUM from expert gastroenterologist: The carcinomas are poorly differentiated without specific histologic features but are consistent with colon primaries. These findings are consistent with an MLH1-deficient carcinoma. Given the background chronic active colitis consistent with ulcerative colitis, this likely represents colitis-associated neoplasia which can be associated with multifocality.

The path report from a left pneumonectomy says: This squamous cell carcinoma had several different variants present including typical non-keratinizing squamous cell, spindled cell squamous cell, clear cell squamous cell and a small cell variant of squamous cell.

I cannot find a combination code that fits; the majority of the tumor is not stated; so do you code the highest specific type mentioned - 8084 - Squamous cell, clear cell type?

The partial nephrectomy final diagnosis is renal cell neoplasm. The College of American Pathologists (CAP) Summary lists histology as: multilocular clear cell neoplasm of low malignant potential. The diagnosis comment adds: This neoplasm currently termed multilocular clear cell renal cell neoplasm of low malignant potential (WHO 2016), was previously termed cystic renal cell carcinoma.

The only reportable term listed is "EBV positive B-cell lymphoproliferative disorder of the elderly." Are the following cases reportable?

• Does the diagnosis of EBV positive B-cell lymphoproliferative disorder specifically have to include the expression "of the elderly" to be reportable? Is there an age range associated with the term "of the elderly"?

• Is "iatrogenic EBV positive lymphoproliferative disorder" reportable?

• Is a diagnosis of "EBV positive B-cell lymphoproliferative disorder" reportable when there is no further classification of the LPD as lymphoma?

The only documentation in the record is that there is a history of DLBCL.

The only available information is the following pathology report:

On 7/18/00 a wide excision of the primary lesion is done. The report reads, "Lesion approximately 1 cm. Residual superficial spreading malignant melanoma with deepest penetration 4 mm."

The only Other Sites H Rule related to extramammary Paget disease is included in the Multiple Tumors Abstracted as a Single Primary module. Rule H28 instructs one to code the histology of the underlying tumor when there is extramammary Paget disease and an underlying tumor of the anus, perianal region, or vulva. Therefore, a vulvar extramammary Paget disease with underlying adenocarcinoma is coded as adenocarcinoma (8140/3), and not extramammary Paget disease (8542/3).

However, there is no M Rule confirming extramammary Paget disease and the underlying adenocarcinoma are a single primary (i.e., multiple tumors abstracted as a single primary) making it difficult for one to use the Multiple Tumors Abstracted as a Single Primary H rules module.

We recognize this is a longstanding histology coding rule, but how are registrars supposed to arrive at Rule H28 when the M Rules must be applied first and do not instruct one to accession a single primary? Moreover, if this is to be a single primary (per rule M2), why is there no H Rule in the Single Tumor module?

The note in the Urinary Terms and Definition states, Both Ta and Tis tumors are technically noninvasive. Code the histology specified by the pathologist. While it is true that both Ta and Tis are technically noninvasive, the AJCC defines Ta specifically for, A pathologist's use of Ta does indicate the noninvasive carcinoma did arise from a papillary tumor. However, not all pathologists use terminology that, following the Urinary Solid Tumor Histology Coding Rules, will result in a histology coded to 8130, despite an AJCC-defined Ta (noninvasive papillary carcinoma) tumor having been diagnosed because the tumor projected from the wall on a stalk.

In our region a number of pathologists provide the following types of diagnosis.

Histologic type: Noninvasive.

Histologic grade (WHO/ISUP 2016): High-grade.

Tumor configuration: Papillary.

The pathologist and/or physician may then stage this as Ta. How is the histology coded for these cases if the H Rules do not allow one to code the papillary and noninvasive Ta disease as not equivalent to noninvasive papillary carcinoma?

Flat (in situ) urothelial carcinoma has an increased risk of invasive disease compared to the noninvasive papillary urothelial carcinomas. Will there be inconsistencies or a resulting impact to analysis of truly flat/in situ urothelial carcinoma vs. papillary urothelial carcinomas if the papillary tumors are not being coded as such?

The note explains: The International Society for the Study of Vulvovaginal Disease (ISSVD) in 2004 revised its classification of VIN by eliminating VIN 1 and combining VIN 2 and VIN 3 into a single category (see table below). Classification of VIN (usual type) ISSVD [International Society for the Study of Vulvovaginal Disease]1986 classification 2004 classification VIN 1 VIN2 VIN3 VIN Note: VIN 2 and VIN 3 combined into single [non-graded] category, VIN Reference: Scurry J and Wilkinson EJ.  Review of terminology of precursors of vulvar squamous cell carcinoma. Journal of lower genital tract disease, 2006; 10(3):  161-169

The most recent version of the Brain Site Specific Surgery schema has a note that states "Assign code 20 [Local excision of tumor, lesion, or mass, excisional biopsy] for stereotactic biopsy of brain tumor." Does this also apply to a stereotactic CORE biopsy?

SINQ 20081118 also states that a stereotactic biopsy should be coded as Surgery of Primary Site code 20.