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Abstract two primaries and assign

Primary 1: C772, 9699/3

Primary 2: C162, 9699/3

Per Rule M7, you would change the first case to histology 9699/3 based on Note 4 under Rule M7, Note 4: Change the histology code on the original abstract to the more specific histology when the original diagnosis is in your registry database. Use previous editions of ICD-O (i.e., ICD-O-1, ICD-O-2) or the Hematopoietic Database to assign the code applicable to the year of diagnosis for the more specific histology.

Per Rule M2 this would be the same primary based on both being the same histology; however, there is an exception for MALT lymphomas (9699/3), which states: Abstract multiple primaries when a nodal MALT (C770-779, 9699/3) occurs before or after an extranodal MALT (all other sites, 9699/3).

When the choice is between ovary, fallopian tube, or primary peritoneal, any indication of fallopian tube involvement indicates the primary tumor is a tubal primary. Fallopian tube primary carcinomas can be confirmed by reviewing the fallopian tube sections as described on the pathology report to document the presence of either serous tubal intraepithelial carcinoma (STIC) and/or tubal mucosal invasive serous carcinoma.

If there is no information about the fallopian tubes, refer to the histology and look at the treatment plans for the patient. If all else fails, you may have to assign C579 as a last resort. Use text fields to document the details.

For additional information, see the CAP GYN protocol, Table 1: Criteria for assignment of primary site in tubo-ovarian serous carcinomas.

Code the primary site to vulva. Use text fields to record the details.

According to the WHO classification, several types of primary vulvar mammary-like carcinoma have been reported. It is rare and is thought to arise from specialized anogenital mammary-like glands within the vulva. It does not arise from ectopic breast tissue and is does not represent metastatic breast carcinoma.

For solid tumors, ignore the term "evolving" and apply the registry rules for reportability to this case. Squamous cell carcinoma of the vermillion border of the lower lip (C001) is reportable.

Abstract a single primary and code as 8147/3 using Rule M18 and Rule H17 of the 2018 Other Sites Solid Tumor Rules. This is based on the findings of basal cell carcinoma of the prostate (8147/3) and adenocarcinoma (8140/3). We consulted with the Subject Matter Expert who advises that basal cell carcinoma and basal cell adenocarcinoma can be used interchangeably.

This updates previous consultation regarding this histology. The Other Sites rules will be updated for 2022 and include this information in the prostate histology table.

The clinical assessment code takes priority over the pathological assessment code in this case because the clinical assessment was worse than the pathologic assessment. Although there was a pathological assessment, the clinical assessment is greater. According to the general coding guidelines for neoadjuvant therapy, code the worst information, which in this case is the clinical assessment.

The 2018 EOD General Instructions for EOD Regionals Nodes, instruction #4, addresses neoadjuvant therapy as follows. Neoadjuvant (preoperative) therapy: If the patient receives neoadjuvant (preoperative) systemic therapy (chemotherapy, immunotherapy) or radiation therapy, code the clinical information if that is the most extensive lymph node involvement documented.

A new note is being included for the 2022 updates. Exception: If patient has neoadjuvant therapy, and the clinical assessment is greater than the pathological assessment, the clinical assessment code takes priority.

Code the behavior to /3, not just to pass edits, but because this is an invasive case based on the positive lymph nodes.

For most cases, behavior is based on the primary tumor, but in situations like this where an invasive component cannot be found and there are positive lymph nodes, the /3 behavior is assigned based on the positive lymph nodes.

Stratified mucin-producing intraepithelial lesion (SMILE) of the cervix is not reportable. SMILE is a variant of adenocarcinoma in situ and is coded 8140/2. In situ neoplasms of the cervix are not reportable. According to the WHO Classification of tumors, p16 is positive and there is a high Ki-67 proliferation index.

If SMILE is stated to be invasive, it is reportable, as any other invasive cervical malignancy would be reportable.

Carcinoma cuniculatum of the hard palate is reportable. Code to SCC, NOS (8070/3). Use text fields to record the details.

While WHO recognizes carcinoma cuniculatum to be a new variant of oral cancer, it has not proposed a new ICD-O code for this neoplasm.

This is a correction to the SEER manual. Lymphomas originating in lymph nodes (C77) could have distant metastases to any site except lymph nodes. The following corrections to the manual apply now and will appear in the next version of the manual.

Remove C770-C779 from the instruction for assigning code 8 on the following pages.

Page 135 Mets at Dx--Bone

Page 137 Mets at Dx--Brain

Page 139 Mets at Dx--Liver

Page 141 Mets at Dx--Lung

Page 145 Mets at Dx--Other

Example

Biopsy of axillary lymph node: Diffuse Large B-Cell lymphoma. Lymph nodes involved above and below the diaphragm, multiple nodules seen in lung, lesions in liver. Bone marrow biopsy positive for DLBLC. Per Hematopoietic manual, primary site would be C778 for multiple lymph node regions involved.

Mets at Dx--Bone-0

Mets at Dx--Brain-0

Mets at Dx--Liver-1

Mets at Dx--Lung-1

Mets at Dx--Distant Lymph Nodes-8

Mets at Dx--Other-1