Scenario 2023:
- Patient presented with RLQ pain. Physical exam abdomen tender to palpation, otherwise within normal limits
- CT Ab/Pelvis: Suspect Appendicitis. No enlarged lymph nodes. No other pertinent findings
- Snips from Path Report
- Final Diagnosis: Appendix (laparoscopic appendectomy): High-grade appendiceal mucinous neoplasm (HAMN)
- SYNOPTIC STAGING SUMMARY
- Procedure: Appendectomy
- Tumor Site: Diffusely involving appendix
- Histologic Type: High-grade appendiceal mucinous neoplasm
- Tumor Extension: Mucin extends into but not through muscularis propria
Question: How would you code the behavior for this site?
- /2
- /3
Answer: /2
Rationale:
Solid Tumor Rules Colon
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- Rule H5 Code low grade appendiceal mucinous neoplasm (LAMN) and high grade appendiceal mucinous neoplasm (HAMN) 8480/2 when:
- Diagnosis date is 1/1/2022 forward AND
- Behavior is stated to be in situ/non-invasive OR
- Behavior is not indicated
- Note 1: ICD-O-3.2 lists LAMN with behavior of /1. WHO 5th Ed Digestive Systems Tumors indicates this neoplasm is considered in situ. After consulting with WHO Digestive System editors, College of American pathologists, and AJCC GI chapter experts, the standard setting organizations have agreed LAMN should be collected and should be assigned a behavior code of /2 beginning with cases diagnosed 1/1/2022 forward.
- Note 2: A diagnosis of LAMN or HAMN does not require the tumor be comprised of greater than 50% mucinous in order to be coded 8480.
- Note 3: If the pathologist indicates LAMN or HAMN is invasive or has a malignant behavior, continue through the rule
- Rule H5 Code low grade appendiceal mucinous neoplasm (LAMN) and high grade appendiceal mucinous neoplasm (HAMN) 8480/2 when:
-
Other Fields to Consider:
| Field | Answer | Rationale |
| Primary Site | C181 | Solid Tumor Rules Colon 2023 Update Appendix=C181 |
| Histology/Behavior | 8480/2 | Solid Tumor Rules Colon 2023 Update |
| EOD Primary Tumor | 000 | EOD Manual 000=High-grade appendiceal mucinous neoplasm confined by the muscularis propria (HAMN) |
| EOD Regional Nodes | 000 | EOD Manual 00 No regional lymph node involvement |
| EOD Mets | 00 | EOD Manual 00 No distant metastasis |
| SEER Summary Stage | 0 | Summary Stage Manual v3.1 0 In situ, intraepithelial, noninvasive= High-grade appendiceal mucinous neoplasm confined by the muscularis propria (HAMN) |
| AJCC Clinical Stage | cT Blank cN Blank cM Blank Stage 99 | Incidental finding during surgical procedure for presumed appendicitis.
Refer to Common staging scenarios (Note CSS): AJCC Cancer Staging System: Appendix: Version 9 of AJCC Cancer Staging System |
| AJCC Path Stage | pTis cN0 cM0 Stage 0 | Refer to AJCC Cancer Staging System: Appendix: Version 9 of AJCC Cancer Staging System
AJCC Critical Clarification In Situ Neoplasia
AJCC Curriculum for Registrars
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P.S. Don’t forget to recognize your hero in the cancer registry field! I know I have so many! NCRA will be spotlighting 50 registrars to celebrate NCRA 50th anniversary!
