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Tumor Tip of the Week – Prolactinoma

Scenario:

  • 02-20-2021 MRI Brain: Approximately 0.7 cm T2 hyperintense, hypoenhancing lesion in the central pituitary gland is suspicious for a pituitary microadenoma. There is minimal local mass effect without suprasellar extension. No other sellar/suprasellar abnormalities
  • 04-21-2021 Office Visit: Hyperprolactinemia, Microprolactinoma 7 mm. Prolactin in 50s, outside records from last year. Prolactin was checked due to inflammation in the breast. No drugs on board to elevate prolactin. No FHx of pituitary tumors.+ galactorrhea, no headaches, regular cycles, no h/o infertility, not planning any more conception. Plan: Complete pituitary panel, including prolactin. If prolactin high, start dopa agonist treatment (cabergoline 025-0.5 mg weekly). Interestingly, there are reports on elevated prolactin associated with Idiopathic Granulomatous Mastitis.
  • 04-29-2021 Prolactin 40.90 ng/mL (High)
  • 06-11-2021 Prolactin again mildly elevated, thus would start treatment with Dostinex 0.25 mg weekly

 

Question:  How will you assign histology/behavior?

    • 8272/0 Pituitary Adenoma
    • 8271/0 Prolactinoma

 

Answer:   8271/0 Prolactinoma

 

Rationale

SINQ Question: 201800118

Other Fields to consider:

Field Answer Rationale/Notes
Primary Site: C751 Solid Tumor Rules Non-Malignant CNS Table 5 Most Common Intracranial Primary Site
Histology/Behavior: 8271/0 Be sure to include in text physician office notes stating physician calling this a prolactinoma & prolactin lab  levels
Grade Clinical: 1 Grade Manual Page 185 Version 2.0.1 For benign tumors ONLY (behavior 0), code 1 can be automatically assigned for all histologies. This was confirmed by the CAP Cancer Committee
Grade Pathological: 9 Grade Manual  page 189 Version 2.01 Note 7:Code 9 (unknown) when No resection of the primary site (see exception in Note 6, Surgical resection, last bullet)
Diagnostic Confirmation: 5 CAnswer Forum Always code the procedure with the lower numeric value when presence of cancer is confirmed with multiple diagnostic methods. This data item must be change to the lower (higher priority) code if a more definitive method confirms the diagnosis at any time during the course of the disease. Bullet point: Code 5 when the diagnosis of cancer is based on laboratory test or marker studies which are clinically diagnostic for that specific cancer. In your case the tumor marker 5 is priority over code 7https://cancerbulletin.facs.org/forums/forum/fords-national-cancer-data-base/fords/cancer-identification/diagnostic-confirmation-except-hematopoietic-dx/70185-diagnostic-confirmation-code-for-prolactinoma
Hormone: 01 SEER*Rx Interactive Antineoplastic Drugs Database Cabergoline (Alternate Name Dostinex)

Category: Hormones and hormonal mechanisms Primary Site: Pituitary (prolactinoma)

Remarks: Pharmacia, Upjohn. Suppresses prolactin secretion by anterior pituitary.

Coding: This drug should be coded

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