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Tumor Tip of the Week-Ovarian Grade

Scenario:  06-18-2020 Ovarian primary TAH/BSO- endometrioid adenocarcinoma-FIGO grade 1, however, focal areas (1-2%) with high nuclear grade, consistent with FIGO grade 2

Question:  How would the pathological grade be coded?

  • 1 G1: Well differentiated
  • 2 G2: Moderately differentiated
  • 3 G3: Poorly differentiated, undifferentiated
  • B GB: Borderline Tumor
  • L Low grade
  • H High grade
  • 9 Grade cannot be assessed (GX); Unknown

Answer: 9 Grade cannot be assessed (GX); Unknown

Resource:  Grade Coding Instructions and Tables

Note 3: The grading system for this chapter is based on histology

  • Immature teratomas and serous carcinomas, codes L and H, otherwise code 9
  • All other histologies: Code 1-3 if a nuclear grade is documented, otherwise code 9
  • If your registry collects ovarian borderline tumors (/1), code “B” for grade

Rationale: Always refer to the appropriate Manual, the drop downs will not give you all the information you need to determine the proper code. The path report noted high nuclear grade, however, Ovary instructions note 3 of the grade manual states only immature teratomas and serous carcinomas can be coded L or H, so you cannot use H.  The path report also lists FIGO grade 2, however the grade manual provides no instructions for using FIGO grade for this site/histology, thus grade would be documented as 9.  **Special Note the instructions for grade for Ovary is different from the other GYN sites, regarding use of FIGO grade. **

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