# Urological Path report



## wk052558 (Aug 23, 2010)

I have a path reports that reads " Atypical Small Acinar Proliferation" (ASAP), single focus, suspicious for Carcinoma.

Could you please help with coding the Pathology Report on this on.
Thank you in advance,
Wilma


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## Kelly_Mayumi (Aug 25, 2010)

Neoplasm uncertain behavior (236._, I don't have my ICD-9 in front of me)?


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## preserene (Aug 26, 2010)

From the pathology report, I infer that it is a biopsy specimen Prostatic gland.
Prostatic intraepithelial neoplasia (PIN), particularly high-grade PIN (HGPIN), and atypical small acinar proliferation (ASAP) have been identified as precursor lesions to prostatic carcinoma.
[ASAP includes a group of lesions (eg, adenosis, atypical adenomatous hyperplasia, intraductal hyperplasia, acinar atypical hyperplasia) that have varying clinical significance. Some ASAP lesions mimic cancer, and, in many instances, focal carcinoma may be present, but cytological, histochemical, and architectural atypia are insufficient to establish a definitive diagnosis. 
some urologists believe that observation alone is safe for these patients while others employ a course of medication such as finasteride, dutasteride, or toremifene, which may eliminate these cells.]
What we infer from these findings is, *it could range from uncertain behavior to Ca in situ*. But could not be placed in benign anyway, by its clinical behavior, nor to unspecified.
But once pathologist has labeled it as carcinoma, it cannot be definitely benign. It is in borderline or ca in situ.
*If *the pathologist had *asked for repeat biopsy*, I would still safely place it under *uncertain behavior*, because of their varying plethora of clinical behavior (please read the passage above in parenthesis), until next specimen result  arrives.
*If * the pathologist did not ask for a repeat specimen then, it should be construded that his report for just* carcinoma  with atypical small acinar **is final *and I would *place it  **under carcinoma in situ *.

But above all, what the treating doctor with all the clinical scenario, has a say about it ,and so, you can verify with him as to report how.
This is just my discussion. Thank you


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