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20220016 | Histology--Thyroid: What is the correct histology code for a follicular carcinoma, minimally invasive, oncocytic variant of the thyroid? See Discussion. |
There is an ICD-O histology code for follicular carcinoma, minimally invasive (8335/3) as well as follicular carcinoma, oxyphilic cell (8290/3). Per SINQ 20150045, the term oncocytic is synonymous with oxyphilic in this context. The Multiple Primaries/Histology General Instructions and histology rules do not include the term “variant” as a term that can be used to code a further histologic subtype. The term “variant” can be used for the Other Sites (non-updated STR sites) when the ICD-O-3.2 (or ICD-O-3 for older cases) provides the term “variant” in the histology name. |
Code follicular carcinoma, minimally invasive, oncocytic variant of the thyroid to follicular carcinoma, oncocytic variant (8290/3). The term "variant" is commonly used in thyroid histologies and if appropriate, used to determine histology code. The WHO Classification of Tumors of Endocrine Organs, 4th edition, lists synonyms for 8290/3 as Hürthle cell carcinoma; oncoycytic carcinoma; oxyphilic carcinoma; follicular carcinoma, Hürthle cell type; and follicular carcinoma, oncocytic variant. |
2022 |
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20220021 | Solid Tumor Rules/Multiple Primaries--Brain and CNS: How many primaries are accessioned, and what M Rule applies, for a 2012 diagnosis of left cerebral transitional meningioma (9537/0) that transforms to an atypical meningioma (9539/1) in 2022? See Discussion. |
The patient underwent a resection of the transitional meningioma in 2012, but residual tumor was left behind. The patient was on surveillance until imaging showed growth of the residual tumor. The resection in 2022 proved atypical meningioma. Rule M2, the first rule that applies, indicates this situation represents a single primary (a single tumor). However, Rule M4 states the transformation from a benign meningioma to a borderline meningioma would only be a single primary if the meningioma was a NOS. This patient has microscopic confirmation of a meningioma showing different subtypes/variants (listed in Column 3, Table 6). Should this be accessioned as multiple primaries based on the transformation and distinctly different histologies? |
Non-malignant CNS rule M4 applies, this is a single primary. This scenerio is covered in Example 2: A meningioma 9530/0 transforms into an atypical meningioma 9539/1. |
2022 |
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20220022 | Tumor Size--Pathologic--Anus: In 2019, the pathology report of an anal canal squamous cell carcinoma stated the tumor size is 2.5 cm from proximal to distal (3.5 cm in circumference). Is the pathologic tumor size tumor size 025 or 035? |
Based on the information provided, code the tumor size as 035. We asked an expert pathologist to review this question and she said to use the larger measurement. She also said "the pathologist usually cuts the anus and rectum open like a tube; the “circumference” would be measured flat." |
2022 | |
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20220028 | Reportability/EOD Primary Tumor--Ovary: Bilateral ovary shows gonadoblastoma with germ cell neoplasia in situ (9064/2). Pathology report clearly states in situ. Is this case reportable? If this case is reportable, how would you code Extent of Disease (EOD) Primary Tumor and SEER Summary Stage (SS)? In situ code 000 for primary tumor and code 0 for SS 2018 is not given as an option. |
Report germ cell neoplasia in situ (9064/2). Assign 999 for EOD Primary Tumor and assign 9 for SS2018. This particular histology is in the Soft Tissue Abdomen and Thoracic schema where EOD PT 000 and SS2018 0 are not available. This histology will be moved to the Ovary schema after redefining certain schemas and thus making the more accurate choices for EOD and SS2018 available. The schema redefine is planned for 2024 implementation. |
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20220040 | Laterality--Brain and CNS: Can Laterality be coded as 5 (midline) for a sella turcica meningioma (or tuberculum sellae meningioma) when no other statement regarding tumor laterality is documented? See Discussion. |
Laterality is often not noted for these sella turcica meningiomas; therefore, Laterality is often coded as 9 (Unknown). Because the sella turcica appears to be a midline structure in the base of the skull, is Laterality code 5 (midline) more appropriate when additional information is unavailable? |
You may assign code 5 (Paired site: midline tumor) for laterality of a meningioma of the sella turcica (C700). The 2022 SEER manual states in Laterality coding instruction 5: Assign Laterality code 5 only when the primary site is C700, C710-C714, C722-C725, C443, C445. Do not assign code 5 to sites not listed in 5.a. Note that code 9 is for paired sites and there is no information concerning laterality. Document laterality information in the appropriate text field. Note: Laterality does not factor into the CNS Solid Tumor rules. |
2022 |
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20220019 | Solid Tumor Rules/Histology--Thyroid: What is the correct histology code for a papillary carcinoma, encapsulated with columnar cell features? See Discussion. |
There is an ICD-O histology code for papillary carcinoma, columnar cell (8344/3) as well as papillary carcinoma, encapsulated (8343/3). Per Rule H13, the terms “with features of” may be used to identify a subtype. Considering these two subtypes, and knowing there is no specific histology code for this combination, is the first rule that applies H17 (code the numerically higher histology code)? |
Code to papillary carcinoma, encapsulated (C73.9) (8343/3) using Solid Tumor Rules, Other Sites, Rule H11, code the histology when only one histologic type is identified. The usage of features is describing the cellular architecture of the encapsulated papillary carcinoma and does not necessarily indicate a specific histologic type. We consulted with our endocrine specialist pathologist who agrees and indicated terminology used in thryoid neoplasms is inconsistent. |
2022 |
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20210076 | Reportability/Brain and CNS: Is a 2021 case of ecchordosis physaliphora (lesion within the prepontine cistern) on brain MRI reportable? |
Ecchordosis physaliphora is not reportable. |
2021 | |
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20210077 | First Course Therapy/Neoadjuvant Treatment: How are Neoadjuvant Therapy--Clinical Response and Neoadjuvant Therapy--Treatment Effect coded when the neoadjuvant therapy was not completed? Does the entire course of neoadjuvant therapy need to be completed before we can code these fields? See Discussion. |
Example: The neoadjuvant therapy was started, the patient progressed, the treatment plan was altered, and a new course of systemic therapy was started; surgery was cancelled. 01/25/21 Bile duct brushing: Malignant cells present, adenocarcinoma 01/26/21 Surgical oncology consult: Currently unresectable; recommend neoadjuvant chemo 02/22/21-3/29/21 Neoadjuvant Gemzar & Abraxane, two cycles, discontinued due to disease progression 04/17/21 Surgical oncology re-eval: CT positive for disease progression, need to change Rx 04/26/21 Second change of treatment due to progression: Irinotecan, Oxaliplatin, and 5FU 07/16/21 Surgical oncology re-eval: Unresectable, advise 4-6 months of chemo followed by radiation |
Assign code 3 (Progressive disease (PD)(per managing/treating physician statement) for Neoadjuvant Treatment--Clinical Response and code 7 (Neoadjuvant therapy completed and planned surgical resection not performed) for Neoadjuvant Treatment--Treatment Effect. These are the best choices under the circumstances. Use text fields to record the details. |
2021 |
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20210001 | SEER*RSA/Required data items--Melanoma: The site-specific data item, Ulceration, states it is required by "All" in SEER*RSA but in the NAACCR Data Dictionary table it states is it required by SEER, Commission on Cancer (CoC), and Canadian Cancer Registry (CCCR), not the National Program of Cancer Registries (NPCR). Does the definition of "All" in SEER*RSA not include NPCR? Also, please explain the difference between Required by: "All" and "Required by CCCR/Canada, COC, NPCR, SEER" (all listed out). |
Use the NAACCR Data Dictionary Required Status Table or refer to standard setter requirements. Do not use SEER*RSA to determine which data items are required to be collected or transmitted. Though "All" in SEER*RSA generally refers to the standard setters including CoC, NPCR, CCCR, and SEER, some items in SEER*RSA need updating; this is planned for 2022. |
2021 | |
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20210012 | Solid Tumor Rules (2018, 2021/Multiple Primaries/)--Lung: How many primaries should be reported and what M rule applies when a diagnosis of presumed adenocarcinoma in situ (AIS) of the left lung follows a known diagnosis of progressive multifocal malignant adenocarcinoma in the right lung? See Discussion. |
Patient was initially diagnosed with a right lower lobe (RLL) lung adenocarcinoma in 2014 followed by subsequent right upper lobe (RUL) lung adenocarcinoma in 2016 (single primary). Both were treated with radiation and the nodules were seen as stable on surveillance. There was subsequent growth in the RUL nodule in 2019 and RLL nodule in 2020 as well as a new right middle lobe (RML) nodule in 2020. All left sided nodules were noted to be stable and/or ground glass opacities. There was no documented diagnosis of malignancy in the left lung until June 2020 when the physician noted that if there was a response in the left lung to systemic treatment, then this was probably multifocal AIS. However, only one tumor in the left lung responded to treatment. While it seems somewhat unlikely that only a single AIS in the contralateral lung should be metastasis from the right lung malignancy, it is difficult to apply the multiple tumors rules to this case. |
Abstract a single primary using 2018 Lung Solid Tumor Rule M9. The 2014 and 2016 R lung tumors were pathologically confirmed; it is not stated if they were resected. Follow up after XRT noted stable disease but no indication of NED. Subsequent right lung tumor is also the same primary. The issue is the assumed left lung adenocarcinoma in situ. It is not clear how long the left lung nodules were present, but they appeared to be stable as well and only diagnosed as a malignancy based on treatment response. At this time M9 applies and the left lung AIS is not a separate primary. We have discussed at length with lung pathology experts the issue of determining multiple primaries. Identifying and diagnosing lung tumors has become easier with new technology and the result is patients are being diagnosed with multiple lung tumors. Some lung experts feel we are under-reporting lung primaries but all noted the many issues with creating rules for consistency. |
2021 |
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