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20180043 | Solid Tumor Rules (2018)/Histology--Breast: Can the College of American Pathologists (CAP) protocol be used to determine whether in situ tumor is present for the purpose of determining which H Rule applies in the example presented? See Discussion. |
The Histology Coding Instructions give priority to the Final Diagnosis over the CAP protocol. However, when pathology reports are formatted using the CAP protocol, the presence of in situ carcinoma is generally only mentioned in the CAP protocol. Can the presence of in situ tumor mentioned only in the CAP protocol be used to apply rule H7 (Single Tumor: Invasive and In Situ Components Module)? Or are the rules in the Single Tumor: Invasive Only module used? Example: Final diagnosis is invasive ductal carcinoma. CAP protocol mentions, |
Apply Rule H12 of the 2018 Solid Tumor Rules for Breast Cancer, released April 2019. Remember the protocol is a checklist only and should not be used to code histology unless it is the only document available. |
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20180066 | Solid Tumor Rules (2018)/Laterality--Brain and CNS: How is laterality coded for bilateral non-malignant central nervous system (CNS) or malignant CNS tumors now that laterality is no longer used to identify these tumors as multiple primaries? See Discussion. |
The Equivalent Terms and Definitions sections in the Solid Tumor Rules for these schemas identify which sites must have laterality coded, but there is no instruction for coding laterality when bilateral tumors are a single primary. The SEER Manual currently only indicates code 4 (bilateral) is seldom used (e.g., bilateral ovarian tumors, Wilms tumors, etc.) but does not indicate laterality code 4 should be used for CNS tumors. Is this note going to be updated or should a non-bilateral code be applied? Example: MRI demonstrates multiple left-sided dural-based meningiomas including a 4.4 cm left posterior fossa meningioma, a 0.8 cm left frontal-parietal meningioma and a right posterior frontal meningioma. The large left posterior fossa meningioma was resected and proved atypical meningioma. Should the laterality be 4 (bilateral) as the patient had both left and right-sided meningiomas confirmed to be a single primary? Or should the laterality be coded as 2 (left) since only the large left-sided meningioma was proven to be a borderline tumor (atypical meningioma, 9539/1) and the others were benign? |
Determine whether the CNS tumors are single or multiple primaries. Multiple cerebral meningiomas are a single primary according to the non-malignant CNS Solid Tumor Rules. Assign laterality using the 2018 SEER Manual for select invasive, benign, and borderline primary intracranial and CNS tumors using codes 1-9 for all sites listed in the Sites for Which Laterality Codes Must Be Recorded table. In the example, assign code 4, bilateral involvement at time of diagnosis, lateral origin unknown for a single primary. The solid tumor rules are not a one-stop-shop for all coding. Refer to the appropriate coding manual for laterality. We removed laterality for determining multiple primaries in meningiomas as they were being over-reported according to CBTRUS. |
2018 |
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20180090 | Reportability--Ovary: Is an ovarian serous borderline tumor with microinvasion with serous tumor aggregates (3 mm in greatest dimension) in 2 of 10 pelvic lymph nodes reportable? See Discussion. |
SINQ 20170043 is a similar question about an ovarian mucinous borderline tumor with microinvasion, but the answer seems to be specifically referencing mucinous tumors only. It is unclear if that SINQ could be applied to this case. In addition, we were not sure how to interpret the nodal involvement. The physician assessment after surgery was low grade serous carcinoma, chemo not recommended and letrozole started. |
Ovarian serous borderline tumor with node implants is not reportable; it is a borderline neoplasm. However, if the oncologist believes he or she is dealing with a low grade serous carcinoma rather than a borderline tumor, this case is reportable. We recommend that you determine whether the diagnosis of low grade serous carcinoma, chemotherapy not recommended, is based on the pathological findings or on something else before reporting this case. |
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20180022 | Reportability/Histology: Is a focal high grade squamous intraepithelial lesion (HSIL/moderate to severe dysplasia/VIN II-III) in the vulva reportable for cases diagnosed in 2018? See discussion. |
Since high grade squamous intraepithelial lesion (HGSIL) is reportable for the vulva in 2018 (per SINQ 20130185) but VIN II-III is not reportable, we need to clarify this reporting format seen in our area. |
Report when stated to be high grade squamous intraepithelial lesion of the vulva. The 2018 SEER Manual says to assign 8077/2. HGSIL is a synonym for squamous intraepithelial neoplasia, grade III for vulva and vagina only. |
2018 |
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20180064 | Solid Tumor Rules (2018)/Recurrence--Breast: Does any recurrence within the multiple primaries-stated timeframe count, not those just in the primary site? See Discussion. |
A patient has a left breast cancer diagnosed in 2011; then has a "recurrence" in her lymph nodes in 2017. In 2018, she has a new left breast mass that is the same histology and behavior as the 2011 cancer. Based on the 2017 "recurrence" in the lymph nodes, this is not a new breast primary, is that correct? |
This is a single primary using 2018 Breast Solid Tumor Rule M11. Rule M8 does not apply because the patient was not clinically disease free for 5 years. We are interpreting the 2017 diagnosis as lymph node metastasis from the 2011 breast cancer diagnosis. |
2018 |
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20180095 | Solid Tumor Rules (2018)/Histology--Lung: How is histology coded when the term "predominant" is used to describe solid adenocarcinoma, acinar adenocarcinoma, etc.? Pathology reports often say "See Synoptic" (also known as the College of American Pathologists (CAP) protocol) included in the Final Diagnosis rather than including all the detail. Based upon the new Solid Tumor Rules for lung, predominant/predominantly is no longer a subtype/variant and should not be coded unless there is a specific code/subtype-variant for the NOS in Table 3, e.g., adenocarcinoma, lepidic predominant. See Discussion. |
Examples Example #1: CAP histology type: Adenocarcinoma, solid predominant, Final diagnosis states that Adenocarcinoma, poorly differentiated, solid predominant (80%) and cribriform (20%) subtype (see lung carcinoma synoptic report) Example #2: CAP histology type : Invasive adenocarcinoma, solid predominant, Other Subtypes Present (specify subtype(s), may also include percentages): acinar (45%) and micropapillary (5%) Final diagnosis : adenocarcinoma of the lung, please see Synoptic Report Example #3: CAP histology type: Adenocarcinoma, acinar predominant , Adenocarcinoma, solid predominant Final diagnosis: Adenocarcinoma, poorly differentiated, solid predominant (60%), papillary (30%) and acinar (10%) subtype (see lung carcinoma synoptic report) |
The lung H rules and tables have been updated to include histologies that CAP identifies using the term "predominant" in the diagnosis. Example: Code adenocarcinoma, lepidic predominant, to 8250/3 rather than 8140/3. When the final pathology diagnosis includes more than one "predominant" adenocarcinoma subtype such as acinar, solid, or lepidic, then code the type with the greatest percentage according to Lung Solid Tumor Rule H7. |
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20180071 | Solid Tumor Rules (2018)/Histology--Cervix uteri: What is the correct histology code for malignant mixed Mullerian tumor (MMMT/Carcinosarcoma)? See Discussion. |
An endometrial cancer was diagnosed in 2018. The endometrial biopsy showed malignant mixed mullerian tumor (MMMT/Carcinosarcoma). The total abdominal hysterectomy/bilateral salpingo-oophorectomy showed Endometrial Carcinosarcoma (50% serous carcinoma, 50% high grade sarcoma with rhabdomyoblastic differentiation) with invasion of 100% of the myometrium and involvement of the uterine serosa. I am not finding this in the Solid Tumor Rules or the site-specific ICD-O-3 code lists. |
According to the WHO Classificationof Tumors of Female Reproductive Organs, 4th edition, MMMT (8950/3) is now a synonym for carcinosarcoma (8980/3) even though it has a separate ICD-O code. The ICD-O code for MMMT is no longer in the WHO book. Per the subject matter experts, when both terms are used in the diagnosis (carcinosarcoma/MMMT), code the histology to 8980/3. If the ONLY term used is MMMT, assign 8950/3. The information in the 4th edition of the WHO Classification of Tumors of Female Reproductive Organs has not yet been incorporated into the Other Sites Solid Tumor Rules. |
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20180031 | First Course of Treatment/Other Therapy: Where do you code Optune TTF therapy? What needs to be included in the text portion to document this treatment? |
Code OPTUNE in the Other Treatment field. See NovaTTF in SEER*Rx (http://seer.cancer.gov/seertools/seerrx/). NovaTTF is the pre-FDA approval name for OPTUNE. If OPTUNE was administered for recurrence, be sure NOT to record it in the first course of treatment fields. Check with CoC if you have questions about coding treatment for recurrence. |
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20180062 | Histology--Heme & Lymphoid Neoplasms: How is histology coded when a lymph node excisional biopsy shows Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL), predominantly in diffuse T-cell histiocyte rich large B-cell lymphoma-like (THRLBCL) pattern. Comment states: The findings are that of nodular lymphocyte predominant Hodgkin lymphoma with diffuse T-cell rich pattern (T-cell/histiocyte-rich large B-cell lymphoma-like). This variant is regarded as clinically more advanced. See Discussion. |
It appears an argument could be made for both NLPHL (9659/3) and THRLBCL (9688/3). We favor coding NLPHL (9659/3) because the pathologist did specifically call this a Hodgkin lymphoma, and also specified that it only has a T-cell/histiocyte-rich large B-cell lymphoma-like pattern. |
Assign histology code 9659/3. According to the Hematopoietic database, this histology frequently has T-cells. The other description was not an actual histology, but noting that the appearance of the cells was similar to that histology. |
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20180032 | Reportability--Appendix: Is low grade appendiceal mucinous neoplasm (LAMN) reportable for 2018? It is staged as pTis(LAMN) AJCC 8th ed by pathologist. |
Low grade appendiceal mucinous neoplasm (LAMN) is not reportable in 2018. See page 6, https://20tqtx36s1la18rvn82wcmpn-wpengine.netdna-ssl.com/wp-content/uploads/2018/02/2018-ICD-O-3-Coding-Table-Alpha-order-.pdf. Use cancer registry reportability instructions to determine reportability. Do not use the AJCC TNM manual to determine reportability. |
2018 |
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