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Report Produced: 09/06/2025 05:14 AM

Report Question ID Question Discussion Answer Year
20160035

Reportability/Histology--Pituitary Gland: How are Rathke cleft cyst and Rathke pouch tumor distinguished and are they both reportable?

Rathke cleft cyst is not reportable. Cysts are not neoplastic. However, Rathke pouch tumor (C751, 9350/1) is a reportable neoplasm for cases diagnosed 2004 and later. The Rathke pouch is coded to the pituitary gland. Benign and borderline pituitary tumors have been reportable since 2004.

2016
20160041

First course treatment/Surgery of Primary Site--Skin: How are Surgery of Primary Site and Surgical Procedure of Other Site coded for an eyelid skin primary diagnosed by punch biopsy and treated with an orbital exenteration? See Discussion.

Unlike most other sites, there is no specific code for a radical surgical procedure of a skin primary. In this case, the patient was diagnosed with a sebaceous cell carcinoma of the lower eyelid skin by punch biopsy. The tumor was large and an orbital exenteration was planned. Despite the extensive surgery performed, skin margins were less than 1 cm. Is an orbital exenteration a "major amputation" (code 60) in this case? Given that the margins were not greater than 1 cm, codes 45 - 47 (which includes a minor (local) amputation) don't seem to apply. However, if this procedure cannot be classified as "minor amputation" then doesn't it seem overkill to refer to the procedure as a "major amputation"?

An alternative would be to code Surgery of Primary Site to 32 for the skin resection (punch biopsy followed by a gross excision of the lesion, margins less than 1 cm) and code Surgical Procedure of Other Site to 2 (non-primary surgical procedure to other regional sites) to record the removal of the globe and orbit as part of the orbital exenteration. Which is correct?

There is a similar question in the FORDS forum of the CoC CAnswer Forum. CoC is the curator for the surgery codes.

Surgical Procedure to Primary Site - Gross excision of the lesion, code in 30s series

Surgical Procedure to Other Site (removal of eye) - code 4

http://cancerbulletin.facs.org/forums/forum/fords-national-cancer-data-base/fords/first-course-of-treatment/surgery/56355-sebaceous-carcinoma-of-the-eyelid-primary-surgery-code

 

2016
20160017

Surgery of Primary Site--Melanoma: Please further explain the SEER Note under Melanoma surgery codes 30-36 for these two examples. Are both examples coded 31?

1. Shave bx: +melanoma in situ, +microscopic margins  Wide excision: no residual melanoma in situ

2. Shave bx: melanoma, +microscopic margin   Wide excision: Melanoma, margins negative (margin status negative but distance not stated)

Revised answer: Assign surgery code 30 for both examples based on the SEER Note on the top of page 2 in the Surgery of Primary Site Codes for Skin: If it is stated to be a wide excision or reexcision, but the margins are unknown, code to 30.

 2016
20160013

Reportability--Breast: Is mammary fibromatosis reportable and if so, what histology code is assigned? See discussion.

The pathologist completed a CAP protocol using soft tissue. Pathology revealed a 2.5 cm tumor with invasion of skeletal muscle with deep margins positive for tumor.

Mammary fibromatosis is not reportable. The WHO classification for breast tumors assigns mammary fibromatosis a behavior code of /1. According to WHO, mammary fibromatosis "is a locally infiltrative lesion without metastatic potential…"

2016
20160058

First course treatment--Heme & Lymphoid Neoplasms: Are blood thinners, e.g., warfarin, coded as treatment in the Other Therapy data item for polycythemia vera and myelodysplastic syndrome? See Discussion.

Under the hematopoietic data base, treatment for polycythemia vera shows chemotherapy, immunotherapy, and phlebotomy. Essential thrombocytopenia shows blood thinners, anti-clotting medications, aspirin, chemotherapy, immunotherapy, and other therapy (Anagrelide) (for essential thrombocythemia only) and watchful waiting (for asymptomatic patients). Myelodysplastic syndrome shows bone marrow transplant, chemotherapy, immunotherapy, and stem cell transplant.

SEER*RX under warfarin says: Per the 2012 Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual (page 10), blood thinners and/or anti-clotting agents are to be coded as treatment (Other Therapy) for the following histologies: 9740/4 Mast cell sarcoma 9741/3 Systemic mastocytosis 9742/3 Mast cell leukemia 9875/3 Chronic myelogenous leukemia BCR/ABL 1 positive 9950/3 Polycythemia vera 9961/3 Primary myelofibrosis 9962/3 Essential thrombocythemia 9963/3 Chronic neutrophilic leukemia 9975/3 Myelodysplastic/myeloproliferative neoplasm, unclassifiable.

Based on information from the National Cancer Institute and the Food and Drug Administration, aspirin and/or other blood thinners are not valid treatment for polycythemia vera and myelodysplastic syndrome. These drugs are often given to relieve symptoms of the disease such as bone pain or side-effects of standard treatments including blood clots. The treatment information found on page 22 (2015 Hematopoietic & Lymphoid Neoplasms coding manual) will be updated and ICD-O-3 codes 9950/3 and 9975/3 will be removed from the list. SEER*RX has been updated to reflect this change.

2016
20160009

MP/H Rules/Histology--Appendix: What is the histology for an appendix resection diagnosis of "Malignant neoplasm of the appendix with the following features: Histologic type: Adenocarcinoma ex goblet cell carcinoid with mucin production (adenocarcinoma arising from goblet cell carcinoid)"? Is this histology best coded to a mixed adenocarcinoma/carcinoid tumor (8244/3)?

Code histology to combined carcinoid and adenocarcinoma (8244/3). The tumor is a mix of adenocarcinoma and carcinoid.

2016
20160034

First course treatment/Immunotherapy--Heme & Lymphoid Neoplasms: Is donor leukocyte infusion for treatment of hematopoietic neoplasms coded as a bone marrow transplant per the Hematopoetic Manual or as immunotherapy per SEER Inquiry System (SINQ) 20110048?  See Discussion.

In the Hematopoetic Manual, page 22, it is states: "The use of donor leukocyte infusions for treatment of hematopoietic neoplasms, specifically leukemias, is increasing.  Abstract as bone marrow transplant when a reportable hematopoietic neoplasm is treated with donor leukocyte infusion, even if it is not listed in the treatment section of the Heme db for the specific neoplasm."  Question 20110048 in the SEER Inquiry, it is stated "Donor lymphocyte infusion (DLI) is coded as immunotherapy."  Donor lymphocyte infusion and donor leukocyte infusions are the same procedure.  Please clarify discrepancy as coding is needed for a case treated with donor lymphocytic infusion.

Code donor lymphocyte infusion as immunotherapy. SINQ 20110048 is correct. The Hematopoietic Manual will be corrected during the next update.

2016
20160012

Reportability--Brain and CNS:  Is a thalamic amyloidoma reportable if so what histology code is used?

Thalamic amyloidoma is not reportable. Amyloidoma (tumoral amyloidosis, amyloid tumor) is a tumor-like deposit of amyloid. It is not neoplastic. Amyloid is a protein derived substance deposited in various clinical settings.

2016
20160015

Multiple primaries--Heme & Lymphoid Neoplasms: Could you please clarify Note 2 found in Rule M10, which is " 'Transformations to' (acute neoplasms) and 'Transformations from' (chronic neoplasms) are defined for each applicable histology in the database." Do the neoplasms being considered have to contain the words 'chronic' and/or 'acute'?

Hematopoietic neoplasms that transform generally don't have 'chronic' or 'acute' as part of their preferred name. The 'chronic' and 'acute' designations are determined by the usual course of the neoplasm. Chronic neoplasms are generally slow growing while acute neoplasms grow fast and are more widespread. Not all Hematopoietic neoplasms transform. Each neoplasm that has the ability to transform has the transformations listed under the 'Transformations to' and/or 'Transformation from' sections in the Hematopoietic database.

For example, Diffuse large B-cell lymphoma (histology code 9680/3) has no histologies/neoplasms listed under 'transformations to.' This means that this neoplasm does not transform to any other neoplasm. There are multiple histologies/neoplasms listed under 'Transformations from' indicating the neoplasms listed under the Transformations from are the chronic neoplasms, and DLBCL is the acute neoplasm. If DLBCL (9680/3) occurs at the same time, within 21 days, or greater than 21 days of any of the histologies listed under 'Transformations From,' rules M8-M13 apply. If DLBCL (9680/3) occurred at the same time as a neoplasm not listed in the Transformations sections, the acute and chronic rules do not apply.

2016
20160073

MP/H Rules/Multiple primaries/Histology: What histology and how many primaries are coded for a mixed germ cell tumor with a somatic type malignancy (rhabdomysarcoma) if the patient was diagnosed with seminoma of the testis in 2009 followed by a 2015 metastatic germ cell tumor in a retroperitoneal lymph node, stated to be a recurrence of the testicular cancer? See Discussion.

In September 2009 the patient was diagnosed with seminoma, classical type, following an orchiectomy. Testicular mass recurrence in 2014 was treated with chemotherapy.

Then in April 2015 a retroperitoneal dissection of a peri-aortic LN was positive for mixed germ cell tumor with somatic type malignancy (rhabdomyosarcoma) involving 1/11 nodes. Path Comment: major component of tumor is teratoma, rhabdomyosarcoma represents <5% of mass.

Now in October 2016, the patient has a retroperitoneal mass biopsy positive for spindle cell sarcoma with rhabdomyosarcomatous differentiation. The comment section of the pathology report states, "Given the history of a germ cell tumor w/ rhadbomosarcomatous component, the findings are consistent with a recurrence of rhabdomyosarcomatous component of germ cell tumor."

Can a seminoma transform to a mixed germ cell tumor with a somatic type malignancy (see SINQ 20140082 - testicular teratoma with somatic type malignancy)?

According to our expert pathologist consultant, yes, seminoma could transform to a mixed germ cell tumor with a somatic type malignancy. He advises us to code this case as 9061/3.

From our expert pathologist consultant: This occurs as "reprogramming" of the initial germ cell tumor/seminoma cell. The process is not understood, but genetic studies support this progression concept. Most often the next step is teratoma. It is out of the teratoma that the somatic malignancy usually comes. I do wonder about the possibility that this was really an embryonal carcinoma which resembles a seminoma - occasionally this can be a difficult separation. I wonder if they radiated the scrotum following the orchiectomy, also, given the scrotal recurrence.

 2016