SEER Inquiry System - Search

We received an edit error in SEER*DMS on the following site/histology (Orbit, NOS (C696)/9699/3) that involved an incorrect staging code being assigned to SS2018. The staging language is identical in AJCC, EOD and SS2018. SEER*RSA notes that SS2018 should be coded distant, but in the SS2018 manual, this language is noted Regional. Staging language is: Orbital adnexal lymphoma AND extraorbital lymphoma extending beyond the orbit to adjacent structures--Bone, Brain, Maxillofacial sinuses

In Table 3 (Specific Histologies, NOS/ NST, and Subtypes/Variants), the entry for papillary carcinoma, NOS includes a change in column 3 of the 2018 Breast Solid Tumor Rules that conflicts with the H Rules. It is not accounted for in the change log. No explanation is offered as to why this change was made. This is a major change because encapsulated papillary carcinoma is frequently associated with carcinoma NST, and we have not been collecting these as such.

Encapsulated papillary carcinoma (8504) in column 3 now includes an indented entry, with invasive carcinoma, NST/invasive duct carcinoma 8504/3. However, most encapsulated papillary carcinomas are in situ or there is no definitive statement of invasive encapsulated papillary carcinoma, so when in situ and invasive tumors are present, we are instructed to code the invasive histology (which would be the invasive carcinoma (NST), 8500/3). How are registrars to arrive at the correct histology without a new H rule or a clarification regarding this update being documented in the change log?

Does the same change/addition apply to solid papillary carcinoma? These are often also associated with carcinoma, NST. Again, without an explanation regarding the change mentioned above, it is difficult to understand why the change was made.

This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales.

7/8/16 Urinary bladder, biopsy: Non-invasive low grade papillary urothelial carcinoma. Muscularis propria (detrusor muscle) is not identified.

9/2/16 Urinary bladder, bladder tumor, transurethral resection: High grade papillary urothelial carcinoma. No definite invasion identified. Muscularis propria (detrusor muscle) is identified and not involved by tumor.

1/7/17 A\S\Bladder: Noninvasive low grade papillary urothelial carcinoma. Granulomatous cystitis, consistent with BCG (Bacillus Calmette-Guerin) treatment. Lamina propria is not involved with tumor. Detrusor muscle is not identified.

4/4/17 Dome: Papillary urothelial carcinoma, low grade. No evidence of invasion. Muscularis propria is not present.

Patient is clearly followed for at least a year but no further information until 19 months later, 11/14/18, when biopsy of lung indicates metastatic disease.

11/14/18 Lung, right lower lobe, mass, biopsy: Metastatic urothelial carcinoma. Immunohistochemical analysis results (CK7 positive, CK20 focally positive, P63 positive, GATA3 positive, TTF1 negative and NAPSIN-A negative) support the diagnosis

Example: Patient is found to have a 9.4 cm GIST in the jejunum and 2 cm GIST in the stomach during resection, neither stated to be outright malignant. Similar to the instruction in SINQ 20190041, this case is coded as a malignant jejunal primary due to multifocal tumor. However, it is unclear how to account for the stomach tumor, or any other multifocal tumor for GIST, when coding EOD and Summary Stage.

Per SEER 20140003, an omentectomy is not recorded under Surgery of Other Site when performed with a hysterectomy for an endometrial primary. Is this still correct? CoC appears to have different guidelines stating in a forum that an omentectomy is coded in data item Surgical Procedure to Other Site. I would like to confirm SEER guidelines. Is this one of those unique situations that SEER and STORE differ? Our state follows SEER guidelines and would like to communicate the appropriate rules to our facilities.

Path report reads: 7/15/2019 A. Endometrium, curettings: Serous carcinoma, high grade. B. Endometrial polyp, curettings: Serous carcinoma, high grade.

If coded to 8461/3, according to AJCC, this would not be an ideal code (since it is outdated). Also, endometrium is not included in the suggested site codes for 8461/3 according to the 8/22/2018 ICD-O-3 update.

SINQ 20200022 indicates that cases originally diagnosed as in situ do not have a new primary when a new invasive tumor with a different histology is diagnosed within 5 years. Should histology and/or behavior get updated for the in situ breast primary?

Examples:

1) New tumor at the ileocolic anastomosis, described as a, Circumferential centrally ulcerated mass with raised borders. Tumor extension: Tumor invades through muscularis propria into subserosal adipose tissue, no involvement of the serosal surface identified. The only mention of mucosa on the resection is the uninvolved enteric mucosa or uninvolved colonic mucosa in the otherwise uninvolved portions of the ileum/colon. If neither bullet 1 or 2 apply, is this a new primary per M7 bullet 3?

2) Right colon with anastomosis site. Tumor site: Anastomosis. Tumor extension: Tumor invades through the muscularis propria. Gross description does not describe mucosa, only noting, at the central area of anastomosis is an ill-defined, slightly raised, tan-brown to purple mass measuring 2.2 x 2 cm, which is nearly circumferential, causing obstruction at the site of anastomosis. If neither bullet 1 or 2 apply, is this a new primary per M7 bullet 3?

3) Polyp at ileocolonic anastomosis, polyp biopsy final diagnosis was, Invasive moderately differentiated colonic adenocarcinoma in association with adenoma. No mention of mucosa on the biopsy final diagnosis or gross description. Clinical info indicates, There is an ulcerated 5 cm mass at the ileo-colonic anastomosis that was biopsied. If neither bullet 1 or 2 apply, is this a new primary per M7 bullet 3?

The patient underwent a partial mastectomy and sentinel lymph node biopsy, followed by an axillary lymph node dissection for the first right breast primary in 2011. The separate 2020 right breast primary was treated with a total mastectomy and removal of one involved axillary lymph node. The operative report only refers to this as a non-sentinel lymph node, with no mention of other axillary findings.

Cumulatively, this patient has undergone a modified radical mastectomy since there were likely no remaining axillary lymph nodes. If the Surgery of Primary Site data item is cumulative, does the order of surgeries matter?

It is unclear whether this question should be directed to SINQ (for coding in a SEER registry) or to CAnswer Forum because both have addressed similar surgery related questions in the past and and there is no guidance regarding this specific situation.