SEER Inquiry System - Search

Evaluation of Malignancy and Prognosis of Gastrointestinal Stromal Tumors: A Review. Miettinen, M. et al, Human Pathology 2002 May; 33(5) 478-83). This article states there is an increasing number of GISTs because the majority of tumors previously diagnosed as gastrointestinal smooth muscle tumors (leiomyomas, leiomyoblastomas and leiomyosarcomas) are now classified as GISTs. It states that gastrointestinal autonomic nerve tumors (GANTs) are also GISTs based on their KIT positivity and presence of KIT-activating mutations. This article also states that a GIST is probably malignant if it meets the following criteria: 1) Intestinal tumors: Maximum diameter >5 cm or more than 5 mitoses per 50 HPFs. 2) Gastric tumors: Maximum diameter >10 cm or more than 5 mitoses per 50 HPFs.

Some of the path reports that meet these criteria use the word "malignant", and others do not. Some of the cases that are not called "malignant" in the path diagnosis are signed out clinically as "malignant."

Endometrial primary confirmed by biopsy on 10/26/06. Pelvic washing on 11/14/06 was 'suspicious for malignancy.' Resection path the same day stated the primary tumor invades the inner 1/3 of the myometrium.

Can we use the pelvic washing cytology & code CS extension 61 or should CS extension be coded 12?

Endocrine mucin-producing sweat gland carcinoma (EMPSCG) is a rare type of low-grade sweat gland carcinoma. Some journal articles indicate that most patients with EMPSCG have coexisting mucinous carcinomas, suggesting that EMPSCG is a precursor to invasive mucinous carcinoma of the skin. Sweat gland carcinoma has its own histology code per the ICD-O-3 (8400/3); should an endocrine mucin-producing sweat gland carcinoma also be coded as 8400/3? If so, would the correct histology for the skin case above be mucinous carcinoma (8480/3) per Rule H17? Conversely, if the terms "mucin-producing" are referring to mucin-producing carcinoma, and not referring to the sweat gland carcinoma, would the histology be coded 8481/3 (mucin-producing carcinoma)?

Does the rule on page 111 of the SEER Program Coding Manual, 3rd Edition, for code 1 apply to myelomas (in the same way it applies to leukemias)?

Does the Other Sites MP/H Rule H17 apply in this case, which results in coding the higher histology 8805/3 (undifferentiated sarcoma)? Or does the "undifferentiated" statement only refer to grade, which results in coding histology to 8802/3 (pleomorphic sarcoma)?

Does Rule M5 only apply if both diseases are present at the original diagnosis, or does it also take into account a recurrence of an old disease? The answer to this question makes a difference between stopping at rule M5 and abstracting as one disease, or going on to rule M15 to query the Hematopoietic Database to determine whether the patient has two separate primaries.

Example: Patient had Stage II Hodgkin disease in 2005 (all lymph nodes above diaphragm, supraclavicular LN biopsied at diagnosis), treated and patient achieved complete remission. In 2010, the patient is admitted for suspected recurrence. A supraclavicular lymph node biopsy showed, "Recurrent Hodgkin" AND "EBV+ Diffuse Large B-cell Lymphoma," both in the same lymph node. Applying rule M5, this is a single primary and states not to query the DB. However, this doesn't seem correct as it does not account for the new DLBCL.

Does Rule H19 apply which indicates the histology is coded to 8221 [adenocarcinoma in multiple adenomatous polyps] because there are multiple polyps (number not specified) throughout the colon? Does tumor have to arise in at least one of the adenomas in order to apply Rule H19?

Or, does Rule H22 apply which indicates the histology is coded to 8140 [adenocarcinoma, NOS] because the adenocarcinomas are both frank invasive adenocarcinomas and not adenocarcinoma arising in an adenoma?

Does ductal carcinoma with tubular features qualify for Breast MP/H Rule H28? Or, is it more appropriate to strictly follow Table 2 (not a type of ductal tumor) and apply Rule H29, thus losing the lobular component?

Do we use the highest applicable value because all three definitions are used in the following example? Ex: Path diagnosis: Sigmoid polyp: tubulovillous adenoma with a focus within upper portion of stalk consistent with superficially invasive (intramucosal) colonic adenocarcinoma (see Comment). Comment: ... in the upper stalk region, there is evidence of superficially invasive carcinoma which appears to be limited to the muscularis mucosa and thus would be intramucosal by classification.

Do DCO cases have default values for the Multiplicity Counter and Multiple Tumor Reported as One Primary fields? Should these fields be coded as 88 or 99?

In the data item pages for these fields, there is only a reference to see the NAACCR Death Clearance Manual. However, this manual does not provide an answer. There is guidance to use code 88 for unknown primaries but we noticed that SEER edits skip enforcing this requirement for DCO cases (see SEER IF205 and 206).