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| Report | Question ID | Question | Discussion | Answer | Cancer Site Category | Data Item Category | Year |
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20160021 | Primary Site--Stomach: How do I code the primary site when the operative report and pathology report state that the tumor site is incisura of the stomach? |
Assign C163. Incisura, incisura angularis, gastric angular notch, angular incisure of stomach all refer to the sharp angular depression in the lesser curvature of the stomach at the junction of the body with the pyloric canal. See Gastric angular notch in #12 on page 76 in the SEER manual, http://seer.cancer.gov/manuals/2015/SPCSM_2015_maindoc.pdf. See also the SEER training website, #12 on the illustration corresponds to the angular notch, http://training.seer.cancer.gov/ugi/anatomy/stomach.html. We will correct the key for this illustration. |
Stomach | Primary site | 2016 | |
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20140009 | Primary site: What primary site do I assign to a Squamous Cell Carcinoma of the parapharyngeal space when there is no other info available regarding a more definitive site within the parapharyngeal space? Each physician involved with the case states the primary site is the parapharyngeal space. This is a patient who was diagosed and treated elswhere and was seen at our hospital several months later for a radical neck dissection for suspected lymph node mets. |
Assign C139 for a primary originating in the parapharyngeal space. This space contains part of the parotid gland, adipose tissue, lymph nodes, nerves, arteries and veins. |
N/A | Primary site | 2014 | |
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20071116 | Behavior--Bladder: What behavior code is used for a TURB path specimen diagnosis of "non-invasive urothelial carcinoma, no muscle found, depth of invasion cannot be assessed" when the clinician stages the case as Ta? See Discussion. | The SEER site specific coding module for bladder says, "If the only surgery performed is a TURB and if it is documented that depth of invasion cannot be measured because there is no muscle in the specimen, code the behavior as malignant and not in situ." | Assign behavior code 2 [in situ] based on the physician's stage Ta. When no other information is available and the TNM designation is not available, use the instructions on page C-844 in Appendix C of the 2007 SEER manual as a default. |
Bladder | Behavior | 2007 |
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20230075 | EOD/Summary Stage--Eye: How is stage coded for a patient with extranodal non-Hodgkin lymphoma involving bilateral choroids (single focus, both sites) and no lymph node involvement? Since the eyes are a paired site, is this two separate extranodal sites? If so, there are no Summary Stage or EOD tumor codes that best fit this scenario. |
Assign as Stage IV as recommended by our expert hematological oncologist. This is a rare occurrence and this type of presentation does not fit the definition of intraocular extension. Stage IV is probably the best stage for this type of presentation, since there are two extranodal organs involved, even though they involve a bilateral site. EOD Primary Tumor: 700 SS: 7 (Distant) |
Eye | EOD Primary Tumor | 2023 | |
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20260017 | Multiple Primaries/Histology--Heme & Lymphoid Neoplasms: Should histology be coded as 9895 when the pathologist's diagnosis on the bone marrow biopsy is "consistent with transformation of the patient's known polycythemia vera to acute myeloid leukemia?" See Discussion. |
The patient has a known history of polycythemia vera (PV). The Hematopoietic and Lymphoid Neoplasms Database (Heme DB) entry for myelodysplasia-related acute myeloid leukemia ("acute myeloid leukemia post myelodysplastic-myeloproliferative neoplasm") states, "The pathologist must make the diagnosis of being myelodysplasia-related." However, it's unclear if the pathologist's statement of an acute myeloid leukemia (AML) "transforming from" counts as the AML being myelodysplasia-related since AML can arise/transform from PV. The Heme DB does indicate histology 9895 should not automatically be used just because the patient has a history of MPN. The bone marrow did not identify any of the specific cytogenetic or molecular abnormalities listed in the Heme DB. However, next generation sequencing identified mutations in BCOR, DNMT3A, IDH1, JAK2, EZH2. The managing physician's clinical diagnosis was "AML arising from polycythemia vera." |
Assign a second primary as Acute Myeloid Leukemia, NOS (9861/3), per Rule M10, the first being polycythemia vera (9950/3). The physician states “consistent with transformation of the patient's known polycythemia vera to acute myeloid leukemia.” This is not the same thing as “Acute myeloid leukemia with myelodysplasia-related changes.” The Heme DB states: Do not automatically assign this histology (Acute myeloid leukemia with myelodysplasia-related changes (9895/3) if patient has a history of a myeloproliferative neoplasm (Myelodysplastic Syndrome [MDS], or Myeloproliferative Neoplasm [MPN]). Note: Polycythemia Vera is a Myeloproliferative Neoplasm (MPN). The pathologist must make the diagnosis of being myelodysplasia-related. |
Heme & Lymphoid Neoplasms | Histology | 2026 |
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20200028 | EOD 2018/EOD Primary Tumor/EOD Mets--Lung: Is EOD Primary Tumor coded to 500 and EOD Mets 10 when there are bilateral lung nodules with nodules in same lobe as the primary tumor? How is EOD Primary Tumor coded when separate tumor nodes are in an ipsilateral lung but there is no documentation as to whether it is in the same or different ipsilateral lobe from the primary tumor? |
Assign 999 to EOD Primary Tumor if this is the only information you have for your case.The mention of nodules does not automatically mean that you have separate tumor nodules. There are many reasons for the appearance of nodules in the lung, some of which are not due to cancer. Unless you have further information on whether the physician has determined that they are related to the lung cancer, then assume that they are not related. Assign 00 to EOD Mets. Do not code EOD Mets to 10 since you cannot determine whether those nodules are based on the tumor or not. If you are able to obtain more information, then you can update the EOD Primary Tumor and EOD Mets. Regarding the second question, if separate tumor nodules are noted, you cannot assume that they are due to tumor. Further information, or clarification, is needed on whether the separate tumor nodules are related to the lung cancer. Without further information, code EOD Primary Tumor to 999. There is also some information in the CAnswer Forum since Separate Tumor Nodules are a Site-Specific Data Item: http://cancerbulletin.facs.org/forums/forum/site-specific-data-items-grade-2018/96061-lung-separate-tumor-nodules |
Lung | EOD Mets, EOD Primary Tumor | 2020 | |
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20220031 | Tumor Size/Neoadjuvant Treatment: If a patient discontinues neoadjuvant therapy and then has surgery, how is the pathologic tumor size coded with the pathologic tumor size greater than the clinical tumor size? Currently, we are instructed to code 999 for the pathologic tumor size when neoadjuvant therapy is given; what happens when neoadjuvant chemotherapy is discontinued after 3 cycles (plan for 4 cycles)? |
Assign 999 for pathologic tumor size when patient has received neoadjuvant therapy, even when neo-adjuvant therapy is not completed. Describe the details in text fields. |
N/A | Tumor size | 2022 | |
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20260016 | Solid Tumor Rules/Histology--Head & Neck: How is the histology of a sinonasal tumor coded when the initial biopsy addendum diagnosis is "High-grade malignant neoplasm with features in between olfactory neuroblastoma and large cell neuroendocrine carcinoma" and the repeat biopsy diagnosis is "High-grade neuroendocrine carcinoma?" See Discussion. |
The patient has an overlapping sinonasal tumor and only underwent diagnostic biopsies of the ethmoid sinus component. Neither biopsy can be determined to be the more representative specimen. The initial biopsy, addendum diagnosis, states there are features in between olfactory neuroblastoma and large cell neuroendocrine carcinoma. The addendum comment states the findings, "makes the distinction between olfactory neuroblastoma (ONB) and neuroendocrine carcinoma difficult." The final diagnosis on the repeat biopsy (approx. 2 weeks later) was high grade neuroendocrine carcinoma, but the diagnosis comment states, "There are no features to suggest underlying olfactory neuroblastoma; however, the material may not be representative of the entire tumor." The managing physician states this is most consistent with olfactory neuroblastoma (esthesioneuroblastoma) in the medical record. If this were a mixed histology tumor, there is no applicable H Rule in the Head & Neck schema. It is unclear which biopsy diagnosis to use since there is conflicting information. Should this be coded as an olfactory neuroblastoma per the initial biopsy diagnosis and the diagnosis provided by the physician? Or should this be a high grade neuroendocrine carcinoma as it is likely the tumor component with the worst prognosis? |
Assign 9522/3 (olfactory neuroblastoma) as a single histology to this case based on the initial pathology and managing physician’s diagnosis. World Health Organization Classification Head and Neck Tumors, 5th edition defines olfactory neuroblastoma as a malignant neuroectodermal neoplasm derived from the specialized sensory olfactory neuroepithelium. |
Head & Neck | Histology | 2026 |
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20160031 | MP/H Rules/Histology--Brain and CNS: What is the code for Rosette-forming glioneural tumor from a pathology report of a brain tumor biopsy for a date of diagnosis in 2015? See Discussion. |
This diagnosis is not listed in the ICD-O-3 though it is listed as code 9509/1 for this specific tumor in the 2007 WHO classification of Tumours of Central Nervous System. (See link: http://link.springer.com/article/10.1007/s00401-007-0243-4/fulltext.html.) |
Assign 9505/1 for Rosette-forming glioneuronal tumor. The new code, 9509/1, has not been implemented in the United States. 9505/1 is to be used until the new code is implemented. See page 7 of the NAACCR Guidelines for ICD-O-D Implementation, effective January 1, 2014, http://www.naaccr.org/LinkClick.aspx?fileticket=u7d3sB71t5w%3d&tabid=126&mid=466. |
Brain and CNS | Histology | 2016 |
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20190105 | Histology--Brain and CNS: What morphology code should be assigned to a low-grade glial/glioneuronal neoplasm? See Discussion. |
Pathology Diagnosis: Left temporal lesion - Low grade glial/glioneuronal neoplasm BRAF mutant. Pathologist Comment: The histopathological appearance of this lesion does not allow for a definitive diagnosis. However, the low-grade appearance, fibrillary nature, immunohistochemical profile, and the presence of a BRAF V600E mutation allow this to be categorized as a low-grade glial or possibly glioneuronal tumor. Despite the lack of exact classification this neoplasm can be expected to behave in a very indolent manner consistent with a WHO grade I classification. |
Assign 9413/0 for glioneuronal neoplasm. We consulted with our expert neuropathologist about the histology "glioneuronal neoplasm." This term is relatively new and has not yet been recognized by WHO or assigned an ICD-O code. Until such time that WHO determines a code for this neoplasm, our expert instructed us to use 9413/0. Since this is not a recognized neoplasm it is not included in the solid tumor rules. |
Brain and CNS | Histology | 2019 |
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