SEER Manual/Reportability--Appendix: Is low-grade appendiceal mucinous neoplasm (LAMN) with peritoneal spread followed by evidence of extraperitoneal metastatic disease reportable prior to 2022? See Discussion.
In 2021, the patient was diagnosed with a non-reportable appendiceal LAMN. Resection showed a tumor diffusely involving the appendix and perforating the visceral peritoneum, as well as extensive intraperitoneal metastasis. In 2023, a lung wedge resection revealed metastatic mucinous neoplasm involving lung parenchyma and pleura, consistent with metastasis of the known appendiceal primary. It is understood that intraperitoneal spread of an appendiceal LAMN does not make it reportable because the peritoneal disease is also non-invasive. Does extraperitoneal metastasis of an appendiceal LAMN diagnosed prior to 2022 make it invasive disease and therefore reportable?
LAMN diagnosed prior to 1/1/2022 is not reportable even when it spreads or metastasizes according to our expert pathologist consultant. Spread of this neoplasm does not indicate malignancy. For this case to be reportable, the diagnosis must indicate “carcinoma”or “adenocarcinoma.” Pre-2022, LAMN is not reportable even when treated with surgery and chemotherapy. LAMN is reportable starting with cases diagnosed in 2022.
MP/H Rules/Histology--Kidney, renal pelvis: How would you code this histology: Renal cell carcinoma, clear and eosinophilic cell type?
Kidney rule H5 applies, code the more specific histology which is clear cell renal cell carcinoma (8310/3). Per the WHO Tumors of the Urinary System, clear cell renal cell carcinoma contains both clear and eosinophilic cytoplasm. Eosinophilic is not a type or variant of renal cell carcinoma.
Solid Tumor Rules (2018)/Histology--Lung: What is the difference between Lung Rules H7 and H8 (Single Tumor Module)? When would one use H8 rather than H7? See Discussion.
Is Rule H8 a duplicate of Rule H7? Rule H7 instructs one to use Table 2 when there are multiple histologies and the combination is listed in Table 2 (or a combination code was received from Ask a SEER Registrar). Rule H8 states to code adenocarcinoma with mixed subtypes (8255) when there are multiple adenocarcinoma subtypes OR any combination of histologies which are not listed in Table 2. However, both conditions for Rule H8 are already included in Table 2 (the last row). How would one ever move past Rule H7 if all the conditions for both Rules H7 and H8 are covered first under Rule H7?
Example: A resection pathology report proves invasive adenocarcinoma, acinar, solid and papillary types. Rule H7 seems to be the first H Rule that applies as there are multiple histologies (identified using a reportable term: type) AND the combination is listed in Table 2. The last row of Table 2 instructs one to code Adenocarcinoma with mixed subtypes (8255) when there are at least two of the subtypes/variants of adenocarcinoma listed in Column 1 (Required Terms). In this case, there were three subtypes/variants that are listed in Column 1 (acinar, solid and papillary). However, Rule H8 also instructs one to, Which rule applies here, Rule H7 or Rule H8?
January 2019 update: The differences between H7 and H8 are H8 applies to tumors with multiple subtypes of adenocarcinoma while H7 applies to histology combinations other than adenocarcinoma such as adeno and squamous.
Behavior/Summary Stage 2018--Colon: What is the correct behavior and Summary Stage for a case of intramucosal adenocarcinoma arising in tubular adenoma? AJCC states this is Tis, though SEER Summary Stagie states this is Localized (code 1). The histology is 8140/2 (adenocarcinoma in situ), but the SEER Summary Stage is Locallized.
Intramucosal carcinoma of the colon is assigned behavior code of /3. Intramucosal is not the same as in situ in terms of behavior. Behavior and staging are separate concepts, although there is some overlap. Use the instructions for coding behavior to code this field. Do not use stage to determine behavior in this case.
For purposes of Summary Stage, intramucosal carcinoma is a localized lesion; however, for purposes of AJCC staging, assign Tis for the stage.
Reportability--Is "intraductal papillary mucinous neoplasm with low grade dysplasia" (also called IPMN adenoma) reportable? See Discussion.
According to the ICD-O-3, the histology for IPMN adenoma is 8453/0 is non-reportable. However, per SINQ 20021099, this is reportable.
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas with low grade dysplasia, also referred to as IPMN adenoma, is not reportable.
IPMN of the pancreas is reportable when stated as "IPMN with high-grade dysplasia," or "IPMN with an associated invasive carcinoma," or "IPMN with an associated in situ carcinoma."
The case in SINQ 20021099 is stated to have "multifocal high grade dysplasia (so-called borderline tumor and carcinoma in-situ)" and is reportable because there is an explicit statement of carcinoma in situ, not because of the reference to the presence of high grade dysplasia. It is coded 8453/2 [Intraductal papillary-mucinous carcinoma, non-invasive].
Reportability--Liver: Is intraductal papillary mucinous neoplasm (IPMN) of the liver a reportable diagnosis? See Discussion.
Pathology shows: Right liver lobe, partial hepatectomy " intraductal papillary neoplasm with high grade dysplasia.
Intraductal papillary mucinous neoplasm (IPMN) of the liver with high grade dysplasia is reportable. While most IPMNs arise from the pancreas, there exists a subset of IPMN of the biliary tract (BT-IPMN). Code as 8453/2.
Reportability--Gallbladder: Is Intracholecystic papillary neoplasm (ICPN) with low-grade intraepithelial neoplasia reportable? The primary site is gallbladder.
Intracholecystic papillary neoplasm (ICPN) with low-grade intraepithelial neoplasia is not reportable. The WHO assigns a behavior of 0 to these neoplasms.
Surgery of Primary Site--Melanoma: How is Surgery of Primary Site coded when a path specimen is labeled as a “staged excision” for a cutaneous melanoma. See Discussion.
Patient was diagnosed on biopsy with lentigo maligna melanoma of the nasal dorsum. The only available documentation of the subsequent surgery is a single pathology report with the nasal dorsum “staged excision (debulking specimen)” and four additional “staged excision” specimens of the same site.
Is it safe to assume this is a Mohs surgery? Would it be safe to assume staged excisions of sites other than skin of face, are also Mohs surgery?
Interpret a "staged excision" for cutaneous melanoma as a type of Mohs surgery.
Skin surgery codes are currently under review and revision. Document details in available text fields.
Solid Tumor Rules (2018)/Histology: Please provide further explanation for prioritizing biomarkers in the histology coding rules. See Discussion.
The 2018 Solid Tumor (ST) Rules General Rules state: For those sites/histologies which have recognized biomarkers, the biomarkers frequently identify the histologic type. Currently there are clinical trials being conducted to determine whether these biomarkers can be used to identify multiple primaries. Follow the Multiple Primary Rules; do not code multiple primaries based on biomarkers.
Additionally, Biomarkers is at the top of the priority order to identify histology in several sections (it appears to be excluded from only Colon, Melanoma and Other sections). In the sections that include this rule, there is not much additional information on using biomarkers. Can you please provide further explanation for prioritizing biomarkers in the histology coding rules? For example, will the ST manual be updated when we need to look for specific biomarkers in a diagnosis?
Instructions for biomarkers will be added to other site rules when applicable. The use of biomarkers to determine a specific histologic type is not yet a standard of care in the majority of cases.
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