Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20220001 | Solid Tumor Rules (2022)/Histology--Bladder: Can the term configuration be used to code the more specific histology for bladder primaries diagnosed 2022 and later? See Discussion. |
In the September 2021 Urinary Sites Solid Tumor Rules update, the term configuration was removed from the “DO NOT CODE histology when described as” list. However, it was not added as a term that can be used to code the more specific histology for urinary tumors. Can configuration be used to code the more specific histology 8130 (papillary urothelial carcinoma) when the diagnosis is urothelial carcinoma, tumor configuration: papillary? |
Beginning with cases diagnosed 1/1/2022, the term "configuration" can be used to code histology for urinary sites only. At the request of the AJCC urinary experts, the instructions were changed to allow configuration to be used to code histology. |
2022 |
|
20240015 | Solid Tumor Rules/Histology--Breast: Is ductal carcinoma in situ (DCIS), solid type coded as 8500/2 or 8230/2? See Discussion. |
In the NAACCR Coding Pitfalls 2023 webinar, the example of DCIS, solid type is given. The webinar advised us to code 8230/2 (ductal carcinoma in situ, solid type). When going through the beginning of the solid tumor rules in the Changes from 2007 MPH Rules section it states "DCIS/Carcinoma NST in situ has a major classification change. Subtypes/variant, architecture, pattern, and features ARE NOT CODED. The majority of in situ tumors will be coded to DCIS 8500/2." In the equivalent or equal terms section it lists "Type, subtype, variant" can be used interchangeably. Since the example has it listed as as ductal carcinoma in situ, solid "type," would we code 8500/2 or 8230/2? |
Assign 8230/2 (ductal carcinoma in situ, solid type/intraductal carcinoma, solid type) using Breast Solid Tumor Rules Table 3 as instructed in Rule H2 for in situ tumors. The carcinoma, NST row lists this histology in the subtype/variant column 3. Coding histology for in situ breast tumor differs from invasive. While the majority of in situ breast primaries will be coded to DCIS 8500/2, there are others that are listed in Table 3 that should be coded according to the specific histology. Some codes have the word subtype or type as part of their histologic term so these can be coded based on the histologic term as listed in the table. We suggest you routinely review the histology tables to see if a term is listed. |
2024 |
|
20031171 | Reportability: Is pseudomyxoma peritonei always reportable? See Description. | In the ICD-O-3, pseudomyxoma peritonei has a behavior code of 6, indicating that it is malignant. Does this imply that pseudomyxoma peritonei is always a reportable malignancy? In the past, our pathologist consultant told us that pseudomyxoma peritonei is only a reportable malignancy if the underlying tumor is malignant. A benign cystadenoma of the appendix, for example, can rupture causing pseudomyxoma perionei. Does SEER agree with our pathologist consultant? Example: Patient was found to have psuedomyxoma peritonei. Right hemicolectomy was done. Path reported an appendix with mucinous cystic tumor of undetermined malignant potential. A definite diagnosis of cancer can not be rendered. |
Reportability is determined from the behavior of the primary tumor and the behavior of implants. If either are malignant, the case is reportable. The case example does not seem to be reportable, based on the available information. Cancer diagnosis has not been made according to the pathology report. |
2003 |
|
20130202 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported when a solitary plasmacytoma diagnosed in 2010 (T spine) is followed by another solitary plasmacytoma (L spine, different primary site) in 2013? See Discussion. | In the Heme Manual it indicates one is to abstract a second primary when a solitary plasmacytoma (chronic) is followed by a plasma cell myeloma (acute) greater than 21 days after the chronic diagnosis.
The Heme Manual does not indicate what to do when a solitary plasmacytoma diagnosed in 2010 (T spine) is followed by another solitary plasmacytoma (L spine, different primary site) in 2013. The physician specifically stated the patient does not have multiple myeloma. Is this case one or two primaries? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule M2, this is a single primary. According to Rule M2, the single histology is always the single primary.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
2013 |
|
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 |
|
20061105 | CS Extension--Bladder: Can the physician TNM be viewed as a clarifying statement when it provides information not documented elsewhere in medical record as in the example of a pathology report for bladder primary that demonstrates extension into bladder muscle, NOS but the physician documented TNM notes a more definitive T code for depth of muscle invasion? See Discussion. | In the Collaborative Stage manual in general instructions this guideline exists: "The extent of disease may be described only in terms of T (tumor), N (node), and M (metastasis) characteristics. In such cases, assign the code in the appropriate field that corresponds to the TNM information. If there is a discrepancy between documentation in the medical record and the physician's assignment of TNM, the documentation takes precedence..." (Similar to language to use SEER information over TNM). |
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Yes, you may code CS extension using the physician assigned "T" when it provides information not found elsewhere in the medical record. |
2006 |
|
20200022 | Solid Tumor Rules (2018)/Multiple primaries--Breast: How many primaries should be reported for a December 2013 diagnosis of lobular carcinoma in situ (8520/2) in the left breast, treated with a lumpectomy, followed by a July 2018 diagnosis of invasive ductal carcinoma (8500/3) also in the left breast? See Discussion. |
In the April and July 2019 updates to the Solid Tumor Rules, the term simultaneous and Note 1 indicating histologies must be the same behavior were removed from rule M10 (ductal and lobular are a single primary). We would like to confirm that rule M10 is the correct rule to apply to this case. This case is an invasive diagnosis approximately 4.5 years after an in situ diagnosis, so it seems like M17 should apply (invasive tumor following an in situ tumor more than 60 days later are multiple primaries). An invasive tumor following an in situ tumor more than 60 days later of the same histology is a new primary. Similarly, it seems like an invasive tumor following an in situ tumor more than 60 days later of different histologies should be a new primary. |
Abstract a single primary using 2018 Breast Solid Tumor Rule M10. Unless the tumors were diagnosed more than 5 years apart, they are a single primary. The 2021 breast update will include examples and notes plus updating table 2. |
2020 |
|
20190038 | Solid Tumor Rules (2018)/Histology--Breast: How is the histology coded and which H Rule applies for a single tumor with final diagnosis of invasive mammary carcinoma and College of American Pathologists (CAP) synoptic report states, Histologic type: Invasive cribriform carcinoma with no mention of a tumor percentage? See Discussion. |
In the April 2019 Breast Solid Tumor Rules update, the Priority Order for Using Documentation to Identify Histology was changed, giving equal priority to the Final diagnosis / synoptic report as required by CAP (item 2B). There are technically two histologies documented for the case above; a Not Otherwise Stated (NOS)/No Special Type (NST) (invasive mammary carcinoma, per final diagnosis text) and subtype/variant (invasive cribriform carcinoma, per CAP report). If we do not use the synoptic report with priority over the final diagnosis, Rule H14 indicates the histology would be the NOS histology (invasive mammary carcinoma) because the percentage of tumor is not given for the subtype. However, SINQ 20180045 states, In the CAP protocol, the term Histologic Type is a label where the histology that corresponds to the largest carcinoma is collected. According to the CAP protocol for invasive breast cancer, the histologic type corresponds to the largest carcinoma. If the pathologist summarizes the findings in a synoptic report, should the specific Histologic Type identified have priority? |
Based on the synoptic report findings, code cribriform carcinoma using Breast Solid Tumor Rule H12 which says to code the histology when only one histology is present. The histologic type describes one histology and does not describe the components of an NOS/NST with a subtype, in which case a different rule would apply. The priority order for using documentation to identify histology gives equal weight to final diagnosis and synoptic report, secondary to addendum or comments. Use the more specific histology if either the final diagnosis or synoptic provides the additional information on the histology. |
2019 |
|
20240037 | Solid Tumor Rules/Histology--Bladder: How is histology coded for a bladder tumor when the diagnosis is 95% large cell neuroendocrine carcinoma and 5% high grade urothelial carcinoma of no special type? See Discussion. |
In the 2024 Solid Tumor Rules update, the small cell neuroendocrine carcinoma row in Table 2 was changed. The NOS histology became neuroendocrine carcinoma, NOS (8246) and both large cell and small cell neuroendocrine carcinomas (8013 and 8041, respectively) became the subtype/variants. This change impacts Rule H4 but Rule H4 was not updated. Rule H4 still refers to small cell neuroendocrine carcinoma as being the NOS histology. In the prior STR versions, it was clear the tumor in question would be coded as 8045 per Rule H4 and Table 2. Considering Rule H4 was not updated according to the changes for Table 2, does histology 8045 still apply to this diagnosis? There is currently no way to arrive at a histology for this case. Does Rule H4, bullet 3 need to be updated to indicate, “subtype/variant of neuroendocrine carcinoma mixed with any other carcinoma (does not apply to sarcoma)”? |
Assign 8013/3 (combined large cell neuroendocrine carcinoma). There are two histologies present: large cell NEC and urothelial. Literature search found primary large cell NEC of the bladder is extremely rare with less than 20 reported cases. This case does not fall into the site-specific rules and given it's raity, a specific rule for this situation was not and will not be added to the Bladder rules. See #1, Example 2, in the general instructions for coding histology. |
2024 |
|
20200084 | Primary Site/Histology--Sarcoma: Do the clarifications in the 2018 ICD-O-3 Update Table regarding undifferentiated high-grade pleomorphic sarcoma (8830/3) apply to cases diagnosed 1/1/2021 and later with the implementation of ICD-O-3.2? See Discussion. |
In the 2018 ICD-O-3 Update Table, undifferentiated high-grade pleomorphic sarcoma and undifferentiated high-grade pleomorphic sarcoma of bone (C40_) were both listed as a New Term for histology 8830/3. There was no site restriction for a diagnosis of undifferentiated high-grade pleomorphic sarcoma. Therefore, it appears the diagnosis could easily be applied to a soft tissue tumor. This histology is used by pathologists in our region for soft tissue tumors as well as bone tumors. However, in the ICD-O-3.2 Table an entry (or synonym) was not provided for a tumor outside the bone. The ICD-O-3.2 Table only lists undifferentiated high-grade pleomorphic sarcoma of bone for site codes C40_ and C41_ as a synonym for histology 8830/3. This also is not listed in the ICD-O-3.2 Implementation Guidelines. As a result, it is unclear whether a diagnosis of undifferentiated high-grade pleomorphic sarcoma of the soft tissue can be coded to 8830/3 and/or can be a synonym for the preferred term (8830/3, Malignant fibrous histiocytoma). Can a diagnosis of undifferentiated high-grade pleomorphic sarcoma of the soft tissue be coded to 8830/3, C49_ as it was per the 2018 ICD-O-3 Update Table? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
8802/3 applies to soft tissue tumors and 8830/3 applies to tumors arising in bone. The 2018 ICD-O update lists undifferentiated pleomorphic sarcoma as code 8802/3 and 8830/3 applies to undifferentiated high grade pleomorphic sarcoma of bone and is specific to C40 _. This is still valid in ICD-O-3.2. The 2018 update also noted undifferentiated pleomorphic sarcoma, NOS was a new term for 8830 based on WHO documentation available at that time. However that is incorrect and ICD-O-3.2 provides the correct codes. |
2020 |