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Based on the Solid Tumor Rules, we would make this two since it is over one year. According to a previous SINQ question 20110046, we are to code this as one primary. We see patients come back with multiple carcinoid tumors over the years and would like clarification.

Based on the EOD General instructions for accessible sites, the following three requirements must be met

a. There is no mention of regional lymph node involvement in the physical examination, pre-treatment diagnostic testing, or surgical exploration;

b. The patient has localized disease;

c. The patient receives what would be the standard treatment to the primary site (treatment appropriate to the stage of disease as determined by the physician), or patient is offered usual treatment but refuses it.

As a central registry, we receive a lot of melanoma path reports but never receive an abstract since the patients are seen at a dermatology office that does not report to the central registry. In these scenarios, we have both the diagnosis and wide excision or Mohs surgery from which we create a consolidated record. It is not often that lymph nodes are removed which indicates there were no palpable nodes.

Since the Breslow’s and Clark’s level allow for summary staging, is it possible to have central registry guidelines that allow for coding lymph nodes other than 999? The path reports meet two of the three criteria. Is there any new literature that supports coding lymph nodes 000 based on a Clark’s level or Breslow measure providing the patient has a wide excision?

A common scenario is a patient has a positive CT of the abdomen/pelvis for liver mass only. Biopsy of the liver mass is positive for cholangiocarcinoma. The physician is also calling the liver tumor the primary site with histology of cholangiocarcinoma. There is no evidence of intrahepatic bile duct (C221) or gallbladder (C240) involvement which are sites specific to this histology. The hematology/oncology consult stages this as Stage IIIA, T3N0M0 intrahepatic cholangiocarcinoma.  Can we code cholangiocarcinoma with site code C220 (liver) or should we assume that C221 (intrahepatic bile ducts) would be a better code to reflect this histology?  

Autopsy/Pathology Report (2020) excerpts

External Examination

Nervous System: There is an 8.5 cm mass located in the right thoracic paraspinal area.

Final Anatomic Diagnosis

Clinical History: Paraspinal mass suspicious for neuroblastic tumor (detected by imaging studies)

Nervous System: Right thoracic paraspinal neuroblastoma, poorly differentiated

At the central registry, we have accessioned this scenario as three primaries per Multiple Primaries/Histology (MP/H) Rule M10 (diagnosed more than 1 year apart), as the patient was stated to be disease free between each occurrence. However, the diagnosing/treating facility is not reporting these cases due to clinical statements of recurrent disease.

This is an example of a case type identified on casefinding audits conducted by our central registry in which we have learned SEER's expectation of MP/H rule application does not match hospital reporting. Can the 2018 version of the MP/H rules more clearly address how this type of clinically recurrent (multiple times) case should be handled?

At a recent meeting, one registry stated that they apply the following guidelines.

1) If the tumor is described as a hilar mass and there is no mention of LN involvement, Primary Site is coded to hilum (C340)

2) If there is LN involvement along with the mention of a hilar mass, then Primary Site is coded to C349

Aspirin is listed as treatment for "thrombocythemia" in the Abstracting and Coding Guide for the Hematopoietic Diseases but not for "primary polycythemia."

As of 2013, radiofrequency ablation is coded to "radiation therapy," chemoembolization is coded to "chemotherapy," and microwave ablation code to "other."  Or, is coding microwave ablation (using heat not alcohol) coded to surgical code "16"? The latest documentation year that I could find in the SEER website regarding the above was 2013. I would appreciate clarification/confirmation of correct coding especially for microwave ablation.

Are there timing rules related to the comparison of slides from a subsequent hematopoietic primary diagnosis to the slides from the original hematopoietic primary diagnosis that impact the number or primaries reported?

For example, how many primaries are reported for a patient was diagnosed in 3/2010 with large B-cell lymphoma who underwent 7 rounds of chemo. Per 10/2010 PET scan, there was no evidence of disease. In 12/2010 a liver biopsy revealed, "features consistent with recurrence of previously diagnosed non-Hodgkin lymphoma." The pathologist did not compare slides to the original, but several immunoperoxidase stains were done to obtain the final diagnosis in 12/2010.

Does timing or comparison to the original slides matter for Heme & Lymphoid Neoplasms? Is a comparison of slides needed as required for solid tumor "recurrences"?

Are the multiple primary rules applicable when a patient has multiple gastric carcinoid tumors? The patient was diagnosed with carcinoid tumors starting in 12/2003 through 3/2009. According to the 2004 SEER Manual, rule 5, if a tumor with the same histology is identified in the same site at least two months after the original diagnosis, this is a separate primary. The physician does not indicate that the pre-2007 carcinoid tumors were recurrent. The patient does not have familial polyposis syndrome. Should each of the following tumors be a separate primary?

12/2003 - Gastric Polyp Removal - Path: Gastric carcinoid tumor

05/2004 - Stomach body polyp removal - Path: Carcinoid Tumor (endocrine cell tumor)

09/2004 - Single polyp in body removal - Path: Gastric carcinoid

03/2005 - Multiple gastric body polyps removed - Path: Carcinoid tumor

07/2005 - 3 small polyps in fundus removal - Path: Carcinoid tumor

02/2007 - Localized nodularity in lesser curvature - Path: Carcinoid (neuroendocrine) tumor

03/2009 - Stomach body polypectomy - Path: Carcinoid tumor