Home
| Report | Question ID | Question | Discussion | Answer | Year |
|---|---|---|---|---|---|
|
|
20170018 | MPH Rules/Multiple primaries--Melanoma: Does MP/H Rule M7 (diagnosed more than 60 days apart) apply to invasive melanoma cases with margins positive for in situ melanoma, or are these further excision of the original diagnosis and the same primary, even when it appears treatment was complete after the initial excision? See Discussion. |
A dementia patient has been managed for a persistent right cheek skin lesion that has been slow growing for about 5 years. It was biopsied in 12/23/15 revealing a Breslow 0.12 mm lentigo maligna melanoma by an outside provider. A larger resection of the lesion on 2/3/16 demonstrated a Breslow 0.30 mm lentigo maligna melanoma with melanoma in situ present at the margins per the available pathology report. There was no statement in the record that any additional treatment was planned or necessary. Patient healed well from the 2/3/16 procedure but developed a recurrent lesion in May that was biopsied on 5/10/16 by the same outside provider which again reveal lentigo maligna melanoma. 7/5/16 Reexcision at the current facility revealed a Breslow 6.1 mm lentigo maligna melanoma, Clarks level V. This was a cutaneous tumor per the path report and not a subcutaneous nodule. Clinically, the MD called this a , but there was no slide comparison to the previous melanoma. In auditing files for expected (but not received) abstracts due from facilities, we've observed these types of cases not being consistently reported as multiple primaries. |
Rule M7 pertains to separate tumors. Rule M7 does not apply to invasive melanoma cases with margins positive for in situ melanoma. Based on the information provided, it is not clear whether or not the 5/10/16 diagnosis is a separate lesion or the same lesion that was diagnosed earlier. |
2017 |
|
|
20220039 | Reportability/Histology--Eye: Is “squamous mucosa with high grade dysplasia” equivalent to a diagnosis of “high grade squamous dysplasia?” See Discussion. |
A conjunctival biopsy final diagnosis is squamous mucosa with moderate to high grade dysplasia. The diagnosis comment states that immunostains were performed and confirm squamous histology. This seems to imply a high grade squamous dysplasia, rather than a non-reportable high grade dysplasia. Does this case meet the criteria for reportable high grade squamous dysplasia? |
Squamous mucosa with high grade dysplasia is the same as high grade squamous dysplasia in the conjunctiva and is coded to 8077/2. |
2022 |
|
|
20081026 | MP/H rules/Multiple primaries: Is a 2007 cytology diagnosis of adenocarcinoma in bile duct a new primary for a patient with a 2005 diagnosis of adenocarcinoma of gallbladder? See Discussion. | A case abstracted for an adenocarcinoma of gallbladder (C23.9) in 2005. In 2007, cytology diagnosis of adenocarcinoma in bile duct(C24.0). Oncologist calls this recurrence. There is no pathologist statement of recurrence.
Using Other Sites multiple primary rules, rule M10 indicates this is multiple primaries. Sequence 01 dx in 2005 and sequence 02 dx in 2007. Is this correct? There is no statement of a primary tumor; the MP/H rules talk in terms of mass, lesion, tumor in a primary site. |
For cases diagnosed 2007 or later, abstract the 2007 bile duct diagnosis as a new primary unless it is described as metastatic. | 2008 |
|
|
20071073 | MP/H Rules/Histology--Breast: How is histology coded for a single tumor with ductal and tubular features in only the invasive component and not in the in situ component? See Discussion. | A breast tumor diagnosed in Feb. 2007 is a single tumor with in situ and invasive components. The invasive component is diagnosed as ductal with tubular features. The only rule that applies is H9 which says 'code the invasive histology.' Is it ductal (8500) or tubular (8211)? If you continue through the H rules, then H12 does not apply, because tubular is not a type of ductal. So then you end up at H17, which would make this 8523. Which code is correct? |
For cases diagnosed 2007 or later, code the histology 8523 [duct mixed with other types of carcinoma]. After determining that the invasive histology is to be coded using rule H9, there is another decision to make in this case -- which invasive histology should be coded? Make a second pass through the histology rules, begining with rule H10. Stop at H17 and code 8523. This advanced concept of a "second pass" through the rules is discussed in an online web training session called "Beyond the basics." Go to the SEER website to view this session http://www.seer.cancer.gov/tools/mphrules/training_advanced.html |
2007 |
|
|
20051140 | CS Reg LN Pos/Exam--Breast: How are nodes positive/examined coded for a positive FNA of a lymph node followed by a subsequent lymph node dissection? See Discussion. | A breast cancer patient had an FNA of an axillary lymph node positive for metastases. A modified radical mastectomy with lymph node dissection showed six lymph nodes negative for metastases. Example 1: Patient received neoadjuvant chemotherapy prior to mastectomy and lymph node dissection. Example 2: Patient received no neoadjuvant therapy. This question is answered for EOD in SINQ 20031059. What is the answer for Collaborative Stage? |
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.Include all nodes examined by the pathologist in Regional lymph nodes positive and Regional lymph nodes examined, unless there is disease progression. These fields are cumulative -- record the total number of regional nodes positive and examined during first course of treatment. Preoperative treatment does not affect the coding of these fields. An FNA alone, positive for regional lymph node metastasis is coded as 95 for number positive and 95 for number examined. For the case examples above, assuming there has been no disease progression, include all nodes positive and all nodes examined from both the FNA and the lymph node dissection in the counts. Code number of regional nodes positive as 01, number examined as 07 for both examples. |
2005 |
|
|
20031059 | EOD-Pathologic Review of Number of Lymph Nodes Positive and Examined: How are nodes positive/examined coded for a positive FNA of a lymph node followed by a subsequent lymph node dissection? See Description. | A breast cancer patient had a FNA of an axillary lymph node positive for metastases. A modified radical mastectomy with lymph node dissection showed six lymph nodes negative for metastases.
Example 1: Patient received neoadjuvant chemotherapy prior to mastectomy and lymph node dissection. Example 2: Patient received no neoadjuvant therapy. |
For cases diagnosed 1998-2003, the number of Regional Nodes Positive and Examined include all nodes examined by the pathologist, unless there is disease progression. In other words, these fields are cumulative. An FNA alone, positive for regional lymph node metastasis is coded as 97 for number positive and 95 for number examined. 1 & 2. Assuming there has been no disease progression, include all nodes positive and all nodes examined from both the FNA and the lymph node dissection in the counts. Case example: Code number of regional nodes positive as 01, number examined as 07. | 2003 |
|
|
20081050 | MP/H Rules--Fallopian Tube: How many primaries are to be abstracted for a case in which a bilateral fallopian tube primary is staged T1c by the pathologist? See Discussion. | A bilateral fallopian tube primary was coded to multiple primaries. However, the AJCC staging for T1b says, "tumor limited to both tubes" and T1c "tumor limited to one or both tubes." The tumor is T1c according to the pathologist. Is this two T1c primaries or one? |
For cases diagnosed 2007 or later, abstract as two primaries using Other Sites rule M8. This issue will be reviewed during the next update to the MP/H rules. |
2008 |
|
|
20071111 | MP/H Rules/Histology--Lung: How many primaries should be abstracted when a patient has an adenocarcinoma with bronchioalveolar-like features in the right upper lobe, adenocarcinoma in the right middle lobe and non-small cell carcinoma with clear cell features in the right lower lobe? See Discussion. | A RUL lung wedge resection and RML and RLL lobectomies were performed. The RUL resection showed invasive adenocarcinoma with bronchioalveolar-like features. Tumor size 9x.9x.8cm. The RLL lobectomy showed invasive non-small cell carcinoma with clear cell features. Tumor size 4.1x2.5x1.8cm. The RML lobectomy showed invasive adenocarcinoma. Tumor size 3.0x1.6x2.2cm. Comment: Essentially three invasive tumors and a focus of bronchioalveolar carcinoma were identified in 3 specimens. All of the tumors appear somewhat histologically different. The larger tumors in the right upper and middle lobe were somewhat similar but still appear histologically different and therefore the pathologic staging is done based on all tumors being separate. The pathologic staging for this case is pT2(4) pN0 pMX. What histology code and what site code are to be used on each abstract? |
For cases diagnosed 2007 or later: Abstract two primaries:
First, determine the number of tumors. There are three separate tumors in right lung in the example above:
Because there are three tumors, begin with rule M3 in the Multiple Tumors module. Stop at rule M11, multiple primaries for the tumor in the RLL (8310) compared to the tumors in the RUL and RML (8140 and 8140).
Now evaluate the tumors in the RUL and RML using the multiple primary rules. Start at rule M3 and stop at rule M12, single primary. |
2007 |
|
|
20220005 | Reportability--Ambiguous Terminology: Can the term “at most” preceding a statement of a reportable diagnosis be used to accession a case? See Discussion. |
A January 2022 endometrium biopsy and curettage both show final diagnosis of “mild cytologic atypia and glandular crowding, at most endometrioid intraepithelial neoplasia.” Any subsequent surgery path is unlikely to provide clarification. |
Do not report the case in this scenario based on the diagnosis alone of mild cytologic atypia and glandular crowding, at most endometrioid intraepithelial neoplasia. "At most" is not an ambiguous term for reportability. It appears that "at most" in this case refers to the worst possible option within other possible options (differential diagnosis). Differential diagnoses are "educated guesses" or hypotheses and are usually not reportable unless proven otherwise. As there is no clear statement of the diagnosis in this case, we recommend that you seek additional information, for example, clinical diagnosis, treatment, and patient care. |
2022 |
|
|
20220024 | Update to Current Manual/Residence at diagnosis: Would an exchange student be a temporary resident of the SEER area or a non-resident? See Discussion. |
A 17 year old exchange student was brought into the hospital with appendicitis. The patient had an appendectomy; there was no follow up treatment. 5/27/2006 pathology report of vermiform appendix: Adenocarcinoid appendix <5 mm tumor limited to appendix. The patient has no record in Lexis Nexus and no social security number. The address is a post office box; additionally, the patient’s birthplace is Switzerland and is lost to follow up. |
Code the residence where the student is living for exchange students temporarily living in the U.S. Code the temporary address if known or the Post Office Box if unknown. We will add this scenario to the next release of the SEER manual. |
2022 |
An official website of the United States government
