Report | Question ID | Question | Discussion | Answer | Year |
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20190095 | Reportability/Histology--Thymus: Is a thymoma a malignancy if described as having separate tumor nodules within peri-thymic adipose tissue? See Discussion. |
Patient had a thymectomy including pericardial fat for a mediastinal mass found incidentally during lung screening. Final diagnosis is WHO B3 thymoma. Staging Summary lists transcapsular invasion: "Present, as separate tumor nodules within peri-thymic adipose tissue." Tumor extension is stated to be "Confined to thymus, including peri-thymic adipose tissue." The pathologist staged this resection as pT1a pNX with no mention of mets. Clinically, there are no noted metastatic sites and no further treatment is planned. |
Report this case as a malignant thymoma. Our expert pathologist consultant reviewed this case and in his opinion, the "separate tumor nodules within peri-thymic adipose tissue" fit registry reporting criteria for separate tumor nodules making this a malignant thymoma. |
2019 |
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20160005 | Reportability--Skin: Is this a reportable skin cancer? See discussion. |
Patient had a skin biopsy and this is the interpretation: NASAL SUPRATIP: INVASIVE BASAL CELL CARCINOMA OF SKIN WITH NEUROENDOCRINE DIFFERENTIATION
NOTE: The deep margin is positive for tumor; peripheral margins negative for tumor. The tumor has a basaloid appearance with focal areas appearing slightly squamoid, and it demonstrates myxoid/mucinous retraction from the stroma. It does not demonstrate peripheral palisading of cells within tumor nests and has nuclear chromatin which suggests neuroendocrine differentiation. Mitotic rate is more brisk than typical basal cell carcinoma as well. The differential diagnosis includes basal cell carcinoma with or without neuroendocrine differentiation, basal cell carcinoma with squamous differentiation, basaloid squamous cell carcinoma, Merkel cell carcinoma and metastatic small cell carcinoma. The tumor is further characterized per immunostains x 9 (controls work well). Tumor cells are positive for Ber EP4 and p63; focally positive for Chromagranin; while negative for EMA, CK20, CK7, TTF-1, CD56 and Synaptophysin. Overall, the staining pattern supports basal cell carcinoma with neuroendocrine differentiation. |
Basal cell carcinoma with neuroendocrine differentiation of the skin is not reportable to SEER.
In this case, the pathologist discussed several possible options, and determined that the final diagnosis is basal cell ca with neuroendocrine diff based at least partially on the immunostains. |
2016 |
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20230045 | Reportability/Histology--Thyroid: Is a diagnosis of “angioinvasive oncocytic thyroid neoplasm with features worrisome for a poorly differentiated oncocytic carcinoma” reportable if the diagnosis comment states, additional immunostains were performed which demonstrate the carcinoma cells are positive for thyroglobulin and negative for calcitonin? See Discussion. |
Patient had a right thyroid lobectomy on 12/2022, with initial diagnosis of “thyroid carcinoma pending expert consultation for definitive classification.” The slide review documented in the addendum shows a final diagnosis of “Angioinvasive oncocytic thyroid neoplasm, see comment.” The subsequent comment states, “I would classify this lesion as an angioinvasive oncocytic thyroid neoplasm with features worrisome for a poorly differentiated oncocytic carcinoma.” The comment goes on to state, “Additional immunostains were performed which demonstrate the carcinoma cells are positive for thyroglobulin and negative for calcitonin. The diagnosis remains unchanged.” |
Do not report angioinvasive oncocytic thyroid neoplasm with features worrisome for a poorly differentiated oncocytic carcinoma based on the final, unchanged diagnosis. Worrisome is not a reportable ambiguous terminology. |
2023 |
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20200010 | Solid Tumor Rules (2018)/Histology--Head & Neck: How is histology coded for a glossotonsillar sulcus tumor with both squamous cell carcinoma and mucoepidermoid carcinoma? See Discussion. |
Patient had a radical pharyngectomy showing a glossotonsillar sulcus tumor with high grade squamous cell carcinoma and adjacent high grade mucoepidermoid carcinoma. The pathologist commented, the tumor is composed of high grade mucoepidermoid carcinoma and high grade conventional-type squamous cell carcinoma that are immediately adjacent to one another. Given that the tumors are arising so close together and could represent a single neoplastic process with divergent morphologies, they are staged together. Employing Solid Tumor Manual Rule M1 (single primary if unable to determine if there is a single or multiple tumors), it was determined that this should be reported as a single tumor because the pathologist referred to the case as both a tumor singular and tumors pleural. However, the Solid Tumor Manual Histology Rules for a Single Tumor do not appear to have an instruction for coding this histology combination. |
Abstract multiple primaries using 2018 Head and Neck Solid Tumor Rule M8 as these are separate tumors described as arising close together, and are on different rows in Table 3. Code histology separately as squamous cell carcinoma (8070/3) and mucoepidermoid carcinoma (8430/3). This appears to be a collision tumor. Collision tumors are counted as two individual tumors for the purpose of determining multiple primaries. Collision tumors were originally two separate tumors that arose in close proximity. As the tumors increased in size, they merged or overlapped each other. While more common in the colon, they can occur in other sites as well. |
2020 |
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20160056 | MP/H Rules/Histology--Testis: How should histology be coded for a testicular primary with a combination of teratoma, yolk sac tumor and embryonal carcinoma? See discussion.
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Patient had a radical orchiectomy with the final diagnosis of "Mixed germ cell tumor with the following features -- histologic type: Mixed germ cell tumor (teratoma 50%, yolk sac tumor 25%, and embryonal 25%)." |
Assign 9085/3. Code this combination of teratoma, yolk sac tumor, and embryonal tumor in the testis to mixed germ cell tumor (9085/3) based on the WHO Classification of Tumors of the Male Genital Organs. |
2016 |
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20220013 | Reportability/Histology--Kidney: What is the histology and behavior of a papillary renal neoplasm with reverse polarity? See Discussion. |
Patient had a partial nephrectomy with final diagnosis of papillary renal neoplasm with reverse polarity. Diagnosis comment states: Papillary renal neoplasm with reverse polarity is currently considered to be a histologic variant of papillary renal cell carcinoma; however, recent studies suggest that it has a very indolent clinical behavior. |
Report papillary renal neoplasm with reverse polarity as 8260/3. According to the WHO Classification of Urinary and Male Genital Tumors, 5th edition, this is a distinctive pattern of papillary renal cell carcinoma that has been recently recognized. These tumors have recurrent mutations of KRAS, differing from typical papillary renal cell carcinoma. We recommend that you include with reverse polarity in your histology text to differentiate this entity from others classified in 8260/3. |
2022 |
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20230047 | Reportability/Histology--Head & Neck: Is a 2023 mandibular biopsy showing “severe squamous dysplasia with microscopic focus suspicious for superficial invasion” reportable? See Discussion. |
Patient had a mandibular mucosal lesion resected in June of 2023, with a diagnosis of “atypical squamous proliferation” and case was forwarded to an expert in oral pathology for best classification. Subsequent slide review final diagnosis was “moderate to severe squamous dysplasia.” That slide review diagnosis goes on to state “microscopic focus suspicious for superficial invasion.” Currently there is no ICD-O code for severe squamous dysplasia, however it is unclear if this terminology is equivalent to high grade squamous dysplasia (histology code 8077/2). |
Report as squamous cell carcinoma (8070/3) on the basis of “microscopic focus suspicious for superficial invasion.” "Severe dysplasia" is equivalent to "high grade dysplasia" in the Head and neck. As such, "severe squamous dysplasia" would be coded to 8077/2. However, in combination with the statement of "with microscopic focus suspicious for superficial invasion,” report as squamous cell carcinoma (8070/3) based on “microscopic focus suspicious for superficial invasion.” The 2023 SEER Manual instructs us to code the behavior as malignant (/3) if any portion of the primary tumor is invasive no matter how limited, i.e., microinvasion. Use text fields to record the details. |
2023 |
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20230068 | Solid Tumor Rules/Histology--Thyroid: What is the histology code for a diagnosis of poorly differentiated thyroid carcinoma arising in a background of solid papillary thyroid carcinoma? See Discussion. |
Patient had a hemithyroidectomy with the final diagnosis above. There does not appear to be an Other Sites H rule or table that addresses this combination of histologies for thyroid primaries. |
Code to poorly differentiated thyroid carcinoma, 8337/3. In this case the tumor is comrpised of two difffernat thyroid histologies: poorly differentiated carcinoma 8337/3 and papillary thyroid carcinoma 8260/3. WHO does not have a code for this combination. Per our endocrine pathology expert, the poorly differentiated carcinoma is the more agressive histology and will determine treatment and progrnosis. |
2023 |
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20130100 | Multiple primaries/Primary site--Heme & Lymphoid Neoplasms: How many primaries are there and how should I code the primary site(s)? See discussion. |
Patient had a hemicolectomy and a salpingo-oophorectomy and was found to have diffuse large B cell lymphoma in the colon (10 cm cecal mass), 3/16 regional lymph nodes involved with lymphoma. Fallopian tube showed involvement with diffuse large B Cell lymphoma.
Multiple primaries - Colon and fallopian tube?
One primary - Colon? Stage IV, or lymphoma from an unknown primary? Note: There were no other lymph nodes involved. |
Use Rule M2. Abstract as a single primary when there is a single histology.
When you have questions about how to code the primary site, start with the abstractor notes. If the answer isn't found there go to Module 7 (a specific module to help code primary site for lymphomas).
The abstractor notes for DLBCL in this case do not provide information you can use for this case. Go to Module 7 in the PH rules.
Use Rule PH25 Code the primary site to the organ when lymphoma is present in an organ and that organ’s regional lymph nodes. Code the primary site to colon (organ and regional lymph nodes involved). The fallopian tube is secondary involvement. As is common with lymphomas, there can be more than one organ involved. You can differentiate the primary site from the secondary site(s) because of the large colon mass with regional lymph node involvement. |
2013 |
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20100037 | Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries should be accessioned for a patient diagnosed with essential thrombocythemia [9962/3] in 2002 who had a 2010 biopsy consistent with the fibrotic stage for a chronic myeloproliferative disorder that "suggests the patient is transforming to an acute myeloid leukemia"? See Discussion. |
Patient had a diagnosis of essential thrombocythemia [9962/3] in 2002 and was treated with Hydroxyurea. In 2010, the patient was admitted with severe bone pain and a diagnosis described as, "The overall features of the biopsy are consistent with a fibrotic stage of a chronic myeloproliferative disorder. The presence of up to 15% CD34+ immature cells seen in the biopsy suggests that the patient is transforming to an acute myeloid leukemia." In addition, cytogenetic studies and molecular testing for JAK2 were ordered. These findings confirmed a myeloproliferative disorder. JAK2 mutation was not detected. The patient died within 2 weeks. Is this a new primary?
Was this patient diagnosed with AML (which requires 20% or more blasts and this is only 15%)? If this is a new primary, is the histology 9861/3 [AML, NOS] or 9895/3 [AML with myelodysplasia-related changes]? Was the second diagnosis of AML definitively diagnosed? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case is a single primary, essential thrombocythemia [9962/3] in 2002. The 2010 diagnosis is chronic myeloproliferative disorder [9960/3].
According to Rule M15, the Multiple Primaries Calculator is to be used to first determine the number of primaries. Per the calculator, essential thrombocythemia and chronic myeloproliferative disorder are the same primary. (Acute myeloid leukemia is not used as the second histology because it is preceded by a non-reportable ambiguous term, "suggests." "Suggests" is not on the list of reportable ambiguous terms in the Hematopoietic and Lymphoid Neoplasm Coding Manual.
In 2010, this patient was in a late stage of ET. When any of the specific MPN neoplasms such as ET are in the late stage of disease, the characteristics of the specific disease (ET) will no longer be detectable. Accordingly, for this patient the diagnostic testing was positive for MPN, unclassifiable. In this case, do not change the diagnosis from the more specific disease (ET) to the NOS (MPN, unclassifiable).
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. |
2010 |