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Report Produced: 04/20/2025 07:18 AM

Report Question ID Question Discussion Answer Year
20220043

First Course Treatment/Neoadjuvant Therapy--Melanoma:  How are the three Neoadjuvant Therapy data items (Neoadjuvant Therapy, Neoadjuvant Therapy--Clinical Response, Neoadjuvant Therapy--Treatment  Effect) coded when a patient is diagnosed with melanoma in the lymph nodes with no primary skin site identified? The physician gives immunotherapy as neoadjuvant therapy with planned and carried out surgical resection of involved lymph nodes following completion of immunotherapy. There is no "planned definitive surgical resection of the primary site" as no primary site was found,

Assign code 0 to each of the three Neoadjuvant Therapy data items in this situation.

We will add an example to the coding instructions for these data items in the next release of the manual.

 2022
20220042

First Course Treatment/Radiation Therapy:  How should Lutathera be coded? CoC states XRT- Radioisotopes and SEER states Other Treatment.

Lutathera is a radioconjugate consisting of the tyrosine-containing somatostatin analog Tyr3-octreotate (TATE) conjugated with the bifunctional, macrocyclic chelating agent tetra-azacyclododecanetetra-acetic acid (DOTA) and radiolabeled with the beta-emitting radioisotope lutetium Lu 177 with potential antineoplastic activities.

Update to the current manual: Code Lutathera as radiation (isotopes NOS code 13). We will make this change in the next version of the SEER manual. 

 2022
20220041

Primary Site/Histology--Intrahepatic Duct:  How are primary site and histology coded for cholangiocarcinoma cases when the pathology only shows a liver tumor and other involvement.  See Discussion.

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?  

Assign C221 (intrahepatic bile duct) as the primary site for cholangiocarcinoma (8160/3).  Our expert GI pathologist confirms that even when intrahepatic bile ducts are not specifically mentioned, intrahepatic cholangiocarcinoma originates in the intrahepatic bile ducts.

 2022
20220040

Laterality--Brain and CNS: Can Laterality be coded as 5 (midline) for a sella turcica meningioma (or tuberculum sellae meningioma) when no other statement regarding tumor laterality is documented? See Discussion.

Laterality is often not noted for these sella turcica meningiomas; therefore, Laterality is often coded as 9 (Unknown). Because the sella turcica appears to be a midline structure in the base of the skull, is Laterality code 5 (midline) more appropriate when additional information is unavailable?

You may assign code 5 (Paired site: midline tumor) for laterality of a meningioma of the sella turcica (C700).

The 2022 SEER manual states in Laterality coding instruction 5: Assign Laterality code 5 only when the primary site is C700, C710-C714, C722-C725, C443, C445.  Do not assign code 5 to sites not listed in 5.a.  

Note that code 9 is for paired sites and there is no information concerning laterality.

Document laterality information in the appropriate text field. Note: Laterality does not factor into the CNS Solid Tumor rules.

 2022
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
20220038

Solid Tumor Rules/Histology--Thyroid:  What is the histology code for sclerosing mucoepidermoid carcinoma with eosinophilla in the left thyroid and papillary thyroid carcinoma in the right thyroid?  See Discussion.

The left thyroid lobectomy/isthmusectomy returned a diagnosis of sclerosing mucoepidermoid carcinoma with eosinophina, 6.5 cm, replacing nearly the entire left lobe of the thyroid.

The patient has a completion thyroidectomy of the right lobe and returned the diagnosis of papillary thyroid carcinoma, 0.5 mm, in maximum dimension.

The endocrinologist describes it as "co-exsisting" and states the tumor is iodine non-avid.

Abstract two primaries and assign code 8260/3 (papillary adenocarcinoma, NOS) to the right thyroid using Solid Tumor Rules, Other Sites, Rule H14, and 8430/3 (mucoepidermoid carcinoma) to the left thyroid as these are separate tumors with different histology types according to WHO Classification of Tumors of Endocrine Organs, 4th edition.

 2022
20220037

Histology--Brain and CNS: What is the histology code of a primary papillary epithelial tumor of the sella (PPETS)?  See Discussion.

The pathology report states this is a rare entity described in case reports and not incorporated into the WHO classification of tumors. A subsequent endocrinology note stated “papillary tumor, benign by path; tumor was not an adenoma; based on one Mayo study, the recurrence risk is low.”

Assign code 8000/0.  This is an emerging histology and not yet recognized by the World Health Organization. Document the details in text fields. It might also be useful to document this SINQ question in text.

 2022
20220036

Solid Tumors Rules/Histology--Head and Neck:  How is histology coded for head and neck primaries when a tumor is diagnosed as an invasive squamous cell carcinoma with multiple subtypes?  See Discussion.

Example Case 1:  2022 mobile tongue tumor biopsy shows squamous cell carcinoma, basaloid non-keratinizing type.

Example Case 2:  2022 base of tongue mass biopsy shows squamous cell carcinoma, basaloid non-keratinizing type, p16 positive.

Table 5, Note 2 (Head and Neck Equivalent Terms and Definitions) instructs us to code non-keratinizing squamous cell carcinoma which is p16 positive to 8085 (Squamous cell carcinoma HPV-positive), ignoring the non-keratinizing subtype. Does p16 or HPV positivity also take priority over multiple subtypes (basaloid non-keratinizing type)?

Assign 8083/3, basaloid squamous cell carcinoma (BSCC), in both examples. It is more important to capture the variant than to code 8085 or 8086.

WHO Classification of Head and Neck Tumors, 5th ed., states that BSCC is a distinctive form of SCC, characterized by prominent basaloid morphology, squamous differentiation, and aggressive behavior.  Some primary sites capture p16 status as a Site Specific Data Item; you may record the p16 results when that is the case.

 2022
20220035

 

Solid Tumor Rules/Histology--Bladder:  How is histology coded for a transurethral resection of the bladder (TURB) diagnosis with multiple components?  See Discussion.

Examples:

Bladder TURB:  Invasive high grade urothelial carcinoma with poorly differentiated (40%), lipoid (5%), and sarcomatoid (55%) components.

Bladder tumor base TURB:  Invasive high grade urothelial carcinoma with poorly differentiated (65%) and sarcomatoid (30%) components.

The Urinary Sites Solid Tumor Rules, histology coding rules, say to code the most specific histology or subtype/variant, regardless of whether it is described as majority, minority, or component.  Poorly differentiated (8020) and sarcomatoid (8122) are both urothelial subtypes, but there is no rule to instruct how to code a tumor/tumors with multiple urothelial subtypes.

Code histology as 8120/3 in the two examples using Note 1 in the Urinary Sites Solid Tumor Rules, instruction 1 of the Coding Histology section.  The subtypes/variants or components must describe a carcinoma or sarcoma in order to code a histology described by those terms.

 2022
20220034

First Course Treatment--Lymphoma: Is the first round of systemic therapy coded as first course of therapy or is it all the therapy given to achieve remission for a lymphoma case with multiple treatments?  See Discussion.

Lymphoma case diagnosed in 2021: The patient had first round of systemic therapy as documented in the treatment plan and a post-chemotherapy PET scan that showed residual disease. The patient then had a different combination of systemic therapy and still had some residual disease. The patient was given a third round of different combination of systemic therapy in preparation for stem cell transplant. According to the physician post-stem cell transplant note, the patient achieved complete remission.

Is the first course of therapy the first round of systemic therapy only or is it all the therapy given to achieve remission?  It seems like only the first round of systemic therapy is first course of therapy for both leukemia and lymphoma in the hematopoietic manual. I thought all treatment for all hematopoietic cases was first course until remission achieved or progression was evident.

Code all treatments the patient received as first course of treatment. For lymphoma and leukemia, first course of treatment may include first-line, second-line, consolidation, maintenance, salvage, etc., any treatment to achieve remission.

We have added this to the agenda for the 2024 updates to the Hematopoietic Manual and Database.

 2022