| Report | Question ID | Question | Discussion | Answer | Year |
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20150001 | Reportability/Histology: Would a histology reading "Well-differentiated neuroendocrine neoplasm" of the appendix be reportable? Since the word "tumor NOS" and "neoplasm NOS" both code to 8000, I would assume they would be interchangeable but just wanted to verify. According to SINQ 20130027 & 20140002 a "Well-differentiated neuroendocrine tumor" of the appendix IS reportable. |
"Well-differentiated neuroendocrine neoplasm" of the appendix is reportable. According to the WHO classification of Digestive System Tumors, "Well-differentiated neuroendocrine neoplasm" of the appendix is synonymous with NET. WHO states on page 13 "The term 'neuroendocrine neoplasm' can be used synonymously with 'neuroendocrine tumor.'" Neuroendocrine "tumor," or NET G1, is listed in the WHO classification as one of the malignant neoplasms of the appendix. |
2015 | |
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20150061 | Reportability--Vulva: Is this reportable? We have begun to see the following diagnosis on biopsies of the vulva with the statement below. The diagnosis is being given as simply VULVAR INTRAEPITHELIAL NEOPLASIA, no grade is noted. See discussion. |
The note explains: The International Society for the Study of Vulvovaginal Disease (ISSVD) in 2004 revised its classification of VIN by eliminating VIN 1 and combining VIN 2 and VIN 3 into a single category (see table below). Classification of VIN (usual type) ISSVD [International Society for the Study of Vulvovaginal Disease]1986 classification 2004 classification VIN 1 VIN2 VIN3 VIN Note: VIN 2 and VIN 3 combined into single [non-graded] category, VIN Reference: Scurry J and Wilkinson EJ. Review of terminology of precursors of vulvar squamous cell carcinoma. Journal of lower genital tract disease, 2006; 10(3): 161-169 |
Vulvar intraepithelial neoplasia with no grade specified is not reportable. Reportability instructions have not changed. See page 11 in the SEER manual, http://seer.cancer.gov/manuals/2015/SPCSM_2015_maindoc.pdf |
2015 |
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20150039 | Reportability--Skin: Is this reportable? If so, what is the correct histology code? The pathology report says, " bx of 0.7 x 0.5 cm gray-pink papule on tan-pink skin of left inferior centra malar cheek revealed invasive SCC of skin, signet ring cell type, invading papillary dermis; LVI neg; "findings are diag of SCC exhibiting the rare signet ring histologic subtype"; deep margin positive for tumor but peripheral margins clear;". |
SCC of skin, signet ring cell type, is not reportable to SEER. SCC's of skin classifiable to 8050-8084 are not reportable to SEER. See page 11 in the SEER manual, http://seer.cancer.gov/manuals/2015/SPCSM_2015_maindoc.pdf
Signet ring is a rare histological variant of SCC and is coded to 8070/3 according to the WHO classification for skin tumors. |
2015 | |
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20150060 | Reportability/MP/H Rules: Where can I find documentation on how to accession malignant tumors in transplanted organs? See discussion. |
A patient was diagnosed with hepatocellular cancer (HCC) in 2010, and underwent a hepatectomy, and then received a donor liver. In 2014, HCC was discovered in the liver once again. This likely is a new primary, but there are no specific rules to cover this. There are many odd situations involving transplanted organs, many of which pose reportability and multiple primary problems. |
Accession the new tumor in the transplanted organ as you would any other new/second primary. As transplants have become more common especially for liver, lung, and kidney, we are seeing more of these types of cases. We are adding instructions to the revised MP/H rules on coding subsequent primaries when they occur in a transplanted organ. We are also looking at adding a data field that will identify cancers/tumors which arose in a transplanted organ. We feel this is important to track for analysis. Until the revised MP/H rules are implemented, we will look at adding general coding instructions to the SEER Program Manual for transplants. |
2015 |
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20140063 | MP/H Rules--Histology: How is histology coded when a metastatic site is biopsy positive for adenocarcinoma, but the physician clinically states this is cholangiocarcinoma? See discussion. |
The patient underwent a PTA biopsy of a lytic mass showing metastatic adenocarcinoma. Imaging revealed a large hepatic mass consistent with cholangiocarcinoma. The physician's impression on a physical exam note was the PTA biopsy was most consistent with intrahepatic cholangiocarcinoma. However, the PTA pathology report was reviewed at this facility and the final diagnosis was not stated to be cholangiocarcinoma, only adenocarcinoma, NOS.
The priority order for coding histology rules in the MP/H Manual indicates pathology has priority over documentation in the medical record. Following the rules in the MP/H Manual, the histology would be coded as 8140 [Adenocarcinoma, NOS]. While this may be technically correct, it seems that intrahepatic cholangiocarcinoma is often diagnosed as adenocarcinoma on biopsy, but further stated to be cholangiocarcinoma by the physician once other primary sites have been excluded. By applying the rules in the MP/H Manual, cases that seem better characterized as cholangiocarcinomas are being collected as adenocarcinoma, NOS. Should the histology be adenocarcinoma [8140/3] or cholangiocarcinoma [8160/3] for these cases? |
When the physician has reviewed all of the pertinent information, and the physician's opinion is documented stating that the histology is cholangiocarcinoma, code cholangiocarcinoma.
A pathology report from a primary site has the highest priority for coding histology; however, there is no such pathology report in this case. We will review the histology coding instructions and add clarification in the next version. |
2014 |
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20140008 | Primary site: If text supports a pancreatobiliary primary with no other information what primary site code would be assigned? C249 biliary tract NOS, or C269 GI tract nos, or C809 unknown? | Assign C269 in the absence of any additional information. | 2014 | |
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20140077 | MP/H Rules/Histology/Multiple primaries--GE junction: How is histology coded for a goblet cell carcinoma in the GE junction? See discussion. |
The patient was diagnosed with GE junction signet ring adenocarcinoma (8490/3) in 5/2012, treated with radiation. GE junction biopsy on 9/20/2012 showed residual signet ring carcinoma. Subsequent biopsies on 7/8/2013 showed GE junction biopsy of invasive adenocarcinoma, signet ring cell type along with “Esophagus, distal and GE junction biopsies” (site not further clarified in available documentation) with Goblet cell carcinoma. The histology code for the goblet cell carcinoma is needed to determine the number of primaries. |
According to our expert pathologist consultant, goblet cell is a descriptive term and not a specific histology in this context. There is no ICD-O-3 code for it. The "goblet cell carcinoma" in this case is not a new primary.
Goblet cell is used to describe some cells containing mucin. In addition to individual tumor cells containing mucin which compresses the nucleus to give the appearance of signet rings, the mucin is present in columnar cells with the nuclei at one end -- this latter is a pattern often seen when glandular structures are formed by the tumor cells. It is also often intermixed with the signet ring cells in the surrounding stroma. |
2014 |
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20140060 | MP/H Rules/Histology--Lung: What is the correct histology code for this lung tumor? FINAL PATHOLOGIC DIAGNOSIS: CT-guided Rotex and Franseen needle biopsies: Positive for malignancy, consistent with adenocarcinoma. Comment: the adenocarcinoma present also shows rare CD56 staining which indicates a neuroendocrine component.
Is this a mixed histology? 8045/3? 8244/3? |
Assign histology code 8140/3, adenocarcinoma, based on the final diagnosis. The neuroendocrine component in this case is not another histology, nor is it a more specific adenocarcinoma. "Component" is not one of the words that we use to indicate a more specific histology. |
2014 | |
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20140036 | MP/H Rules/Multiple primaries--Prostate: Is duct carcinoma of the prostate the same as an adeno/acinar carcinoma of the prostate? Specifically, does rule M3 apply when there is an adenocarcinoma of the prostate followed by a duct carcinoma of the prostate or a duct carcinoma followed by adenocarcinoma? |
Rule M3 does not apply to adenocarcinoma followed by duct carcinoma of the prostate or vice versa. Rule M3 pertains to cases of adenocarcinoma and acinar carcinoma. These two terms, adenocarcinoma and acinar carcinoma, are equivalent for the purpose of applying the MP/H rules to prostate cases. See page 77 of the Other Sites Terms and Definitions, http://www.seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf
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2014 | |
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20140009 | Primary site: What primary site do I assign to a Squamous Cell Carcinoma of the parapharyngeal space when there is no other info available regarding a more definitive site within the parapharyngeal space? Each physician involved with the case states the primary site is the parapharyngeal space. This is a patient who was diagosed and treated elswhere and was seen at our hospital several months later for a radical neck dissection for suspected lymph node mets. |
Assign C139 for a primary originating in the parapharyngeal space. This space contains part of the parotid gland, adipose tissue, lymph nodes, nerves, arteries and veins. |
2014 |
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