Report | Question ID | Question | Discussion | Answer | Year |
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20230020 | First Course Treatment/Reason for No Surgery of Primary Site: How should Reason for No Surgery of Primary Site be coded for cases when surgery was planned but aborted due to extent of disease seen during planned procedure? See Discussion. |
Lung abnormality on imaging prompted diagnosis on subsequent biopsy and clinical staging was documented as cT1b N0 M0. There was an attempt at resection, but the patient was found to have chest wall involvement and the procedure was aborted. How would Reason for No Surgery of Primary Site be coded in these types of scenarios when the surgery is aborted and the treatment plan changes due to the extension seen during surgery? |
For the example provided: For 2023 cases and forward, if no part of the surgery was performed, code Surgery of Primary Site 2023 (NAACCR Item #1291) as code A000 or B000 (no surgical procedure of the primary site). Code Reason for No Surgery of Primary Site (NAACCR Item #1340) as code 2 (surgery of the primary site was not recommended/performed because it was contraindicated due to patient risk factors (comorbid conditions, advanced age, progression of tumor prior to planned surgery, etc.). In contrast, if any part of the surgery was performed, assign the Surgery of Primary Site 2023 (NAACCR Item #1291) code that best reflects the extent of the surgery performed. Code Reason for No Surgery of Primary Site (NAACCR Item #1340) as code 0 (surgery of the primary site was performed). Use text fields to record the details. For cases prior to 2023, apply the same approach using Surgery of Primary Site (NAACCR Item #1290) instead of Surgery of Primary Site 2023 (NAACCR Item #1291). |
2023 |
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20230075 | EOD/Summary Stage--Eye: How is stage coded for a patient with extranodal non-Hodgkin lymphoma involving bilateral choroids (single focus, both sites) and no lymph node involvement? Since the eyes are a paired site, is this two separate extranodal sites? If so, there are no Summary Stage or EOD tumor codes that best fit this scenario. |
Assign as Stage IV as recommended by our expert hematological oncologist. This is a rare occurrence and this type of presentation does not fit the definition of intraocular extension. Stage IV is probably the best stage for this type of presentation, since there are two extranodal organs involved, even though they involve a bilateral site. EOD Primary Tumor: 700 SS: 7 (Distant) |
2023 | |
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20230041 | Solid Tumor Rules/Multiple Primaries--Breast: Is an in situ tumor followed by an invasive tumor a single or multiple primaries? See Discussion. |
In the examples below, are these a single or multiple primaries? Example 1: Tumor 1: C509/left breast, 8520/2 (in situ lobular carcinoma), dx date-01/10/2019 Tumor 2: C509/ left breast, 8500/3 (carcinoma NST), dx date-08/19/2021 Example 2: Tumor 1: C509, right breast, 8520/2, dx date 06/26/2014 Tumor 2: C508, right breast, 8500/3, dx date-05/23/2019 There seems to be some conflicting info on this. In the 2020 Breast Rules there was a note add to the revision history. “M10 Same behavior requirement re-added.” Which is not in the rules now, nor was it noted to the revision changes in the last two change logs. Inquiry 20200070 would seem to indicate that this is multiple primaries, but that contrasts with 20230010 which would seem to indicate a single primary, and an ASK A SEER Registrar question that we received a response to. I don’t see a scenario where rule M17, an invasive tumor DX more than 60 days after an in situ tumor would come into play. If behavior no longer applies to rule M10, at what point did that change get made? Please advise. |
Abstract a single primary when there are multiple tumors of carcinoma NST/duct and lobular using the current Breast Solid Tumor Rules, Rule M10, May 2023 Update, for cases diagnosed 01/01/2018 and forward in the examples provided. The rule also notes to follow the H rules to determine the correct histology code when a mixture of behaviors is present in carcinoma, NST and lobular carcinoma. Rule M5 does not apply as the timeframe is less than 5 years in both examples. The 2023 update for the Breast Solid Tumor Rules (released November 2022) states: The rules for determining single versus multiple primaries in tumors with carcinoma NST/duct and lobular carcinoma have been revised and now align with ICD-O-3.2. Applicable Histology Rules have also been revised to reflect ICD-O-3.2 histology terminology and corresponding ICD-O codes. |
2023 |
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20230017 | Solid Tumor Rules/Multiple Primaries--Rectum/Anal Canal: How many primaries are accessioned and how should histology be coded for a 2021 abdominoperineal resection showing invasive adenocarcinoma of distal rectum and associated Paget disease of the anal mucosa and perianal skin? See Discussion. |
The synoptic report calls this “Invasive adenocarcinoma with secondary Paget disease of anal mucosa and perianal skin.” The tumor size is listed as “2.1 x 1.7 x 0.7 cm, including associated advanced adenoma; size does not include the extent of the associated Paget disease, which extends for at least 2 cm distally.” Clinically this is called an incidentally discovered Paget’s disease. It is unclear if this is a collision tumor that should be abstracted as separate primaries, or if this is a single tumor with underlying Paget’s disease (similar to that described in Other Sites Rule H26). If this is a single rectal tumor, there does not appear to be an H rule for this scenario. |
Abstract two primaries using rule M4 of the Colon rules or rule M13 of Other Sites: 1. Invasive adenocarcinoma of distal rectum and 2. Paget disease of the anal mucosa / perianal skin (determine site of origin and code primary site accordingly). The rectum and the anus are separate sites and the histologies differ in each site. The WHO Classification of Digestive System Tumors, 5th edition, states that in addition to secondary anal Paget disease arising from anal canal adenocarcinoma, or rarely, adenoma without documented invasive disease, secondary Paget cells may be contiguous with the underlying neoplasm or manifest at different at sites distinctly away from it (with skip lesions). Document the details in the appropriate text fields. |
2023 |
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20230021 | Histology--Soft Tissue: How is histology coded for malignant neoplasm with neuroectodermal differentiation and TPR-NTRK1 gene rearrangement diagnosed on left shoulder excision? See Discussion. |
March 2022, left shoulder soft tissue mass excision shows a spindle cell tumor with outside consultation diagnosis of malignant neoplasm with neuroectodermal differentiation and TPR-NTRK1 gene rearrangement. Diagnosis comments indicate the findings most closely resemble the spectrum of kinase-rearranged mesenchymal neoplasms, such as lipofibromatosis-like neural tumor. However, the expression of SOX10 and mature melanocytic markers is unusual, and does not exclude melanocytic differentiation. Should this be classified as a peripheral neuroectodermal tumor (9364) or as an "NTRK-rearranged spindle cell neoplasm (emerging)" (8990) if there is a NTRK gene rearrangement? |
NTRK-rearranged spindle cell neoplasm is a newly identified variant of sarcoma; however, WHO has not yet proposed a specific ICD-O code for this rare neoplasm. Code to spindle cell sarcoma (8801/3). WHO defines NTRK-rearranged spindle cell neoplasm as an emerging group of molecularly defined rare soft tissue tumors that span a wide group of morphologies and histological grades, and are most often characterized by a spindle cell phenotype among other characteristics. |
2023 |
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20230026 | Solid Tumor Rules/Multiple Primaries--Prostate: How many primaries should be abstracted, and which M rule applies when a patient is diagnosed with intraductal carcinoma of the prostate on biopsy followed by invasive adenocarcinoma on radical prostatectomy more than 60 days later? See Discussion. |
Example: A prostate core biopsy showed intraductal carcinoma in 09/2022, which is an in situ tumor. A core biopsy again showed intraductal carcinoma in 12/2022. The subsequent radical prostatectomy in 04/2023, revealed multiple foci of invasive prostate adenocarcinoma with extensive intraductal carcinoma. Per Solid Tumor Rules, Other Sites, Rule M3, acinar adenocarcinoma of the prostate is always a single primary. Note 4, this rule applies to subtype variants of acinar adenocarcinoma listed in Table 3, which has intraductal/ductal as a variant subtype of acinar adenocarcinoma. Does rule M3 apply to incidence cases (an invasive tumor following an in situ tumor)? |
Rule M1 applies because we don't know if there are separate tumors or separate foci within a single tumor. This is a single primary coded 8140/3. The prostate rules will be reviewed for an addition to cover this situation. |
2023 |
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20230019 | Solid Tumor Rules/Multiple Primaries--Pancreas: How many primaries, and what M Rule applies, when a pancreatectomy identified an invasive adenocarcinoma in one pancreatic head tumor, but multiple separate pancreatic neuroendocrine tumors (PanNETs), WHO grade 1, in the pancreatic body? See Discussion. |
There was a 3.5 cm invasive adenocarcinoma tumor in the pancreatic head. There were four separate, sized pancreatic neuroendocrine tumors measuring 0.9, 0.7, 0.5 and 0.2 cm in the pancreatic body. There are multiple tumors with distinctly different histologies. However, Table 11 (Pancreas Histologies) does not include any entries for neuroendocrine tumors of the pancreas (e.g., pancreatic NET, WHO grade 1, histology 8240). While it would seem Rule M19 should apply as they’re distinctly different histologies, because PanNETs are not included in Table 11, it is not clear which M Rule applies to these multiple tumors. If Rule M19 does not apply, we are left with Rule M21 (Abstract a single primary when there are multiple tumors that do not meet any of the above criteria). Are these separate tumors with distinctly different histologies really a single primary? Pancreatic neuroendocrine tumors are not an uncommon histology, is there a reason these were not included in Table 11? |
Abstract two primaries using the 2023 Solid Tumor Rules, Other Sites, Rule M19, as adenocarcinoma and pancreatic neuroendocrine tumors are two distinct histologies. The WHO Classification of Digestive Tumors, 5th ed., Chapter 10-Tumors of the Pancreas, lists both epithelial tumors and neuroendocrine neoplasm as separate entities. The Solid Tumor Rules histology-specific tables contain histologies that commonly occur in the 19 site-specific histology tables; therefore, not all histologies are listed in the rules. Further, the adenocarcinoma would be staged in the Pancreas Schema, while the neuroendocrine tumor would be staged in the NET Pancreas schema. We will consider adding PanNETs to Table 11 in a future release of the Solid Tumor Rules. |
2023 |
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20230073 | First Course Treatment/Surgery of Primary Site--Liver/Intrahepatic Bile Ducts: For a liver/intrahepatic bile duct primary, is an alcohol embolization the same thing as a percutaneous ethanol injection (PEI)? See Discussion. |
For C220-C221 primaries, Surgery of Primary Site includes code A150 for Alcohol tumor destruction (percutaneous ethanol injection/intratumoral injection of alcohol/alcohol ablation). The SEER and STORE manuals also indicate that alcohol embolization should be coded as Other Therapy, code 1. We are trying to determine whether alcohol embolization should be coded under Surgery of Primary Site or Other Therapy. |
Code alcohol ablation under Surgery of Primary Site 2023. Code alcohol embolization as Other Therapy when tumor embolization is performed using alcohol as the embolizing agent. Alcohol ablation, also known as an ultrasound-guided percutaneous ethanol injection (PEI); is treatment that involves injecting concentrated alcohol directly into the tumor. Embolization uses special techniques to close off blood flow by introducing special medications or using other techniques designed to block blood vessels. Types of embolization are arterial embolization as with alcohol (ethanol), chemoembolization, and radioembolization. Refer to the current SEER Program Coding and Staging Manual when assigning surgery and embolization procedures. |
2023 |
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20220026 | Solid Tumor Rules/Histology--Parotid: How is histology coded for a myoepithelial carcinoma ex-pleomorphic adenoma of the parotid? |
Patient has a 2021 left parotidectomy showing myoepithelial carcinoma ex-pleomorphic adenoma. Is this coded to myoepithelial carcinoma (8982/3) or carcinoma ex-pleomorphic adenoma (8941/3)? It is unclear how to arrive at the correct histology code using the current Solid Tumor Rules. |
Code myoepithelial carcinoma ex pleomorphic adenoma as carcinoma ex pleomorphic adenoma (CXPA) (8941/3) using Head and Neck Solid Tumor Rule H1 as this is a single histology. The WHO Classification of Head and Neck Tumors, 5th ed., describes CXPA as a rare epithelial and/or myoepithelial malignance arising in association with a primary or recurrent pleomorphic adenoma. The histologic type of the carcinoma component is usually recorded, in this case, myoepithelial carcinoma. |
2022 |
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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 |