Report | Question ID | Question | Discussion | Answer | Year |
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20081126 | MP/H Rules--Brain and CNS: Are stigmata of neurofibromatosis in the brain reportable neurofibromatosis lesions? See Discussion. |
Reference: SINQ 20051108; SINQ 20061018 Three year old patient with history of neurofibromatosis 1. 3/05 MRI of the brain showed right optic nerve glioma. It also showed heterogeneous high t2 signal in the middle cerebellar peduncles and near the genu of the internal capsules bilaterally are stigmata of neurofibromatosis type I. 3/08 MRI showed new mass suspicious for glioma in the hypothalamus. Clinical diagnosis is benign glioma secondary to diagnosis of neurofibromatosis. How many primaries are to be accessioned for this patient? Should the matrix principle be invoked for the second glioma? Should the behavior code for the glioma be 0? |
For cases diagnosed 2007 through 2017 Accession NF (9540/1) when there is CNS tumor -- a glioma or some other intracranial/intraspinal tumor. Stigmata of NF are reportable when the stigmata themselves are reportable tumors. For example, glioma, or another intracranial/intraspinal tumor. Do not report sitgmata that are only termed "stigmata seen on MRI," for example, without other reportable terminology. Do NOT accession NF (9540/1) when there is only peripheral nerve/nervous system involvement. Accession the neurofibromatosis itself only once per patient. Accession any initial neoplasm in the CNS separately. Abstract and code any subsequent CNS neoplasms according to the multiple primary brain rules. Accession three primaries for the case described above.
--> Optic nerve gliomas associated with NF are pilocytic astrocytomas. Code pilocytic astrocytoma as 9421/3 in North America. For cases diagnosed 2018 or later See the 2018 Solid Tumor Rules for Non-Malignant CNS tumors. |
2008 |
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20081079 | Ambiguous terminology/Reportability--Kidney: Is a case reportable if a biopsy diagnosis of "suggestive of oncocytoma, malignant neoplasm cannot be excluded" follows a CT scan that was read as "suspicious for carcinoma"? See Discussion. | Pt is nursing home resident. CT abdomen/pelvis shows a "mass in the right kidney, highly suspicious for renal cell carcinoma". CT-guided needle biopsy performed with final diagnosis: "Neoplasm suggestive of oncocytoma. A malignant neoplasm cannot be excluded." No other information is available. | This case is not reportable based on the information provided. The suspicious CT finding was biopsied and not proven to be malignant. "Suggestive of" is not a reportable ambiguous term. | 2008 |
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20081116 | CS Extension--Brain and CNS: How is this field coded for a malignant brain tumor that presents as a lesion with significant pressure on the left frontal ventricle and dilation of the right ventricles? See Discussion. | CS Extension code 30 includes tumor that invades or encroaches upon the ventricular system. Does significant pressure mean the same thing as encroach? | 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.Do not assign extension code 30 in this case unless there is evidence elsewhere of ventricular system involvement. "Significant pressure" is not synonymous with encroachment or involvement. See the list of ambiguous terms for CS staging on page 121 of the 2007 SEER manual. |
2008 |
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20081088 | CS Lymph Nodes/CS Mets at Dx: How should these fields be coded for an in situ diagnosis when the patient was diagnosed by biopsy only and there is no information in the chart regarding an evaluation of lymph nodes or metastatic sites? See Discussion. | In reference to the case below, does it make a difference if the CS T stage is known based on the primary excision but there is no clinical information in the record regarding the nodes or metastasis evaluation. This scenario is seen on outpatient records of breast biopsies and melanoma excisions; i.e., punch bx followed by gross excision of the lesion but the medical record contains no clinical information or statement of everything else normal. I&R Question 17625 2/16/2006 A patient was diagnosed with ductal carcinoma in situ by needle core biopsy of the right breast. There was no further information in the chart stating if or where the patient went for staging work-up and treatment. What are the codes for CS Extension, CS Regional Lymph Nodes and CS Distant Mets at Dx? I&R Answer: Sufficient tissue must be taken to determine the T category. If this is the case, CS Extension = 00. Unless the physician makes the statement that the physical exam is negative, code the CS Regional Lymph Nodes = 99 CS Distant Mets at DX = 99. |
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. Code CS Lymph Nodes and CS Mets at Dx 00 [None] for an in situ diagnosis with no other information. The CS instructions state that CS LN's should be coded 00 for in situ because in situ by definition is non-invasive. The same logic applies to CS mets in the case of in situ. The I&R answer will be revised. |
2008 |
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20081047 | Reason no surgery of primary site/First course treatment: If the Reason no Surgery of Primary Site field is coded as 7 (refused), must the other treatment options (radiation, chemo, hormone) also be coded as 7? See Discussion. | Coding instruction #5 in the SEER manual states: "Assign code 7 (refused) if the patient refused recommended surgery or made a blanket statement that he/she refused all treatment." | Refused [code 7] means this modality was specifically recommended by the physician and the patient refused. If two treatment alternatives were offered and surgery was refused, code Reason no surgery of primary site 1 [Surgery of the primary site was not performed because it was not part of the planned first-course treatment]. Refusal of surgery does not necessarily mean that all treatment was refused. Coding Surgery of Primary Site as "refused" does not affect the coding of Radiation, Chemotherapy, Hormone Therapy, etc. |
2008 |
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20081081 | Reportability: If a dermatopathologist refers to an atypical fibroxanthoma as a malignant process, but the ICD-O-3 indicates it is a borderline process, is this a reportable case? See Discussion. | "Final Diagnosis: Surface of ulcerated histologically malignant spindle cell neoplasm, consistent with atypical fibroxanthoma. Note: An exhaustive immunohistochemical work-up shows no melanocytic, epithelial or vascular differentiation. Atypical fibroxanthoma is a superficial form of a malignant fibrous histiocytoma." | The pathologist has the final say on behavior. In this case, the pathologist states that this tumor is malignant in the final diagnosis. Therefore, this case is reportable. | 2008 |
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20081036 | MP/H Rules--Breast: Is inflammatory breast cancer always one primary per lifetime? Or is a subsequent inflammatory breast cancer a second primary if diagnosed more than five years later? | For cases diagnosed 2007 or later, a diagnosis of inflammatory breast cancer more than five years after a previous diagnosis of inflammatory breast cancer is a separate (new) primary. See rule M5 in the Breast Multiple Primary Rules. | 2008 | |
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20081070 | CS Lymph Nodes/CS Mets at DX--Ovary: How are the following lymph node regions/chains coded in the Collaborative Stage schema for ovary?
1. pericolonic 2. pelvic, NOS 3. mesenteric, NOS |
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.Revised 7-17-09 Assign CS Lymph Nodes code 10 for involvement of pelvic lymph nodes, NOS. Code involvement of pericolonic nodes or mesenteric nodes, NOS in CS lymph nodes. |
2008 | |
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20081125 | Reportability: Is the following tumor(s) reportable? MRI of thoracic spine shows intramedullary hemangiomas in the bodies of T5 and T6. | Intramedullary hemangiomas in T5 and T6 are not reportable. These benign tumors originate in the bone, not spinal canal, cord or dura. Benign tumors of the bone are not reportable. According to WHO, the most common sites of involvement are the vertebral bodies, followed by craniofacial skeleton and long bones. |
2008 | |
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20081006 | Multiplicity Counter: Is there a time frame for the Multiplicity Counter or is it related to the duration for counting new tumors (i.e. 5 years for breast, etc) to capture the number of "local recurrences"? | Record the number of tumors counted as a single primary at the time the case is abstracted. Later, if additional tumors are determined to be the same primary, update this field once. Do not update the multiplicity counter more than once. | 2008 |