SEER Inquiry System - Search

In 2004 the patient has a 1.7cm squamous cell carcinoma diagnosed in the LUL of the lung treated with radiation and chemotherapy. In 2007, the patient was diagnosed with a 2.1cm squamous cell carcinoma in the LUL treated with radiation. According to the lung MP/H rules, the 2007 tumor would be a new primary. Given that there was no surgery, would the second tumor be progression of disease or would it be a new primary?

Benign brain guidelines indicate that named tumors that have been assigned an ICD-O-3 code are reportable. However, per I&R: "Most cystic hygromas (9173/0) are fetal malformations and occur in patients less than two years old. If this patient was an adult, they are primarily treated with surgery. Hygroma (used in a general sense) is a response to trauma (i.e., subdural hematoma) and as such, is not a "new growth" and would not be reportable either as a cyst or as a neoplasm. Unless the patient had some sort of operation, I'd hesitate to include the case as a reportable benign tumor."

How is the cancer registrar to distinguish between reportable and non-reportable hygromas? Example: Brain MRI showed diffuse cerebral volume loss and incidental bilateral frontal subdural hygromas (histology code 9173/0).

Reference: I&R 14825

Cavernous hemangiomas are typically described as vascular malformations in the brain. Per a search of the literature, cavernoma, cavernous hemangioma and cavernous malformation are all synonymous. There is some controversy as to whether cavernomas are vascular malformations or tumors. Cavernous hemangioma (9121/0) has been assigned a code in the ICD-O-3. The other terms are not even listed. Benign brain guidelines indicate that named tumors that have been assigned an ICD-O-3 code are reportable. Would we report a lesion that is labeled cavernous hemangioma but not one that is labeled carvernoma? Are cavernous malformations of the brain to be reported as benign brain tumors? The MP/H guidelines for benign brain tumors do not include blood vessel tumors in chart 1.

Are the following tumors reportable? If so, what is the primary site?

Example 1: Patient admitted for resection. Clinical diagnosis is left temporal cavernous hemangioma. Path diagnosis is cerebral cortex and white matter showing cavernoma.

Example 2: Patient admitted for resection with clinical diagnosis of parietal cavernous hemangioma. Path shows A-V malformation.

Example 3: Patient had T4 spinal tumor removed. Path showed cavernous angioma.

Reference: I&R 18109 and 23460

Scenario: 10/17/07: Right axilla soft tissue bx - infiltrating mammary ca with lobular features arising within apparent breast tissue present within axilla. Tumor size 1.2 cm. 11/3/07: Right breast, reexcision lumpectomy - Several foci of infiltrating lobular CA. (2) foci & (5) foci within specimen (multifocal). (1) large focus also present. No lymphovascular invasion identified. Numerous foci LCIS. Pleomorphic LCIS & CIS with lobular and ductal features. Margins free of invasion however margins diffusely involved with LCIS.

When do you count foci or separate tumor nodules, when do you ignore them, and when do you code unknown values for these fields? Coding instruction 3b states, "When the tumor is multifocal or multicentric and the foci of tumor are not measured, code as 99." Instruction 4b states, "Use code 01 when there is a single tumor with separate foci of tumor." Finally, instruction 6b states, "Use code 99 when the tumor is described as multifocal or multicentric and the number of tumors is not given," which seems to imply that if we know the number of tumors, we would code that number.

Please discuss the significance of JAK2 point mutation.

Example: Bone marrow biopsy showed hypercellular marrow with increased megakaryocytes associated with JAK2 point mutation consistent with myeloproliferative syndrome. Path comment: While the morphologic changes would be compatible with a myeloproliferative syndrome, they are not specific for this as similar findings can be seen in reactive conditions. However, a molecular diagnostic test demonstrated a positive JAK2 point mutation which would support the diagnosis of myeloproliferative syndrome. In summary, the combined histologic and molecular diagnostic findings support a myeloproliferative syndrome. The differential diagnosis would be between polycythemia vera and essential thrombocythemia. Subsequent clinical diagnosis: polycythemia vera.