Report | Question ID | Question | Discussion | Answer | Year |
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20200033 | Solid Tumor Rules (2018)/Multiple primaries--Breast: How many primary tumors should be abstracted for a 2018 breast excision with a final diagnosis of invasive mucinous adenocarcinoma (0.7 cm) with ductal carcinoma in situ (DCIS) present as discontinuous foci, spanning 12 cm? See Discussion. |
If the term discontinuous foci means separate tumors, then rule M14 would apply making these multiple reportable tumors. |
Abstract two primaries, invasive mucinous and DCIS, using 2018 Solid Tumor Rules for Breast, M14, as the discontinuous foci are separate tumors in this example and the histologies are on different rows of Table 3 of the rules. |
2020 |
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20200020 | Reportability/Brain and CNS--Pituitary: Can a clinical diagnosis of pituitary adenoma be accessioned based on imaging if treatment is not given and subsequent imaging years later shows no evidence of pituitary adenoma? See Discussion. |
The patient was clinically diagnosed with a pituitary adenoma on MRI in June 2009. The MRI noted an unusual contour involving the superior margin of the pituitary gland and the clinical interpretation was a small pituitary adenoma. The patient did not follow-up with the recommended repeat imaging and never received treatment for the pituitary adenoma. The patient was eventually seen again in January 2020 and the MRI showed no adenoma in the pituitary gland. Since pituitary adenomas are known to spontaneously regress, should the 2009 diagnosis of pituitary adenoma be accessioned as a SEER reportable benign central nervous system (CNS) tumor? |
Pituitary adenoma is reportable even if it later regresses without treatment. Use text fields to record the details of this case. |
2020 |
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20200015 | Tumor Size--Clinical--Breast: Does information from any type of biopsy take precedence over an imaging report? See Discussion. |
For example, a patient has a 2.6 cm breast tumor on MRI; a core biopsy measuring 0.7 cm is positive for infiltrating duct carcinoma. Rule #1 states "Use the largest measurement of the primary tumor from physical exam, imaging, or other diagnostic procedures before any form of treatment." However, Rule #9 seems to imply that size from an "incisional biopsy" takes precedence over imaging, even though it is known to be less than the entire tumor in size. |
We do not recommend using the size from a core biopsy for clinical tumor size. A core biopsy does not necessarily obtain enough tissue to know the actual tumor size. Since there is imaging for this patient, it is preferable to record clinical tumor size from the imaging report in this case. The instructions will be clarified in the next revision of the SEER manual. |
2020 |
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20200030 | Solid Tumor Rules/Multiple primaries--Lung: How many primaries should be accessioned for the following patient scenario? 1) 09/2014 Left upper lobe (LUL), unifocal, localized acinar adenocarcinoma (8550/3) treated with lobectomy. 2) 04/2016 Right lower lobe (RLL), unifocal, localized acinar adenocarcinoma (8550/3) treated with wedge resection. 3) 04/2019 (within 3 years, but masked full date) Left lower lobe (LLL), unifocal, non-small cell carcinoma (8046/3) with brain metastasis. See Discussion. |
Rule M4 does not seem to apply because Note 1 defines clinically disease free to mean no evidence of recurrence in the same lung on follow-up. Patient had been disease free in the left lung after 09/2014 diagnosis. The 04/2019 diagnosis was in a different lung than the 4/2016 diagnosis. The next applicable rule is either M11 or M14 depending on how we should compare the new 2019 tumor: to the most recent prior tumor in 2016 or to both prior tumors. |
Abstract three primary tumors according to the 2018 Solid Tumor Rules as follows : 2014: LUL, single primary using M2 2016: RLL, multiple primary; abstract second primary using M11 (different lung) 2019: LLL, multiple primary after reapplying rules using M4 when comparing to the same lung in 2014. Abstract this tumor as it has been more than three years and it appears the patient had no clinical evidence of disease in the left lung until 2019. |
2020 |
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20200002 | Reportability/In situ--Prostate: Has there been a change in reportability for prostatic intraepithelial neoplasia (PIN III) (C619)? The 2018 SEER Manual notes: Collection stopped effective with cases diagnosed 01/01/2001 and later; however, on the casefinding list effective 10/01/2019, code D07.5, carcinoma in situ of prostate, is listed as reportable. |
PIN III is not reportable in accordance with the 2018 SEER Manual; however, carcinoma in situ of the prostate is reportable as they represent different histology codes. The casefinding list is used to search for reportable cases and is not the same as a reportable list. |
2020 | |
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20200077 | Solid Tumor Rules (2018)/Histology--Kidney: What is the histology code for succinate dehydrogenase-deficient renal cell carcinoma (SDHD)? See Discussion. |
Table 1 of the 2018 Kidney Solid Tumor Rules (STR) lists succinate dehydrogenase-deficient renal cell carcinoma as histology code 8312, but in the ICD-O-3.2 Coding Table it is listed as histology code 8311. No changes were made in the Kidney STR. As a result, the histology change described in the ICD-O-3.2 Coding Table conflicts with Table 1. Succinate dehydrogenase-deficient renal cell carcinoma (SDHD) is listed in Table 1 as a synonym for renal cell carcinoma, NOS (8312). However, the ICD-O-3.2 Coding Table lists this as a related term for histology code 8311/3. This related term was not discussed in the Implementation Guidelines, and no change was noted in the STR. While it seems we should continue to follow the STR, without clarification as to why this histology change was not implemented in STR, achieving consistency will be problematic if registrars jump straight to the ICD-O-3.2 Coding Table to code histology for cases diagnosed 2021 and later. If this code cannot be used for cases diagnosed prior to 2021, should that clarification be included in the STR? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
When creating table 1, our GU SME's stated Succinate dehydrogenase-deficient renal cell carcinoma (SDHD) is a rare neoplasm and is coded to RCC, NOS until such time a new code is proposed in the 5th Ed BB. ICD-O-3.2 added this term to 8311 as a related term BUT there is no documentation that these neoplasms are different and should be on separate lines in table 1 making them separate primaries. Its likely IARC made the decision to group these rare genetic histologies into one code. SEER is waiting for confirmation from GU experts. If it's valid, the RCC row will be updated in columns 2 and 3 with applicable dates each histology is valid. |
2020 |
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20200071 | Solid Tumor Rules (2018)/Histology--Breast: Rule H13 of the 2021 Breast Solid Tumor Rules (a new H Rule added in the December 2020 revision) indicates metaplastic carcinoma is coded when both metaplastic carcinoma and carcinoma No Special Type (NST) are present. Should Rule H13 also address lobular carcinoma so the histology for a single tumor with metaplastic carcinoma and lobular carcinoma is correctly coded to metaplastic carcinoma (8575)? See Discussion. |
Rule H13 states to code the histology to metaplastic carcinoma when there is metaplastic carcinoma (or a subtype/variant) and invasive carcinoma NST. This rule makes no mention of lobular carcinoma. However, in Table 3, Note 2 for metaplastic carcinoma (8575) states metaplastic carcinoma, NOS and subtypes are almost always mixed with invasive mammary carcinoma, NST and at times lobular carcinoma. These tumors should be coded to metaplastic regardless of percent invasive mammary carcinoma or lobular carcinoma present. While Table 2 (the mixed histology code table) does include an entry for metaplastic carcinoma AND carcinoma NST OR lobular carcinoma, it is unclear why lobular carcinoma has not been added to Rule H13 as well. If a single tumor has metaplastic plus lobular carcinoma, Rule H13 does not apply and one has to continue through the rules. Unfortunately, the next rule registrars would be tempted to use is Rule H18: Code the histology that comprises greater than 50% of tumor when two histologies are on different rows in Table 3. This Rule does not state it does NOT apply to metaplastic carcinoma (only mucinous). So, if for some reason the lobular was greater than 50%, the incorrect histology would be coded (unless the registrar happened to remember Note 2 in the metaplastic carcinoma entry in Table 3). This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
Lobular carcinoma was unintentionally excluded from M13. It will be added in the 2022 update. It is important registrars learn to use the tables and read the notes. |
2020 |
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20200012 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned for a patient diagnosed with myelodysplastic syndrome (MDS) with ring sideroblasts in 2005, and stated to have progressed to high risk disease/early evolving acute myeloid leukemia (AML) in 09/2019? See Discussion. |
The bone marrow biopsy proved bone marrow with blasts comprising 15-19%. Neither the pathologist nor the physician specifically diagnosed this as AML, calling this only high risk disease or early evolving AML prior to starting the patient on Vidaza. No further information can be obtained from the pathologist or the physician for this case. Should this early evolving AML be accessioned as an additional primary per Rule M10, or is this the same MDS that is now high risk as the blast count is up to 19%, but has not yet reached the threshold of 20% blasts usually required for AML per the Hematopoietic and Lymphoid Neoplasm Database? |
Abstract a single primary as we do not abstract early/evolving AML. This is still one primary until there is a confirmed diagnosis of AML. |
2020 |
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20200039 | EOD 2018/Summary Stage 2018--GIST: How should Extent of Disease (EOD) and Summary Stage be coded for a multifocal gastrointestinal stromal tumor (GIST)? See Discussion. |
Example: Patient is found to have a 9.4 cm GIST in the jejunum and 2 cm GIST in the stomach during resection, neither stated to be outright malignant. Similar to the instruction in SINQ 20190041, this case is coded as a malignant jejunal primary due to multifocal tumor. However, it is unclear how to account for the stomach tumor, or any other multifocal tumor for GIST, when coding EOD and Summary Stage. |
For this case, report each GIST diagnosis separately. This differs from SINQ 20190041 because in that case the stomach GIST was incidental and measured only 0.3 cm. Reporting these separately means that each one is no longer a multifocal tumor. If there is no other indication of malignancy for these, they would not be reportable if diagnosed in 2020 or earlier. For cases diagnosed 2021 or later, all GIST are reportable. Report this as two primaries. Use the new GIST schema for EOD and assign EOD Primary Tumor 100 for each. There is no mention of extension outside the primary site. Summary Stage is Localized for each. |
2020 |
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20200041 | Reportability--Brain and CNS: Is an intradural T12/L1 capillary hemangioma reportable? See Discussion. |
Example: MRI found an intradural, extra-axial mass at T12/L1 with possible intramedullary component. Resection of the intradural intramedullary and extramedullary spinal cord tumor found a capillary hemangioma pathologically. The microscopic description on the path report describes a tumor with extensive vascularity involving the dura. Should we equate the statement of capillary to mean the tumor is arising in a blood vessel as we do for venous hemangioma (non-reportable per SINQ 20130001)? Or should it be reportable as C700, 9131/0 because it is described as involving the dura (intradural, intramedullary and extramedullary)? |
Reportability of capillary hemangioma depends on the site of origin. If it originates in the dura, it is reportable. If it originates in a blood vessel, it is not reportable. The site of origin is not clear in the information provided. Sites of involvement are mentioned, but not the site of origin. Capillary could refer to the site of origin or to the propensity of this tumor to form tiny blood vessels. If the site of origin cannot be confirmed as dura, do not report this neoplasm. |
2020 |