Report | Question ID | Question | Discussion | Answer | Year |
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20200009 | First course treatment/Surgery of Primary Site--Corpus uteri: Is an omentectomy performed with a hysterectomy for an endometrial primary site recorded under Surgery of Other Site? See Discussion. |
Per SEER 20140003, an omentectomy is not recorded under Surgery of Other Site when performed with a hysterectomy for an endometrial primary. Is this still correct? CoC appears to have different guidelines stating in a forum that an omentectomy is coded in data item Surgical Procedure to Other Site. I would like to confirm SEER guidelines. Is this one of those unique situations that SEER and STORE differ? Our state follows SEER guidelines and would like to communicate the appropriate rules to our facilities. |
Continue to record an omentectomy performed with a hysterectomy under Surgery of Primary Site and not as a separate procedure under Surgical Procedure of Other Site. The guidance In SINQ 2014003 and 20091118 is unchanged. |
2020 |
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20200046 | Reportability--Vulva: Is well differentiated vulvar intraepithelial neoplasm (dVIN) reportable? See Discussion. |
Is this histologic terminology synonymous with 8071/2 Differentiated-type vulvar intraepithelial neoplasia? Per the 7/20/2018 updates to the 2018 ICD-O-3 Histology list, the reportability flag was changed from N to Y for Differentiated-type vulvar intraepithelial neoplasia as well as Differentiated penile intraepithelial neoplasia, both 8071/2. It appears that both SINQ 20180020 and the second half of SINQ 20160069 are no longer valid and should be deleted. |
Report well-differentiated vulvar intraepithelial neoplasm (8071/2). Our expert pathologist consultant regards this as reportable. Well-differentiated is synonymous with differentiated in this context. The older SINQ questions have been removed. |
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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20200074 | Solid Tumor Rules (2018)/Histology--Head & Neck: What specific table(s) in the 2021 Head and Neck Solid Tumor Rules if any, apply to tumors of the lip? See Discussion. |
Lip has not been added to any of the site-specific histology tables, nor has any other instruction been provided for coding tumors in this site. Coding histology for lip primaries is difficult because registrars do not know where to look first. The Solid Tumor Rules indicate one should use the tables first, but then do not inform registrars what table to use for a lip primary (i.e., a specific table, any table, no table). This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The tables are based on WHO H&N chapters which do not include lip. There are inherent issues in determining reportability for lip primaries based on site and histology. The decision was made prior to release of the 2018 rules to exclude a histology table for lip. We are consulting both our dermatology and H&N pathology experts to explore adding a lip site-specific table to the rules. |
2020 |
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20200047 | Stage-related Data Item/Lymphovascular Invasion--Ovary: The 2018 SEER Program Coding and Staging Manual states that LVI is coded 8 (Not applicable) for Ovary (Schema 00551). What is the reason for having lymphovascular invasion (LVI) coded "8" for Ovary? See Discussion. |
This direction is also in SEER*RSA for Ovary. Researching a possible explanation for this, we found that LVI is an independent predictor of progression and survival in patients with primary epithelial ovarian cancer at early stage but not at advanced stage. However, studies also recommend that routine evaluation of LVI in ovarian cancer is highly recommended in daily practice. |
The coding instructions were developed and implemented in concert with the AJCC Cancer Staging Manual, 7th edition, and updated with the 8th edition as per the 2018 STORE Manual and were based on sites where distinguishing between lymphatic/small vessel invasion and venous/large vessel invasion was not medically appropriate. SEER required LVI for penis and testis cases only beginning in 2016; sites other than penis or testis are coded 8 unless required by state or central registries. The list for use of code 8 has been changed for 2021 and will no longer include Ovary. |
2020 |
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20200049 | Summary Stage 2018/EOD 2018--Lymphoma Orbital Adnexa: What is the correct Summary Stage 2018 (SS2018) for the site/histology Orbit, NOS (C696), 9699/3? In SEER*RSA, Extent of Disease (EOD) Primary Tumor references code 7 (Distant), whereas SS2018 assigns code 2 (Regional)? See Discussion. |
We received an edit error in SEER*DMS on the following site/histology (Orbit, NOS (C696)/9699/3) that involved an incorrect staging code being assigned to SS2018. The staging language is identical in AJCC, EOD and SS2018. SEER*RSA notes that SS2018 should be coded distant, but in the SS2018 manual, this language is noted Regional. Staging language is: Orbital adnexal lymphoma AND extraorbital lymphoma extending beyond the orbit to adjacent structures--Bone, Brain, Maxillofacial sinuses |
To clear this edit of the derived Summary Stage (based on EOD) and the manually assigned Summary Stage (based on Summary Stage 2018), assign the manually assigned Summary Stage to 7. For this particular case, EOD Primary Tumor 700 (which is correct based on the information received) derives Distant; however, for Summary Stage 2018, this description is under Code 2 for Regional by direct extension. This is an error. For 2022, Summary Stage for Lymphoma Ocular Adnexa description under Code 2 (Regional by direct extension) will be moved to Distant. No changes will be done to EOD. |
2020 |
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20200019 | Diagnostic confirmation--Heme and Lymphoid Neoplasms--Lymphoma: Is Diagnostic Confirmation "5" for Hematopoietic Neoplasms appropriate for this case? There appears to be no conclusive histologic diagnosis (Neoplasm, suggestive of lymphoma) and only the IHC/flow cytometry issued a conclusive diagnosis. See Discussion. |
10/4/2018 Frozen Section Diagnosis: Brain tissue with atypical cells and inflammatory cells, defer to permanents for further evaluation. Note: Tissue for flow cytometry is submitted. Final Diagnosis: Preliminary Diagnosis: Brain Tumor, Biopsy: Neoplasm, suggestive of lymphoma (see comment). Comment: The tumor exhibits nuclear atypia and increased mitosis. The tumor cells are immunologically positive for LCA and with very high ki67 labeling index. GFAP and synaptophysin are not expressed by tumor cells. The above suggests a lympho-proliferative process. This case is forwarded to the hematopathology service of this department for further evaluation. The final diagnosis report will be issued by the hematopathologist as an addendum. Supp Rpt Add Addendum Diagnosis: The brain biopsy showed brain tissue large lymphoid cell infiltrate. Additional immunohistochemical stains are performed. The large cells are positive for CD20, BCL2, BCL6 (subset), MUM1, and CD30, negative for CD3, CD5, and CD10. Staining for c-MYC is negative. Ki-67 positive large cells are approximately 18%. EBER is strongly positive by ISH. Diagnosis: Brain lesion, biopsy: EBV+ Diffuse Large B-cell Lymphoma. Addendum Comment: The concurrent flow cytometric study showed monoclonal lambda-positive B-cells without out CD5 and CD10 expression, consistent with B-cell lymphoma. |
Assign Diagnostic Confirmation as code 3, positive histology plus positive immunophenotyping. The biopsy diagnosis demonstrated EBV+ diffuse large B-cell lymphoma, with positive staining as indicated in the Hematopoietic and Lymphoid Neoplasm Database.The information received from the additional studies confirm the more specific diagnosis. |
2020 |
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20200043 | Histology/Behavior--Bladder: Is the behavior of a bladder tumor with low-grade papillary urothelial carcinoma /2 or /3? See Discussion. |
Transurethral resection: Microscopic Diagnosis: Bladder, transurethral resection: Low-grade papillary urothelial carcinoma Gross Description: Received in formalin labeled with the patient's name and bladder tumor is a 3.0 x 2.0 1.0 cm aggregate of friable tan tissue biopsies. The specimen is submitted in toto, cassettes This is all the information there is on this path report. Extent of Disease (EOD) instructions state inferred description of noninvasive: No statement of invasion (microscopic description present) SEER 2018 Appendix C Bladder Coding Guidelines state code behavior 3 if the only surgery performed is a transurethral resection of the bladder (TURB) documenting that depth of invasion cannot be measured because there is no muscle in the specimen OR the pathology report does not mention whether the submucosa is free of tumor or has been invaded by tumor. |
For cases diagnosed 2021 or later Code the behavior as in situ (/2) when the diagnosis is low grade urothelial carcinoma and there is no information regarding invasion. The SEER Manual Appendix C Bladder Coding Guidelines revision reflects this change. No changes have been made to EOD at this time. The guidelines have been updated as follows. Low grade urothelial carcinoma with no other information: Code to /2. High grade urothelial carcinoma with no other information: Code to /3. For cases diagnosed prior to 2021 Code the behavior as malignant (/3) for a bladder tumor with low-grade papillary urothelial carcinoma. |
2020 |
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20200076 | Reportability/Solid Tumor Rules (2018)--Kidney: Should clarification (Notes) be added to Table 1 of the 2018 Kidney Solid Tumor Rules regarding the use of clear cell papillary renal cell carcinoma (8323) and sarcomatoid renal cell carcinoma (8312) as these histologies conflict with the ICD-O-3.2? See Discussion. |
First, reportability of clear cell papillary renal cell carcinoma changed from 8323/3 to 8323/1. Although it does not appear the standard-setters implemented this change, note of the conflict between the ICD-O-3.2 and the Solid Tumor Rules (STR) is not included in the Implementation Guidelines or STR. The current Note for clear cell papillary renal cell carcinoma (8323) was left in Table 1, so this presumably is still reportable. It would be helpful if the conflict with ICD-O-3.2 was addressed, especially since the existing Note refers to changes made back in 2016 (not 2018 or 2021). Second, is the term sarcomatoid renal cell carcinoma still coded as a synonym for renal cell carcinoma (8312) because sarcomatoid is referring to a pattern of differentiation or 8318 (renal cell carcinoma, sarcomatoid)? The STR, Table 1, lists sarcomatoid renal cell carcinoma as 8312, but the ICD-O-3.2 lists this as 8318. The Note in Table 1 still indicates WHO/IARC and College of American Pathologists agree that sarcomatoid carcinoma is a pattern of differentiation, not a specific subtype, of renal cell carcinoma. This appears to conflict with WHO/IARC ICD-O-3.2 Coding Table as it provides a different, specific histology code for this malignancy. How can WHO/IARC classify this both a pattern of renal cell carcinoma and a separate, specific histology? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
For cases diagnosed 2021 or later, use ICD-O-3.2 to determine reportability. Use the Solid Tumor Rules to determine the number of primaries to report and the histology to code for tumors that are reportable. Do not use the Solid Tumor Rules to determine reportability. ICD-O-3.2 was implemented by the North American standard setters as of 1/1/2021 and it is the basis for reportability for cases diagnosed as of 1/1/21. See 1.a on page 6 in the 2021 SEER manual, https://seer.cancer.gov/manuals/2021/SPCSM_2021_MainDoc.pdf WHO 4th edition Tumors of the Urinary System has proposed ICD-O code 8323/1 for clear cell papillary renal cell carcinoma. This has not been approved for implementation by the standard setters. Continue assigning 8323/3 for clear cell papillary renal cell carcinoma. Sarcomatoid RCC is listed as a synonym for RCC 8312/3. This is correct per WHO and our SME. Do NOT code sarcomatoid RCC to 8318/3. |
2020 |
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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 |