Report | Question ID | Question | Discussion | Answer | Year |
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20200069 | Solid Tumor Rules (2018)/Histology--Breast: What histology code is used for an in situ encapsulated papillary carcinoma with an invasive carcinoma, NST? See Discussion. |
In Table 3 (Specific Histologies, NOS/ NST, and Subtypes/Variants), the entry for papillary carcinoma, NOS includes a change in column 3 of the 2018 Breast Solid Tumor Rules that conflicts with the H Rules. It is not accounted for in the change log. No explanation is offered as to why this change was made. This is a major change because encapsulated papillary carcinoma is frequently associated with carcinoma NST, and we have not been collecting these as such. Encapsulated papillary carcinoma (8504) in column 3 now includes an indented entry, with invasive carcinoma, NST/invasive duct carcinoma 8504/3. However, most encapsulated papillary carcinomas are in situ or there is no definitive statement of invasive encapsulated papillary carcinoma, so when in situ and invasive tumors are present, we are instructed to code the invasive histology (which would be the invasive carcinoma (NST), 8500/3). How are registrars to arrive at the correct histology without a new H rule or a clarification regarding this update being documented in the change log? Does the same change/addition apply to solid papillary carcinoma? These are often also associated with carcinoma, NST. Again, without an explanation regarding the change mentioned above, it is difficult to understand why the change was made. This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
In situ encapsulated papillary arising in or with invasive carcinoma, NST (a single tumor) is a single invasive histology. Use rule H14 and code the histology per Table 3. A note as been added to the 2023 breast rule H8 instructing when there is a single tumor with histology of in situ encapsulated papillary with invasive carcinoma or solid papillary carcinoma with invasove, continue through the rules. See H14 and code the appropriate histology per Table 3. Histologic types are becoming more complex and often have both in situ and invasive components but have a single code to identify them. |
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 |
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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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20200031 | Histology/Behavior--Breast: How are histology and behavior coded for a case originally diagnosed as in situ and later an invasive tumor with a different histology is diagnosed but still a single primary using Breast Solid Tumor Rule M10? See Discussion. |
SINQ 20200022 indicates that cases originally diagnosed as in situ do not have a new primary when a new invasive tumor with a different histology is diagnosed within 5 years. Should histology and/or behavior get updated for the in situ breast primary? |
Update the histology and behavior based on the invasive tumor when an invasive tumor is diagnosed within 5 years of an in situ tumor in the same breast. This will be updated in the 2021 revisions of the Breast Solid Tumor Rules. |
2020 |
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20200070 | Solid Tumor Rules (2018)/Multiple Primaries--Breast: The December 2020 revision to 2018 Breast Solid Tumor Rules, Rule M10, using behavior rather than timing to determine the number of primaries, has caused synchronous separate/non-contiguous tumors reported as invasive carcinoma, NST (8500/3) and lobular carcinoma in situ (8520/2) (or vice versa) to be reported as separate primaries per Rule M14. Should an invasive carcinoma NST and a synchronous, separate lobular carcinoma in situ be separate primaries per M14? See Discussion. |
Recognizing the addition of the behavior requirement into this rule is an attempt to stop non-synchronous ductal carcinoma and lobular carcinomas from being accessioned as a single primary (SINQ 20200022), the issue with using behavior rather than timing is that now, synchronous separate/non-contiguous tumors that are invasive carcinoma NST (8500/3) and lobular carcinoma in situ (8520/2) (or vice versa) are separate primaries per M14. Lobular and carcinoma, NST are separate rows in Table 3, so we cannot stop at M10 and code the mixed histology because there are two separate histologies with different behaviors. There is no rule that states we can just ignore the in situ tumors for the purpose of applying the M Rules. (We are instructed to ignore the in situ when coding histology only in certain circumstances.) The problem with Rule M10 appears to be related to timing. This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The original issue with M10 was with registrars being instructed that multiple in situ and invasive tumors were a single primary and then coding 8522/3 when one tumor was in situ and one was invasive. This incorrectly identified both components as being malignant (/3). Our effort to correct this misconception apparently did not work. M10 has been revised to state that yes, an in situ lobular or duct plus an invasive lobular or duct is a single primary with a new note that states: When a mixture of behaviors is present in carcinoma, NST, and lobular carcinoma, follow the H rules to determine the correct histology code. They will stop at H8 which instructs them to code the invasive histology. 8522/3 should only be used when both components are invasive. |
2020 |
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20190002 | Histology/Behavior--Brain and CNS: How should Histology and Behavior be coded for a polymorphous low-grade neuroepithelial tumor of the young (PLNTY) arising in the brain? |
Assign code 9505/1 for ganglioglioma. Per our expert neuropathologist, according to the paper that has done the most work on PLNTY cases, it appears most closely related to the ganglioglioma. It is surely a neoplasm as it has recurrent mutations and fusions seen in other tumors, again, most like gangliogliomas. |
2019 | |
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20190039 | Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of invasive moderately differentiated adenocarcinoma, predominantly papillary subtype, with minor acinar and lepidic subtypes? See Discussion. |
11/01/2018, lung, left upper lobe, wedge resection: Invasive moderately differentiated adenocarcinoma, predominantly papillary subtype, with minor acinar and lepidic subtypes. Would this be 8260/3 since the acinar and lepidic subtypes are described as minor or would this be 8255/3 because there is papillary plus two other subtypes/variants described as subtypes? |
Code as adenocarcinoma, papillary predominant (8260/3) according to the Lung Solid Tumor Rules, Coding Multiple Histologies, which says to code the specific histology. The most specific histology may be described as component, majority/majority of, or predominantly, where predominantly describes the greater amount of tumor. |
2019 |
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20190058 | Solid Tumor Rules (2018)/Histology--Cervix Uteri: What is the histology code and what H Rule applies for a diagnosis of papillary squamotransitional cell carcinoma of the cervix? See Discussion. |
It appears that the first Other Sites applicable rule is H16 (and Table 2) instructing the use of histology code 8323 (mixed cell adenocarcinoma). However, this really is not an adenocarcinoma tumor but is a mixed squamous and transitional cell carcinoma. The 2018 ICD-O-3 Histology Update Table provides a new term for a but does not indicate whether that new term would also include a papillary squamotransitional cell carcinoma of the cervix. |
Code papillary squamotransitional cell carcinoma (PSCC) as 8120/3 using the 2018 Other Sites Solid Tumor Rules, Rule H11. PSCC is a distinctive subcategory of squamous cell carcinoma of the uterine cervix. WHO Classification of Tumors of Female Reproductive Organs say that squamotransitional cell tumors show papillary architecture with fibrovascular cores lines by multilayered atypical epithelium. |
2019 |
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20190029 | Reportability--Testis: Is demarcated scar tissue with atrophic seminiferous tubules and cortical bone consistent with burnt-out germ cell tumor and no evidence of germ cell neoplasia in situ (GCNIS) reportable? See Discussion. |
The patient is a 34 year old who presented with testicular pain radiating into the abdomen approximately 1 month before orchiectomy in 2018. CT abdomen/pelvis: Multiple focal sclerotic bone lesions. Given the lack of change from July 2014, these are likely benign bone islands. No adenopathy mentioned. He has no prior history of germ cell tumor nor any surgery for any tumor/cancer before this. Pathology: Testis, left, radical orchiectomy: - Demarcated scar tissue (1.3 cm), with atrophic seminiferous tubules and cortical bone consistent with burnt-out germ cell tumor. No evidence of germ cell neoplasia in situ (GCNIS). - Margins are unremarkable. |
Burnt-out germ cell tumor (9080/1) is not reportable. According to WHO Classification of Urinary System and Male Genital Organ, regressed germ cell tumors are germ cell tumors that have undergone partial or complete regression leaving a generally well-delineated nodular focus of scar or fibrosis in the testis. |
2019 |