Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20200007 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient is simultaneously diagnosed with systemic mastocytosis and chronic myelomonocytic leukemia (CMML-0) on a single bone marrow biopsy? See Discussion. |
The Hematopoietic and Lymphoid Neoplasms Database (Heme DB) definition for systemic mastocytosis with an associated hematological neoplasm (SM-AHN, 9741/3) states SM-AHN is a variant of systemic mastocytosis that arises with a myeloid disease of non-mast cell lineage (e.g., MDS, MPN, etc.) and that, However, SINQ 20130172 conflicts with the Heme DB stating the systemic mastocytosis and the associated hematological neoplasm are a single primary coded to a single histology (9741/3) per Rule M2. |
Abstract a single primary when the diagnosis is systemic mastocytosis with an associated clonal hematogoical non-mast cell lineage disease (SM-AHNMD) (9741/3). However, if the patient has a previous history of myelodysplastic syndrome, myeloproliferative neoplasm, myelodysplastic/myeloproliferative neoplasm or acute leukemia, abstract the SM-AHNMD as a second primary as stated in the Heme DB. SINQ 20130172 represents a single primary as there is no mention of a prior history of myelodysplastic syndrome, myeloproliferative neoplasm, myelodysplastic/myeloproliferative neoplasm or acute leukemia. |
2020 |
|
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 |
|
20200023 | Solid Tumor Rules (2018)/Histology--Endometrium: Is the histology for a serous carcinoma, high-grade endometrial primary 8441/3 (serous carcinoma) or 8461/3 (high grade serous carcinoma)? See Discussion. |
Path report reads: 7/15/2019 A. Endometrium, curettings: Serous carcinoma, high grade. B. Endometrial polyp, curettings: Serous carcinoma, high grade. If coded to 8461/3, according to AJCC, this would not be an ideal code (since it is outdated). Also, endometrium is not included in the suggested site codes for 8461/3 according to the 8/22/2018 ICD-O-3 update. |
Code histology for this endometrial primary to serous carcinoma 8441/3. Capture "high grade" in the grade field as instructed in the grade coding manual. "High grade serous carcinoma" has specific clinical and histopathologic features found in ovarian tumors. |
2020 |
|
20200053 | Solid Tumor Rules (2018)/Multiple primaries--Bladder. Would the metastatic diagnosis indicate a new primary? If the metastatic diagnosis indicates a new primary, would the primary site be C688 and date of diagnosis 11/14/18? See Discussion. |
7/8/16 Urinary bladder, biopsy: Non-invasive low grade papillary urothelial carcinoma. Muscularis propria (detrusor muscle) is not identified. 9/2/16 Urinary bladder, bladder tumor, transurethral resection: High grade papillary urothelial carcinoma. No definite invasion identified. Muscularis propria (detrusor muscle) is identified and not involved by tumor. 1/7/17 A\S\Bladder: Noninvasive low grade papillary urothelial carcinoma. Granulomatous cystitis, consistent with BCG (Bacillus Calmette-Guerin) treatment. Lamina propria is not involved with tumor. Detrusor muscle is not identified. 4/4/17 Dome: Papillary urothelial carcinoma, low grade. No evidence of invasion. Muscularis propria is not present. Patient is clearly followed for at least a year but no further information until 19 months later, 11/14/18, when biopsy of lung indicates metastatic disease. 11/14/18 Lung, right lower lobe, mass, biopsy: Metastatic urothelial carcinoma. Immunohistochemical analysis results (CK7 positive, CK20 focally positive, P63 positive, GATA3 positive, TTF1 negative and NAPSIN-A negative) support the diagnosis |
Do not use the solid tumor rules to assess the 2018 diagnosis. See Note 1 on page 20 of the Urinary Sites Solid Tumor Rules, https://seer.cancer.gov/tools/solidtumor/Urinary_STM.pdf The 2018 diagnosis proves that this patient had invasive bladder cancer. Change the behavior on the abstract to /3 and use text fields to record the details. |
2020 |
|
20200086 | Solid Tumor Rules (2018)/Histology--Head & Neck: Paraganglioma, NOS is reportable and malignant for cases diagnosed 1/1/2021 and later. Paraganglioma, NOS is listed in the ICD-O-3.2 Coding Table as 8680/3 without synonyms or related terms. Table 4 (ICD-O-3.2 Implementation Guidelines) lists 8693/3 Paraganglioma as a new preferred term. Is this correct? See Discussion. |
Table 4 (Changes in reportable terminology), 2021 ICD-O-3.2 Update, does confirm that the term malignant no longer needs to be used to describe a paraganglioma, but Table 4 includes the histology for extra-adrenal paraganglioma, NOS (8693/3) as the new preferred term for paraganglioma. Paraganglioma, NOS is histology code 8680/3. Which code is correct? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The correct code for extra-adrenal paraganglioma is 8693/3. The preferred term for 8380/3 is Paraganglioma, NOS. Table 4 of the 2021 ICD-O update was based on information from WHO. Table 9 in the Head and Neck ST rules is being revised and formatted differently for ease of coding based on diagnosis year (prior to 2021 and 2021 forward). Not ALL paragangliomas will be included in Table 9. If a term and code are not provided in the rules, refer to ICD-O and updates. |
2020 |
|
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 |
|
20200010 | Solid Tumor Rules (2018)/Histology--Head & Neck: How is histology coded for a glossotonsillar sulcus tumor with both squamous cell carcinoma and mucoepidermoid carcinoma? See Discussion. |
Patient had a radical pharyngectomy showing a glossotonsillar sulcus tumor with high grade squamous cell carcinoma and adjacent high grade mucoepidermoid carcinoma. The pathologist commented, the tumor is composed of high grade mucoepidermoid carcinoma and high grade conventional-type squamous cell carcinoma that are immediately adjacent to one another. Given that the tumors are arising so close together and could represent a single neoplastic process with divergent morphologies, they are staged together. Employing Solid Tumor Manual Rule M1 (single primary if unable to determine if there is a single or multiple tumors), it was determined that this should be reported as a single tumor because the pathologist referred to the case as both a tumor singular and tumors pleural. However, the Solid Tumor Manual Histology Rules for a Single Tumor do not appear to have an instruction for coding this histology combination. |
Abstract multiple primaries using 2018 Head and Neck Solid Tumor Rule M8 as these are separate tumors described as arising close together, and are on different rows in Table 3. Code histology separately as squamous cell carcinoma (8070/3) and mucoepidermoid carcinoma (8430/3). This appears to be a collision tumor. Collision tumors are counted as two individual tumors for the purpose of determining multiple primaries. Collision tumors were originally two separate tumors that arose in close proximity. As the tumors increased in size, they merged or overlapped each other. While more common in the colon, they can occur in other sites as well. |
2020 |
|
20200050 | Surgery of Primary Site/Multiple primaries--Breast: Should the Surgery of Primary Site for the 2020 diagnosis be coded 51 (Modified radical mastectomy without removal of uninvolved contralateral breast) when a partial mastectomy and axillary lymph node dissection are performed for a 2011 right breast primary and a subsequent 2020 right breast primary is treated with a total mastectomy only? See Discussion. |
The patient underwent a partial mastectomy and sentinel lymph node biopsy, followed by an axillary lymph node dissection for the first right breast primary in 2011. The separate 2020 right breast primary was treated with a total mastectomy and removal of one involved axillary lymph node. The operative report only refers to this as a non-sentinel lymph node, with no mention of other axillary findings. Cumulatively, this patient has undergone a modified radical mastectomy since there were likely no remaining axillary lymph nodes. If the Surgery of Primary Site data item is cumulative, does the order of surgeries matter? It is unclear whether this question should be directed to SINQ (for coding in a SEER registry) or to CAnswer Forum because both have addressed similar surgery related questions in the past and and there is no guidance regarding this specific situation. |
Yes, assign surgery of primary site code 51 for the 2020 diagnosis in this case. Code the cumulative effect of all surgeries to the primary site. This means that for the 2020 primary, code the cumulative effect of the surgery done in 2011 plus the surgery performed in 2020. Use text fields on both abstracts to record the details. |
2020 |
|
20200067 | Summary Stage 2018/Extension--Colon: What is the Summary Stage for adenocarcinoma of cecum where the tumor extends into the proximal portion of attached vermiform appendix? See Discussion. |
2020 Diagnosis: Patient had a right hemicolectomy showing adenocarcinoma of cecum, tumor extends into proximal portion of attached vermiform appendix. Tumor invades through muscularis propria into pericolorectal tissues (NOS). Regional lymph nodes: 06/39. Primary Tumor EOD: Where does the appendix involvement come into coding or will this be based on the pericolorectal tissue (NOS) invasion? What is my Summary Stage? I know it is at least 3 due to regional ln involvement, but the appendix involvement is making me question 3 vs 4. |
Assign code 4, Regional by BOTH direct extension AND regional lymph node(s) involved. In this case, the Regional component for Summary Stage 2018 is based on Note 6, under Colon and Rectum where Regional is defined as: -Mesentery -Peritonealized pericolic/perirectal tissues invaded [Ascending Colon/Descending Colon/Hepatic Flexure/Splenic Flexure/Upper third of rectum: anterior and lateral surfaces; Cecum; Sigmoid Colon; Transverse Colon; Rectosigmoid; Rectum: middle third anterior surface] -Pericolic/Perirectal fat |
2020 |
|
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 |