Report | Question ID | Question | Discussion | Answer | Year |
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20200081 | Solid Tumor Rules (2018)/Histology--Pancreas: How is the histology coded, and what H Rule applies, for a 2021 diagnosis when the pathological diagnosis is neuroendocrine tumor (NET) G1 or NET G2, but clinically, the tumor is stated to be insulinoma? See Discussion. |
Insulinoma, NOS is reportable for cases diagnosed 2021 and later. However, the diagnosis of insulinoma is most frequently made with clinical correlation of the patient's clinical syndrome and serum hormone levels. Despite a pathological diagnosis of NET, this will clinically be stated as insulinoma based on the functional type of tumor. At the largest facility in our area, all pathology reports with a diagnosis of insulinoma over the last year only provide a pathological Final Diagnosis of NET (either G1 or G2), but elsewhere specify, Functional Type: Pancreatic neuroendocrine tumor, functional. Correlation with Clinical Syndrome and Elevated Serum Levels of Hormone Product: Insulin-producing (Insulinoma). For 2021 and later, it seems this should be accessioned as insulinoma (8151/3), but one cannot arrive at that histology using the current Other Sites (MP/H) H Rules. Following the existing rules, one would code the histology to NET, G1 or NET, G2 (8240 or 8249) per Rule H6. There are technically two specific histologies to consider: NET (either 8240 or 8249) and insulinoma, NOS (8151). Following the H Rules, Rule H6 instructs one to code the histology with the numerically higher ICD-O-3 code (8240 or 8249). Coding this histology to NET (8240 or 8249) does not seem to reflect the most accurate classification of this tumor, but applying the current rules, this is the only histology that can be coded. There is no current guideline in the Other Sites schema or the ICD-O-3.2 Implementation Guidelines instructing us to ignore the pathological diagnosis of a NET for these tumors (even though insulinomas are NETs). The only SINQ that currently exists (SINQ 20150019) states the histology can be coded as either a NET or an insulinoma in these cases. How are registrars to consistently code histology for these tumors without a rule clarification? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
Code the tissue/pathology histology over the clinical diagnosis. Because of implementation timelines, a comprehensive revision to Other Sites rules will not be available 2022. A limited revision is planned and histology tables will be added for select sites. The General Instructions will also be revised for Other Sites. |
2020 |
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20190090 | Update to current manual/Extent of Disease/Summary Stage 2018--Fallopian Tube: How are behavior, EOD Primary Tumor, and Summary Stage 2018 coded for a diagnosis of serous tubal intraepithelial carcinoma (STIC) of the fallopian tube? See Discussion. |
The 2018 ICD-O-3 Histology Updates table lists serous tubal intraepithelial carcinoma (C57.0) with a behavior code of 2. The EOD Primary Tumor schema for Fallopian Tube shows STIC has an extension code of 100. It also maps code 100 to Summary Stage 2018 L (localized). Summary Stage 2018 for fallopian tube only documents that intraepithelial tumors are summary stage 0 (in situ). |
We are aware of the issue and have been in discussion with standard setters (SEER, NPCR, AJCC, and NAACCR). At this time, we recommend coding: Histology: 8441/2 Extent of Disease (EOD) Primary Tumor: 000 Summary Stage: 0 AJCC Clin/Path T would be 88, since all in situ lesions are not applicable. Edits will not allow you to have a 8441/2 with a T1. Also, EOD is not currently set up to derive the correct T value, unless you code 100. The change to address the issue will take effect in 2021. |
2019 |
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20190092 | First course Treatment/Lymph Nodes: When a Sentinel Lymph Node (SLN) biopsy ONLY is performed and SLNs are negative, are the SLNs included still counted in Regional Nodes (RNs) Examined and RNs Positive, or are the fields filled in: RLN Examined: 00 (No nodes examined) RLN Positive: 98 (No nodes examined) Date RLN Dissection: 00/00/0000 (No RLN dissection performed) or are the SLN included in the RLN Examined/Positive field but the Date RLN Dissection is 00/00/0000? See Discussion. |
According to the 2018 SEER Manual, Sentinel Lymph Nodes (SLNs) Examined and SLNs Positive are included in Regional Nodes (RNs) Examined and RNs Positive when both a sentinel node biopsy procedure and a subsequent dissection procedure are performed or a sentinel node biopsy procedure is performed during the same procedure as the regional node dissection. |
If a SLN biopsy is performed but no RLN dissection is performed, assign as follows. Date of Regional Lymph Node Dissection: Leave blank as this field records the date non-sentinel regional node dissection was performed. Date of Regional Lymph Node Dissection Flag: Assign code 11 (Not applicable: No proper value is applicable in this context (for example, no regional lymph node dissection was performed; autopsy only cases). Regional Nodes Examined: Indicate the number of SLNs examined as this is cumulative from all procedures that remove lymph nodes through the completion of surgeries in the first course of treatment. Regional Nodes Positive: Indicate the number of SLNs positive as this is cumulative from all procedures that remove lymph nodes through the completion of surgeries in the first course of treatment. |
2019 |
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20190073 | Solid Tumor Rules (2018)/Multiple primaries--Lung: How many primaries should be reported for a patient with a March 2018 diagnosis of non-small cell carcinoma with neuroendocrine differentiation on lung biopsy (single left upper lobe tumor only) who also has a prior history of left lung squamous cell carcinoma in 2016 (treated with chemotherapy/radiation)? See Discussion. |
The Solid Tumor Rules instruct us not to use differentiation for coding histology unless it is specifically listed in the table. The terminology non-small cell carcinoma with neuroendocrine differentiation is not in lung histology Table 2. However, SINQ 20150033, prior to Solid Tumor rules, indicates this diagnosis should be coded to 8574 (adenocarcinoma/carcinoma with neuroendocrine differentiation). This presentation appears to represent distinctly different histologies. However, because the 2018 histology diagnosis is not in the table and the prior SINQ appears to disagree with current instruction, it is not clear how to apply the M rules to this case. The outcome of the histology coding will affect the number of primaries reported in this case. |
Abstract separate primaries according to the 2018 Lung Solid Tumor Rules. Lung Table 3 is not an exhaustive list of lung histologies and the H rules instruct you to use the tables, ICD-O and/or ICD-O updates. Per ICD-O-3, carcinoma with neuroendocrine differentiation is coded to 8574/3; whereas, squamous cell carcinoma is coded to 8070/3. These represent distinct histologies on different rows in Table 3. |
2019 |
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20190040 | Reportability--Heme & Lymphoid Neoplasms: Is peripheral blood with a diagnosis of monoclonal B-cell lymphocytosis (MBL) with chronic lymphocytic leukemia (CLL) phenotype reportable for any year? See Discussion. |
SINQ 20180050 and 20130041 appear to have conflicting answers regarding the reportability of MBL with CLL (immuno)phenotype. While the question content of SINQ 20180050 does not reference the CLL phenotype, it is included in the Discussion as part of the oncologist's assessment. The answer does not address the clinical diagnosis of MBL with CLL-phenotype and simply states that monoclonal B-cell lymphocytosis is not reportable. SINQ 20130041 does include the CLL phenotype information in the primary question and it is expanded on in the discussion as present in peripheral blood. Based on that information, the answer is that it should be reportable and coded as CLL (9823/3). |
The description in the question is for 9823/1 per WHO blue book 2016. This description and code are not reportable. We will review the other SINQ questions and revise if necessary. |
2019 |
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20190094 | Reportability/Heme & Lymphoid Neoplasms--Skin: Is elephantiasis nostras verrucosa (ENV) reportable as a lymphoma? See Discussion. |
The autopsy report indicated a diagnosis of: Skin: Hyperkeratosis and pseudoepitheliomatous hyperplasia as well as reactive angioendotheliomatosis indicating Elephantiasis Nostras Verrucosa. |
Elephantiasis nostras verrucosa (ENV) is not reportable. ENV is a rare form of chronic lymphedema caused by any number of conditions including neoplasms, trauma, radiation treatment, congestive heart failure, obesity, hypothyroidism, chronic venous stasis, and parasitic infection. |
2019 |
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20190054 | Update to current manual/Solid Tumor Rules (2018)/Histology--Brain and CNS: Table 6 (Non-Malignant CNS Equivalent Terms and Definitions) lists as a subtype/variant of craniopharyngioma 9350/1. This is not a valid histology per the ICD-O-3 or the 2018 ICD-O-3 Update Table. Is this actually supposed to read, ? |
Adamantinomatous craniopharyngioma (9351/1) is a subtype of craniopharygioma. We will correct the Non-Malignant CNS Solid Tumor Rules in the next update. |
2019 | |
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20190062 | Solid Tumor Rules (2018)/Histology--Brain: How is histology coded for a left frontal lobe mass when the final diagnosis is malignant neuroglial tumor and the diagnosis comment describes multiple possible histologies? See Discussion. |
Left frontal mass biopsy diagnosis comment states: Given the synaptophysin and patchy CD34 staining of these cells, the possibility of ganglioglioma and pleomorphic xanthoastrocytoma is raised. Astroblastoma and ependymoma were considered given the perivascular pseudorosettes, however GFAP staining is quite limited against these tumors. Reticulin stain shows limited perivascular reticulin staining however. Nevertheless, the necrosis, mitotic activity and elevated mitotic activity would point to a malignant neoplasm. Given the neural and limited GFAP staining, a generic classification of neuroglial is provided. This is the only available information. Further clarification or discussion with the physician or pathologist is not possible. Therefore, is this diagnosis of neuroglial tumor equivalent to that described in SINQ 20091037? |
Code to 8000/3. Use text fields to record the details. The WHO Revised 4th Ed CNS Tumors includes a chapter for "Neuronal and mixed neuronal-glial tumors. This chapter lists 13 histologies in this category. Glioneuronal NOS is not listed. Do not assign 9505 because ambiguous terminology was used AND because of the numerous possible histologies discussed for this diagnosis. |
2019 |
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20190020 | Solid Tumor Rules (2018)/Histology--Head & Neck: What table in the Head and Neck Solid Tumor Rules applies to tumors of the lip (C000-C009)? The rules apply to all tumors in sites C000-C148, C300-C339, C410, C411, C442 and C479, but none of the histology tables include the lip. See Discussion. |
Example: Patient has a secretory carcinoma of minor salivary gland tissue (mammary analogue secretory carcinoma [MASC]) of the mucosal lower lip; it is unclear which table to use and how to arrive at the correct histology using the H Rules. Rule H1 (code the histology when only one histology is present) states, Note 1: Use Tables 1-9 to code histology. There is no table that includes the lip. The correct histology should be 8502 which is listed in Table 6 (Tumors of Salivary Glands) however this does not correspond to minor salivary glands of the mucosal lip (site C003 per ICD-O-3 coding instruction). The 2018 ICD-O-3 Update table does not include this histology, however Table 6 indicates code 8502 (secretory carcinoma) is a new code that was approved by IARC/WHO. The ICD-O-3 only includes this histology as secretory carcinoma of breast. Therefore, in order to arrive at the correct histology, one must be aware of previous SINQ entries 20160036 and 20130003 that indicate secretory carcinoma (or MASC) is histology 8502. However, these are related to MP/H Rules, so registrars may be hesitant to apply this guideline to cases coded using Solid Tumor Rules. |
Assign 8502/3 using Table 6 of 2018 Solid Tumor Rules for Head and Neck. Table 4 notes that there is no ICD-O site code for minor salivary glands. Many minor salivary glands are located in the lips, inner cheek (buccal mucosa), and there are extensive minor salivary glands in the linings of the mouth and throat. Code to the site in which the salivary gland is located. Mammary analog secretory carcinoma (MASC), also called secretory carcinoma, is a rare, generally low-grade salivary gland carcinoma characterized by morphological resemblance to mammary secretory carcinoma and ETV6-NTRK3 gene fusion. Common sites are of the parotid gland, oral cavity, submandibular gland, and the axilla with rare sites being the face including the lips, trunk, and limbs according to WHO Classification of Head and Neck Tumors, 4th edition and WHO Classification of Skin Tumors, 4th edition. This histology is usually associated with primary site of breast and you may get an edit that you can override. |
2019 |
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20190019 | Solid Tumor Rules 2018/Histology--Brain and CNS: How is histology coded for a single meningioma tumor when the histology is a meningioma comprised of multiple specific subtypes/variants? See Discussion. |
Example: Patient has a left cerebral meningioma that is meningothelial meningioma (9531) and two right-sided cerebral meningiomas: one that is transitional meningioma (9537) and the other that is meningioma, transitional and angiomatous, WHO Grade I. If the histology for the mixed tumor is 9534 (angiomatous meningioma), then there are three primaries. If the histology is 9537 (transitional meningioma), then there are two primaries. Per Table 6, angiomatous meningioma is 9534/0 and transitional meningioma is 9537/0. There is no mixed histology coding rule, or mixed histology meningioma code. There is also no default rule that would instruct registrars to code the numerically higher ICD-O code or to default to a meningioma (NOS) histology code. |
Code the histology for the meningioma, transitional and angiomatous, WHO Grade I to Meningioma, NOS (9530/0). Since a mixed meningioma ICD-O code has not been proposed by WHO, we consulted with our expert neuropathologist. The other option is to follow back with the pathologist and code what they feel is the predominant type. A new histology rule for coding mixed meningiomas will be added in a future update of CNS rules. |
2019 |