Report | Question ID | Question | Discussion | Answer | Year |
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20180026 | Solid Tumor Rules (2018)--Breast: How many primaries are accessioned when a prophylactic mastectomy reveals a final diagnosis of invasive tubular carcinoma, but the College of American Pathologists (CAP) Protocol includes ductal carcinoma in situ (DCIS) sized separately and it is not clear if these are different tumors? See Discussion. |
The patient was incidentally diagnosed with cancer on a prophylactic mastectomy, so there are no positive imaging findings to correlate the number of tumors/masses. The final diagnosis was invasive tubular carcinoma, and referred to the CAP Protocol. The CAP notes: However, it does not specify whether the single contiguous focus also includes the in situ component. The CAP goes on to note DCIS was present: The gross description does not provide any indication of either a single or multiple tumors/masses/lesions, though it was referred to as "Lesion 1" in the gross description with no indication of other lesions. The format of the CAP Protocol frequently does not specify whether the DCIS is a separate measured tumor, or if it is a component of the invasive tumor. This makes it difficult to determine whether the DCIS should be a separate primary when the invasive tumor is not also a type of ductal carcinoma. Per both the 2007 MP/H and 2018 Solid Tumor Rules, an invasive tubular carcinoma and a ductal carcinoma in situ would be multiple primaries if they were multiple tumors. Should we default to Rule M1: Abstract a single primary when it is not possible to determine if there is a single or multiple tumors? Or should we assume these are separate tumors because they were both sized, the focality only described a single invasive tumor, and the tumors are not both ductal carcinomas? |
Accession a single primary using Solid Tumor Rule M3. Based on the information provided, this was described as "Lesion 1' with no other lesions noted in the gross description. If the DCIS was a separate tumor, this would have been noted by the pathologist. Reminder, the breast CAP protocol is a checklist for pathologists to note their findings while reviewing the slides and/or specimen. The findings and notes should be consolidated into a final/synoptic report. |
2018 |
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20180074 | Solid Tumor Rules (2018)/Multiple primaries--Brain and CNS: Rule M6 notes a diagnosis of glioblastoma multiforme is a new primary when it follows a diagnosis of a glial or astrocytic tumor. Does this rule apply if the subsequent diagnosis was just, glioblastoma, NOS or one of the subtypes/variants of glioblastoma multiforme? See Discussion. |
Glioblastoma multiforme is listed as a synonym for the preferred term glioblastoma, NOS (9440) per Table 3 Column 2. Therefore, it seems reasonable to assume that a diagnosis of glioblastoma, NOS would be a new primary if it followed a glial or astrocytic tumor. However, in general, the Solid Tumor Rules use the preferred terminology and/or indicate when a specific rule also includes any tumor diagnosed as a subtype/variant. Rule M6 does not explicitly include a diagnosis of glioblastoma, NOS or any of its subtypes/variants (e.g., glioblastoma IDH-mutant or gliosarcoma). Does Rule M6 apply to any diagnosis of glioblastoma, NOS and any of its synonyms or subtypes/variants? |
Apply Malignant Central Nervous System Solid Tumor Rule M6 that refers to glioblastoma multiforme and abstract multiple primaries. If glioblastoma, NOS, an associated synonym with the same histology (9440/3), follows a glial or astrocytic tumor, Rule M6 applies. With the identification of new variants of glioblastoma based on genetic profiles, we will likely see fewer diagnosis of GBM. M6 applies to cases where the subsequent/new tumor is specifically stated to be GBM, NOS. |
2018 |
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20180004 | Reportability/MP/H Rules/Multiple primaries: Is a ganglioneuroblastoma (9490/3) following a melanoma (8720/3) a new primary if the diagnosing pathologist states: "Given the clinical context and patient age, then I believe that this may represent transdifferentiation of metastatic melanoma'? If this is a new primary, what MP/H rule would apply? See Discussion. |
March 2017 lung biopsy showing metastatic melanoma. Subsequent workup shows imaging with additional metastatic involvement of multiple bone sites but no primary tumor is identified. Chemotherapy is started in May 2017. July 2017 biopsy of right lower quadrant mass has a final diagnosis of ganglioneuroblastoma and pathologist's comment states I believe that this may represent transdifferentiation of metastatic melanoma. Later, partial colectomy of transverse colon Gross Description indicates this was centered in the mesentery. |
Abstract two primaries: 1. unknown primary site and 2. peripheral nerves and autonomic nervous system of abdomen, based on Multiple Primaries/Histology for Other Sites Rule M11 (topography codes that differ at the second or third character). While it is possible in rare cases that one tumor transforms into the other, transformations do not factor into the current MP/H rules. |
2018 |
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20180019 | Marital Status: Is Marital Status always a self-reported status? See Discussion. |
The SEER Manual states that Marriage is self-reported for the instruction in code 2, but it does not indicate if all other marital statuses are self-reported. Examples: How is Marital Status reported for the following situations? 1. Patient with multiple tumors in the database, for the first tumor marital status is reported as married (code 2), for the subsequent tumor, marital status is reported as single (code 1). 2. Patient self- reports as single, but also has children. 3. Patient states they are in common law marriage, but our state is not a common law marriage state. |
Marital Status is self-reported because the information is recorded in the medical record based on information obtained from the patient. Use text fields to document relevant information. Examples 1. Assign code 2 for the first tumor and assign code 1 for the subsequent tumor unless the available information indicates the patient is divorced at the time of the subsequent tumor diagnosis. Patient may self-report single after a divorce. Assign code 4 in that situation. The code assigned for marital status reflects the patient's marital status at the time of diagnosis for the tumor being abstracted. It is possible that marital status may be different for each tumor if the patient has multiple tumors. 2. If marital status is stated to be single, assign code 1. 3. If marital status is stated to be common law marriage, assign code 2. Common Law Marriage is defined as a couple living together for a period of time and declaring themselves as married to friends, family, and the community, having never gone through a formal ceremony or obtained a marriage license. |
2018 |
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20180043 | Solid Tumor Rules (2018)/Histology--Breast: Can the College of American Pathologists (CAP) protocol be used to determine whether in situ tumor is present for the purpose of determining which H Rule applies in the example presented? See Discussion. |
The Histology Coding Instructions give priority to the Final Diagnosis over the CAP protocol. However, when pathology reports are formatted using the CAP protocol, the presence of in situ carcinoma is generally only mentioned in the CAP protocol. Can the presence of in situ tumor mentioned only in the CAP protocol be used to apply rule H7 (Single Tumor: Invasive and In Situ Components Module)? Or are the rules in the Single Tumor: Invasive Only module used? Example: Final diagnosis is invasive ductal carcinoma. CAP protocol mentions, |
Apply Rule H12 of the 2018 Solid Tumor Rules for Breast Cancer, released April 2019. Remember the protocol is a checklist only and should not be used to code histology unless it is the only document available. |
2018 |
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20180050 | Reportability/Heme & Lymphoid Neoplasms: Is monoclonal B-cell lymphocytosis reportable? See Discussion. |
We noticed this term was added to the most recent version of the Heme Database (DB) as an alternate name for chronic lymphocytic leukemia/small lymphocytic lymphoma; however we do not recall being notified that this was a new reportable term for code 9823 and the term was not included in the 2018 ICD-O-3 Histology updates. The Definition in the Heme DB for Chronic lymphocytic leukemia/small lymphocytic leukemia (CLL/SLL) includes information that the term was added in the 2016 WHO revision, thus would be reportable back to 2016, is that correct? In addition, the Definition seems to be describing it as a precursor condition to CLL and may never actually evolve into CLL, so it is unclear if this term should really be reportable. Example: 09/08/2016 Onc Note: A/P: monoclonal B-cell lymphocytosis of undetermined significance (MBL): I reviewed with him the results of the bone marrow biopsy. Interestingly, there is no evidence of abnormal plasma cell population by flow cytometry and immunohistochemistry. Nevertheless, flow cytometry does demonstrate a very small population of abnormal and monoclonal B-cell lymphocyte population with immunophenotype consistent with CLL/SLL. Given the very low number of the abnormal B cells, this can be categorized as monoclonal B-cell lymphocytosis (MBL). I recommend surveillance visit in one year. 9/12/2017 Onc note: A/P: Monoclonal B-cell lymphocytosis of undetermined significance (MBL) and IgM MGUS. No symptoms concerning for active disease or progression. Explained that MBL is a very indolent process. Patients with CLL-phenotype MBL progress to CLL at a rate of ~1-2 percent per year. Follow-up in 1 year. Is this case reportable? |
Monoclonal B-cell lymphocytosis is not a reportable condition. This term will be removed from 9823/3 since it is a /1 (has it's own code). This will become much more clear once we get the new WHO Heme terms into the database. |
2018 |
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20180012 | First course of treatment: What is the correct code to use for allogenic stem cell transplant? |
Code an allogenic stem cell transplant as 20 (Stem cell harvest (stem cell transplant) and infusion) in Hematologic Transplant and Endocrine Procedures in the 2016 SEER Manual. |
2018 | |
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20180065 | Immunotherapy: Is immunotherapy ever palliative treatment according to any oncologists or SEER? |
Any treatment that destroys or modifies cancer tissue should be recorded as the appropriate type of treatment -- chemo, immuno, etc. Even if immunotherapy is given for symptoms/palliative treatment, it is likely to kill off tumor cells. |
2018 | |
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20180061 | Primary Site: How should primary site be coded when there is an invasive tumor in one subsite and an in situ tumor in another subsite of the breast? See Discussion. |
The previous SEER Program Coding and Staging Manual included Appendix C that has Coding Guidelines for some sites. The breast guidelines specifically instructed one to code the subsite with the invasive tumor when the pathology report identifies invasive tumor in one subsite and in situ tumor in a different subsite or subsites. The current Breast Solid Tumor Rules Table 1: Primary Site Codes refers one back to the SEER Manual and COC Manual for a source document priority list but does not make mention of invasive vs. in situ on that final version of the source document. In addition, the Colon Solid Tumor Rules currently contains no Site Coding Section/Table. However, the Lung Solid Tumor Rules do and also refer one to the SEER/COC Manuals for document priority lists. The Urinary Solid Tumor Rules has both the Primary Site Codes Table and an additional section called Priority for Coding Primary Site, which does not reference a document priority list or other manuals. Unfortunately, there is additional information in Appendix C Bladder Coding Guidelines that may have been used in the past regarding site source priority. Could the remaining applicable Appendix C information be consolidated into the Solid Tumor Rules consistently among all the sites to lessen the need for additional manual referencing? Also, is there a reason one site includes the Priority Site Coding instructions and others do not? |
Code the subsite with the invasive tumor as the primary site when the pathology report identifies invasive tumor in one subsite and in situ tumor in a different subsite or subsites as stated in Appendix C, Breast Coding Guidelines, 2018 SEER Program Coding and Staging Manual. This statement is unchanged from the previous version; however, the priority list was modified for coding a subsite when there is conflicting information. The focus of the Solid Tumor Rules is to differentiate between single vs. multiple primaries and to assist with identifying the appropriate histology code. The site tables in the solid tumor rules are a reference only. The site-specific Coding Guidelines assist with additional considerations when abstracting cases. |
2018 |
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20180007 | Multiple primaries/Primary site--Heme & Lymphoid Neoplasms: Are plasmacytomas in thyroid and laryngeal masses one primary based on rule M2, abstract a single primary when there is a single histology? If so, what is the primary site? See Discussion. |
Patient presented with hoarseness and palpable neck mass. No palpable adenopathy (per hospital abstract). 02/19/16 Thyroid Ultrasound: Right thyroid lobe with mass, 63X35X44XMM (per hospital abstract). 06/01/16 Right thyroid lobectomy, radical resection right laryngeal tumor (per hospital abstract). 06/01/16 Operative Procedure: Tumor was invading laryngeal soft tissue and cartilage anteriorly and to the right. There may be a small amount of residual tumor invading cartilage although this was not clear (per hospital abstract). GROSS DESCRIPTION: 1. The specimen is received fresh for intraoperative consultation, labeled with the patient's name and "right thyroid mass." It consists of a 3.0 x 2.2 x 2.0 cm irregular, ragged fragment of tan-red, firm, rubbery soft tissue. The specimen is serially sectioned to reveal a tan-red, gritty cut surface with focal fleshy areas. A touch prep is performed. A representative section is submitted for frozen section analysis in 1FSA. A portion of tissue is submitted for flow cytometry with the accession number MSO-16-1786. The remaining specimen is entirely submitted in 4 additional cassettes (1B-1E). 2. The specimen is received in formalin and is labeled "right thyroid lobe." It consists of a thyroid lobe measuring 4.3 x 4.0 x 1.3 cm and weighing 10.0 g. The external surface is covered by a thin fibrous capsule with a focal area of roughening on the posterior surface. The lobe is inked black posterior, blue anterior and orange isthmus margin. Serial sectioning reveals a red-brown and beefy parenchyma. A definitive nodule is not grossly identified. The entire specimen is serially submitted from superior to inferior in 9 cassettes. 3. The specimen is received in formalin, labeled with the patient's name and "right neck/laryngeal mass." It consists of an irregular, focally nodular red-tan mass measuring 7.0 x 5.5 x 4.0 cm and weighing 54 g. The convex portion of the specimen is mostly encapsulated with focal adherent red-brown striated skeletal muscle. The concave portion of the specimen is focally ragged and disrupted. The convex portion of the specimen is inked black and the concave portion is inked blue. The specimen is serially sectioned to reveal a white-grey to red, granular, gritty cut surface with focal fleshy areas. Representative sections are submitted in 12 cassettes. Final DX DIAGNOSIS: 1. Right thyroid mass excision Plasma cell tumor /plasmacytoma 3 cm. Tumor cells are positive for kappa and negative for lambda immunostains. Recommend correlation with flow cytometry MSO-16-1786, monoclonal plasma cell population with cytoplasmic kappa positivity. Ki-67 stains 7 percent of cells. Focal stromal hyalinization. Congo red stain for amyloid negative. No thyroidal tissue identified. 2. Right thyroid lobe excision Benign thyroid tissue with focal solid cell nest negative for malignancy. One out of two 1/2 perithyroidal lymph nodes positive for plasma cell tumor. 3. Laryngeal mass excision Plasma cell tumor /plasmacytoma 7 cm involving soft tissue and skeletal muscle. Tumor cells are positive for kappa and negative for lambda immunostains. Ki-67 stains 7 percent of cells. Focal stromal hyalinization and calcification. Congo red stain for amyloid negative |
Abstract this case as a single primary. Hematopoietic Multiple Primary Rule M2 applies. Code to unknown primary, C809, based on rule PH27. There is no indication in the information provided of the site of origin; therefore, PH2 cannot be used. We recommend a thorough review of the case to determine if the site of origin is identified in the medical record. |
2018 |