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20180071 | Solid Tumor Rules (2018)/Histology--Cervix uteri: What is the correct histology code for malignant mixed Mullerian tumor (MMMT/Carcinosarcoma)? See Discussion. |
An endometrial cancer was diagnosed in 2018. The endometrial biopsy showed malignant mixed mullerian tumor (MMMT/Carcinosarcoma). The total abdominal hysterectomy/bilateral salpingo-oophorectomy showed Endometrial Carcinosarcoma (50% serous carcinoma, 50% high grade sarcoma with rhabdomyoblastic differentiation) with invasion of 100% of the myometrium and involvement of the uterine serosa. I am not finding this in the Solid Tumor Rules or the site-specific ICD-O-3 code lists. |
According to the WHO Classificationof Tumors of Female Reproductive Organs, 4th edition, MMMT (8950/3) is now a synonym for carcinosarcoma (8980/3) even though it has a separate ICD-O code. The ICD-O code for MMMT is no longer in the WHO book. Per the subject matter experts, when both terms are used in the diagnosis (carcinosarcoma/MMMT), code the histology to 8980/3. If the ONLY term used is MMMT, assign 8950/3. The information in the 4th edition of the WHO Classification of Tumors of Female Reproductive Organs has not yet been incorporated into the Other Sites Solid Tumor Rules. |
2018 |
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20180066 | Solid Tumor Rules (2018)/Laterality--Brain and CNS: How is laterality coded for bilateral non-malignant central nervous system (CNS) or malignant CNS tumors now that laterality is no longer used to identify these tumors as multiple primaries? See Discussion. |
The Equivalent Terms and Definitions sections in the Solid Tumor Rules for these schemas identify which sites must have laterality coded, but there is no instruction for coding laterality when bilateral tumors are a single primary. The SEER Manual currently only indicates code 4 (bilateral) is seldom used (e.g., bilateral ovarian tumors, Wilms tumors, etc.) but does not indicate laterality code 4 should be used for CNS tumors. Is this note going to be updated or should a non-bilateral code be applied? Example: MRI demonstrates multiple left-sided dural-based meningiomas including a 4.4 cm left posterior fossa meningioma, a 0.8 cm left frontal-parietal meningioma and a right posterior frontal meningioma. The large left posterior fossa meningioma was resected and proved atypical meningioma. Should the laterality be 4 (bilateral) as the patient had both left and right-sided meningiomas confirmed to be a single primary? Or should the laterality be coded as 2 (left) since only the large left-sided meningioma was proven to be a borderline tumor (atypical meningioma, 9539/1) and the others were benign? |
Determine whether the CNS tumors are single or multiple primaries. Multiple cerebral meningiomas are a single primary according to the non-malignant CNS Solid Tumor Rules. Assign laterality using the 2018 SEER Manual for select invasive, benign, and borderline primary intracranial and CNS tumors using codes 1-9 for all sites listed in the Sites for Which Laterality Codes Must Be Recorded table. In the example, assign code 4, bilateral involvement at time of diagnosis, lateral origin unknown for a single primary. The solid tumor rules are not a one-stop-shop for all coding. Refer to the appropriate coding manual for laterality. We removed laterality for determining multiple primaries in meningiomas as they were being over-reported according to CBTRUS. |
2018 |
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20180094 | Reportability--Prostate: According to the 2018 SEER Program Manual, a prostatic intraepithelial neoplasia (PIN) III is not reportable, but is an atypical small acinar proliferation (ASAP) PIN 4 reportable? |
ASAP is not reportable. Patients with ASAP found on needle biopsy will likely undergo another biopsy. |
2018 | |
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20180040 | Reportability--Kidney: Is congenital cellular mesoblastic nephroma reportable for a newborn baby? See discussion. |
2015 Rt kidney nephrectomy pathology states: congenital cellular mesoblastic nephroma, tumor sz 5.9cm, tumor limited to kidney, extension into pelvicalyceal system, margin not applicable, LVI negative. Per PubMed.gov: (In newborns) among the low-grade malignant tumors, congenital mesoblastic nephromas can be successfully treated with simple nephrectomy. Per ScienceDirect: ...currently thought that cellular mesoblastic nephroma is actually a renal variant of infantile fibrosarcoma. |
Do not report congenital mesoblastic nephroma (8960/1). Congenital mesoblastic mephromas are low-grade fibroblastic neoplasms of the infantile renal sinus according to WHO Classification of Tumors of the Urinary System and Male Genital Organs. The WHO classification is the standard used to determine behavior and histology for entities not listed in ICD-O-3. |
2018 |
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20180088 | Solid Tumor Rules (2018)/Multiple primaries--Prostate: How many primaries are abstracted and what M Rule applies when a patient is diagnosed with prostate adenocarcinoma in 2014, followed by liver mass biopsy showing neuroendocrine carcinoma, small cell type of the prostate in 2018? See Discussion. |
The patient has a history of prostate adenocarcinoma with lymph node metastases, status post prostatectomy and treatment by Lupron in 2014. The most recent prostate serum antigen measurement (April 2018) was normal. CT scan of the abdomen and pelvis revealed new hypodense liver lesions, a slightly enlarging lung right lower lobe nodule, and enlarging lobular mass in the prostatectomy bed. The core liver biopsy contains areas of metastatic tumor with a differential diagnosis on pathology of high-grade neuroendocrine carcinoma of the prostate (small cell type), which may have been seen in association with prostate adenocarcinoma, or metastatic small cell carcinoma of a different site. Clinically, the physician impression is that this represents metastatic castration-resistant prostate cancer. The Solid Tumor Rules note that the Multiple Primary Rules are not used for tumor(s) described as metastases. However, SINQ 20130221 indicates that, at least historically, these would have been accessioned as multiple primaries (histology 8140 & 8041 per Rule M10). Does the previous SINQ note still apply to these types of cases, and if so how would one know to move beyond the initial note indicating metastases are not new primaries? |
The guidance provided in SINQ 20130221 still applies. Accession two primaries, adenocarcinoma [8140/3] of the prostate [C619], followed by small cell (neuroendocrine) carcinoma [8041/3] of the prostate [C619] for each of the examples given per Rule M10 of the 2018 Solid Tumor Rules, Prostate. In each case, the second histology (because it is not adenocarcinoma) is a new prostate primary. Small cell carcinoma and small cell neuroendocrine carcinoma are not adenocarcinomas. As a result, they are not covered by Rule M3. For the case described in this SINQ submission, based on the findings of a lobular mass in the prostate bed, this is a second primary (there is residual prostatic tissue). This is unchanged from the 2007 Multiple Primaries Rules for Other Sites. |
2018 |
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20180062 | Histology--Heme & Lymphoid Neoplasms: How is histology coded when a lymph node excisional biopsy shows Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL), predominantly in diffuse T-cell histiocyte rich large B-cell lymphoma-like (THRLBCL) pattern. Comment states: The findings are that of nodular lymphocyte predominant Hodgkin lymphoma with diffuse T-cell rich pattern (T-cell/histiocyte-rich large B-cell lymphoma-like). This variant is regarded as clinically more advanced. See Discussion. |
It appears an argument could be made for both NLPHL (9659/3) and THRLBCL (9688/3). We favor coding NLPHL (9659/3) because the pathologist did specifically call this a Hodgkin lymphoma, and also specified that it only has a T-cell/histiocyte-rich large B-cell lymphoma-like pattern. |
Assign histology code 9659/3. According to the Hematopoietic database, this histology frequently has T-cells. The other description was not an actual histology, but noting that the appearance of the cells was similar to that histology. |
2018 |
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20180098 | Solid Tumor Rules (2018)/Histology: Please provide further explanation for prioritizing biomarkers in the histology coding rules. See Discussion. |
The 2018 Solid Tumor (ST) Rules General Rules state: For those sites/histologies which have recognized biomarkers, the biomarkers frequently identify the histologic type. Currently there are clinical trials being conducted to determine whether these biomarkers can be used to identify multiple primaries. Follow the Multiple Primary Rules; do not code multiple primaries based on biomarkers. Additionally, Biomarkers is at the top of the priority order to identify histology in several sections (it appears to be excluded from only Colon, Melanoma and Other sections). In the sections that include this rule, there is not much additional information on using biomarkers. Can you please provide further explanation for prioritizing biomarkers in the histology coding rules? For example, will the ST manual be updated when we need to look for specific biomarkers in a diagnosis? |
Instructions for biomarkers will be added to other site rules when applicable. The use of biomarkers to determine a specific histologic type is not yet a standard of care in the majority of cases. |
2018 |
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20180102 | Solid Tumor Rules 2018/Histology--Brain and CNS: What code should be used for high grade neuroepithelial tumor with BCOR Alteration? See Discussion |
A recent molecular study of PNET tumors at NCI (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139621) seems to indicate the discovery of four new CNS tumor entities, of which HGNET-BCOR is one. The article suggests that these are not primitive neuroectodermal tumors tumors (PNET), but something different. |
This question was reviewed by an expert neuropathologist. He recommends coding these tumors to malignant tumor, clear cell type 8005/3. He states: these tumors are extremely rare. In summary, CNS HGNET-BCOR represents a rare tumor occurring in young patients with dismal prognosis. Whether CNS HGNET-BCOR should be classified among the category of "embryonal tumors" or within the category of "mesenchymal, nonmeningothelial tumors" remains to be clarified. Because CNS HGNET-BCOR share pathologic features and characteristic BCOR-ITD with clear cell sarcoma of the kidney, these tumors may represent local variants of the same entity. |
2018 |
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20180103 | Histology/Grade--Small intestine: For a 2017 diagnosis, is the grade/differentiation field coded 1 or 9 when the diagnosis is well-differentiated neuroendocrine tumor (NET) (carcinoid)? It seems as though the term well-differentiated defines type of neuroendocrine tumor so they can diagnosis the carcinoid. See Discussion. |
5/15/17 Duodenal bulb, biopsy: Fragments of duodenal mucosa with well differentiated neuroendocrine tumor (carcinoid), extending to the edge of specimen and peptic duodenitis in the submitted tissue. No significant intraepithelial lymphocytosis. |
Assign grade code 1 for well-differentiated NET (8240/3). Well-differentiated is synonymous with NET, grade 1, according to WHO Classification of Tumors of the Digestive System. |
2018 |
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20180109 | Date of diagnosis/Ambiguous terminology--Cervix Uteri: Is the date of diagnosis of a cervical pap smear done in December 2017, that states high-grade squamous intraepithelial lesion with features suspicious for invasion, followed by a cervical biopsy in 2018 positive for squamous cell carcinoma, in 2017? Is the ambiguous term used in the cytology in 2017 (suspicious for invasion) to determine diagnosis as the SEER manual states to use the ambiguous cytology as the date of diagnosis if confirmed later. |
Updated for cases diagnosed 2022 or later For cases diagnosed in 2022 or later, see the instructions in the SEER manual under Reportability and Date of Diagnosis for ambiguous cytology. |
2018 |
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