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Report Produced: 11/20/2024 01:37 AM

Report Question ID Question Discussion Answer Year
20170012

Primary Site/Sarcoma--Breast: How should the primary site and stage be coded for osteosarcoma of breast? Is C509 correct or should the code be a different primary site? When assigning C509, the Collaborative Stage (CS) still pertains to breast cancer and AJCC stages it as a breast cancer and not as a sarcoma.

Code primary osteosarcoma of the breast to breast, C500-C509. Not all site and histology combinations can be staged in CS or AJCC. 9180/3 of breast cannot be staged using the CS breast schema. Breast (C500-C509) cannot be staged using the CS soft tissue schema. The same is true for AJCC. You can stage this case using SEER Summary Stage.

Important: Do NOT change the primary site or histology code based on whether or not the case can be CS or AJCC staged. We need to know how many cases are unable to be staged because of their primary site and histology combinations.

 2017
20170006

Diagnostic confirmation--Heme & Lymphoid Neoplasms (Lymphoma): To code "3" in Diagnostic Confirmation, does the genetic testing need to confirm a specific histology or is it enough that is simply rules out others? See Discussion.

For example, pathology states: Right axillary lymph node, excision: Diffuse large B-cell lymphoma (DLBCL) (see note). COMMENT: FISH studies were performed that were negative for BCL-6, c-Myc/IgH, CCND1/IgH and IgH/BCl-2 gene rearrangement, ruling out the most common forms of double-hit lymphoma. Flow cytometry studies demonstrated positivity for CD45, CD20, HLA-Dr, CD19, CD11c, CD22, CD30, CD38, CD79b, and FMC7. Low positivity was seen for CD5. No reactivity was seen for CD10, CD23, CD25, CD103 or CD123.

Both histologic plus immunophenotyping or genetic testing should be positive to assign code 3 for Diagnostic Confirmation. The Hematopoietic and Lymphoid Neoplasm Coding Manual Diagnostic Confirmation instructions state, assign 3 for

Cases positive for neoplasm being abstracted (including acceptable ambiguous terminology and

provisional diagnosis) AND Immunophenotyping, genetic testing, or JAK2 is listed in the Definitive Diagnosis in the Heme DB AND a.) Confirms the neoplasm OR b.) Identifies a more specific histology (not preceded by ambiguous terminology).

Because the patient was diagnosed with DLBCL by histology, and flow cytometry was positive for CD antigens (immunophenotyping) 20, 22, and 30 for DLBCL, code 3 is appropriate.

 2017
20170008

MP/H Rules/Histology--Colon: Is the code for invasive adenocarcinoma in a serrated adenoma 8213/3? The NAACCR Guidelines for ICD-O-3 Update Implementation, effective 1/1/14, provides new terms including 8213/0 for sessile serrated adenoma/sessile serrated polyp and 8213/3 for serrated adenocarcinoma. This would cause Site/Type and Histology overrides to be set. Coding 8210/3 would allow the case to be reported without overrides. See Discussion.

Pathology report 1/13/15, Histology - Transverse colon resection pathology = Invasive moderately differentiated adenocarcinoma. The invasive adenocarcinoma arises in a sessile serrated adenoma.

Assign 8213/3 to invasive adenocarcinoma arising in a sessile serrated adenoma. The instruction in SINQ 20120089 is still valid. The 2014 ICD-O-3 Update does not change this SINQ answer.

 2017
20170045

Reportability--Brain and CNS: Is meningioangiomatosis reportable as meningiomatosis (9530/1) or angiomatous meningioma (9534/0)? See Discussion.

Pathology report: Brain tumor, left side: Gliotic cortex and subcortical white matter with meningioangiomatosis (see Comment). Comment This specimen represents a meningioangiomatous lesion located in the leptomeninges that projects along the Virchow-Robin spaces into the underlying cortex. The surrounding brain parenchyma demonstrates reactive changes with astrogliosis and microgliosis. An intraparenchymal neoplasm is not seen. Meningioangiomatosis is a rare benign meningovascular hamartomatous condition and usually appears in young patients.

Meningioangiomatosis is not reportable. It is a cortical lesion which may occur sporadically or in NF2 (neurofibromatosis type 2). It is not listed in ICD-O-3.

 2017
20170049

MP/H Rules/Histology--Pancreas: What is the histology code of invasive adenocarcinoma, non-mucinous with intraductal tubulopapillary features, moderately differentiated, from the pathology report final diagnosis of the pancreas? Does 'intraductal" refer to a non-invasive/in-situ component or describe the pattern of growth?

Assign 8503/3, intraductal papillary adenocarcinoma with invasion, to capture the more specific features of the adenocarcinoma. Histology Rule H13 for Other Sites states to code the most specific histologic term. Examples include Adenocarcinoma and a more specific adenocarcinoma. Note: The specific histology may be identified as type, subtype, predominantly, with features of, major, or with ___ differentiation.

 2017
20170018

MPH Rules/Multiple primaries--Melanoma: Does MP/H Rule M7 (diagnosed more than 60 days apart) apply to invasive melanoma cases with margins positive for in situ melanoma, or are these further excision of the original diagnosis and the same primary, even when it appears treatment was complete after the initial excision? See Discussion.

A dementia patient has been managed for a persistent right cheek skin lesion that has been slow growing for about 5 years. It was biopsied in 12/23/15 revealing a Breslow 0.12 mm lentigo maligna melanoma by an outside provider. A larger resection of the lesion on 2/3/16 demonstrated a Breslow 0.30 mm lentigo maligna melanoma with melanoma in situ present at the margins per the available pathology report. There was no statement in the record that any additional treatment was planned or necessary.

Patient healed well from the 2/3/16 procedure but developed a recurrent lesion in May that was biopsied on 5/10/16 by the same outside provider which again reveal lentigo maligna melanoma. 7/5/16 Reexcision at the current facility revealed a Breslow 6.1 mm lentigo maligna melanoma, Clarks level V. This was a cutaneous tumor per the path report and not a subcutaneous nodule. Clinically, the MD called this a , but there was no slide comparison to the previous melanoma.

In auditing files for expected (but not received) abstracts due from facilities, we've observed these types of cases not being consistently reported as multiple primaries.

Rule M7 pertains to separate tumors. Rule M7 does not apply to invasive melanoma cases with margins positive for in situ melanoma.

Based on the information provided, it is not clear whether or not the 5/10/16 diagnosis is a separate lesion or the same lesion that was diagnosed earlier.

 2017
20170025

MP/H Rules/Multiple primaries--Breast: Is this the same primary per MP/H Rule M10? Ductal carcinoma of the left breast in 2013, treated with a lumpectomy. New tumor with ductal and lobular carcinoma in the same breast in 2016.

The 2016 diagnosis is the same primary. MP/H Rule M10 for breast cancer applies. Do not change the original histology code. Use text fields to document the later histologic type -- duct and lobular.

 2017
20170031

MP/H Rules/Multiple primaries--Penis: How many primaries should be reported for a diagnosis of invasive squamous cell carcinoma (SCC) of the penis in 6/2011, treated with excision and fulguration followed by 10/2014 penile lesion found to be SCC with basaloid features focally highly suspicious for invasion? Clinically, the 2014 tumor is stated to be in situ and recurrent penile cancer and follow-up in 2/2015 indicates there was no evidence of tumor following treatment. Subsequently, in 3/2016 the patient has another penile lesion biopsy showing SCC in situ suspicious for invasion, clinically stated to be recurrent. See Discussion.

At the central registry, we have accessioned this scenario as three primaries per Multiple Primaries/Histology (MP/H) Rule M10 (diagnosed more than 1 year apart), as the patient was stated to be disease free between each occurrence. However, the diagnosing/treating facility is not reporting these cases due to clinical statements of recurrent disease.

This is an example of a case type identified on casefinding audits conducted by our central registry in which we have learned SEER's expectation of MP/H rule application does not match hospital reporting. Can the 2018 version of the MP/H rules more clearly address how this type of clinically recurrent (multiple times) case should be handled?

Accession three tumors as the tumors were each diagnosed more than one year apart according to the MP/H Rule M10 for Other Sites. And, as you have noted, the patient was free of disease after each diagnosis.

The MP/H rules have very clear instructions regarding the word "recurrence." See page 10, specifically A.7., https://seer.cancer.gov/tools/mphrules/2007_mphrules_manual_08242012.pdf

SEER will evaluate the MP/H rules in the upcoming revision.

 2017
20170071

Reportability/Brain and CNS: Is incidentaloma reportable from brain and central nervous system (CNS) imaging? See Discussion.

We are seeing the term "incidentaloma" on magnetic resonance imaging (MR) reports of head and also with physician statements. For example, this MR of the head: Impression--Suboptimal study due to motion degradation. Heterogeneously enhancing pituitary gland without evidence of acute abnormality. A 3 mm focus of relative hypoenhancement in the left gland is favored to represent an incidentaloma. Advise correlation with clinical findings.

Also, there are cases where the scans show meningioma and then at a later date it is stated to be an incidentaloma in physician notes.

Is the term "incidentaloma" alone reportable, if the term "tumor" for CNS cases is never stated? When I googled the term, it is stated to mean "tumor."

The term "incidentaloma" alone is not reportable. Look for a reportable term elsewhere or in later information. When the term "incidentaloma" is used on a magnetic resonance imaging (MR) report, it refers to "a disease or physical condition found as a secondary by-product of capturing the necessary volume of tissue within the field of view of the MR examination" (http://radsource.us/incidentaloma). It is not necessarily neoplastic.

 2017
20170040

MP/H Rules/Histology--Lung: What is the histology code for lung cancer case identified pathologically from a metastatic site that differs from the histology stated by the physician? See Discussion.

Bronchial washings were negative. Four lymph nodes were biopsied and found to have metastatic poorly differentiated neuroendocrine carcinoma. The treating oncologist calls it small cell carcinoma, extensive stage, and treats patient with carboplatin and VP-16 (etoposide) The MP/H rule says to take path/cyto from a metastatic site if no pathology/cytology available from the primary site. Is the physician's statement and treatment taken into consideration here?

Code the histology based on the pathology report from the lymph node biopsy for this case. Pathology has higher priority than a physician's statement for assigning histology code. Use text fields to document the physician's statement.

 2017