Report | Question ID | Question | Discussion | Answer | Year |
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20150009 | Multiple Primaries/Behavior--Lung: When a patient has an invasive lung primary, how do in situ tumors of the lung affect the determination of multiple primaries? See discussion. |
How many primaries should be reported when a 12/19/14 RUL lung wedge resection shows: 2.0 cm invasive adenocarcinoma (8140/3) and an additional RUL wedge resection during the same procedure shows: multifocal adenocarcinoma in situ (bronchioloalveolar carcinoma), non-mucinous type (8252/2) size: 1 mm – 2 mm; followed by a 2/12/15 left upper lobectomy also showing Adenocarcinoma, invasive at several foci, with a prominent bronchioloalveolar (in situ) component….tumor focality: multifocal (10 cm mass, 6 cm mass and numerous smaller foci)? |
Most often when the invasive tumor and the in situ component are in the same lung and are the same histology, rule M12 (example 3) applies and this is a single primary. If the first wedge resection included part of the tumor and the in situ was not separate from the tumor, it is a single primary. We suspect that the margins were positive on the first wedge specimen which prompted the second wedge resection where the in situ was found. In addition, terminology for lung malignancies is undergoing change: what was called BAC (invasive) is now called adenocarcinoma in situ. |
2015 |
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20150045 | MP/H/Histology--Thyroid: What is the histology code for primary site of thyroid cancer with the histology of papillary thyroid carcinoma, classical and oncocytic type? |
Code the histology to 8342/3, thyroid oncocytic (oxyphillic) papillary carcinoma. |
2015 | |
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20150065 | First course treatment/Chemotherapy/Drug category: Instructions in SEER*Rx state that Ibrance should be coded as chemotherapy. They also state that it is an endocrine-based therapy. Local physicians refer to Ibrance as hormone therapy. Please clarify. |
For cancer registry data collection, follow the instructions in SEER*Rx. It is important for all data collection to be consistent for reporting of cancer information.
Per the FDA: Ibrance is a chemotheraputic agent which was approved for use WITH Letrozole. Letrozole is a hormonal drug which may be why the physicians are stating the patient is receiving hormones. Ibrance should not be given alone to treat breast cancer. This drug will not be changing categories in SEER*Rx. |
2015 | |
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20150067 | MP/H Rules/Histology--Kidney: What is the correct histology for this diagnosis? See discussion. |
Procedure: Nephrectomy
Laterality: Left
Tumor type: SOLID VARIANT RENAL CELL CARCINOMA
Nuclear grade: High grade (3/4)
Histologic grade: Poorly differentiated
Pattern of growth: Solid
Tumor size: 5x4.5x4cm
Local invasion: Present
Renal vein invasion: None
Surgical margins: Negative
Non-neoplastic kidney: Unremarkable
Adrenal gland: Not submitted
Lymph nodes: Not present
Pathologic stage: T1b
There are solid sheets of tumor cells without papillary structure. The tumor stains positive for Pax-2, negative for Ecadherin, P63 and CK7, consistent with renal cell carcinoma, solid variant. |
Assign histology code 8312, renal cell ca, NOS. There is no specific code for the solid variant of renal cell carcinoma. |
2015 |
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20150048 | Reportability--Skin: Is low grade trichoblastic carcinoma, with a small focus of high grade carcinoma of the scalp reportable? See discussion. |
Pathology report states: the individual nodules of trichoblastic cells resemble those seen in trichoblastoma, but the lesion is very poorly circumscribed with an infiltrative border that extends into the subcutis. the lesion may behave in a locally aggressive fashion, and should be completely removed. High grade trichoblastic carcinomas can metastasize. |
Trichoblastic carcinoma of the skin is not reportable. The WHO classification lists trichoblastic carcinoma as a synonym for basal cell carcinoma, 8090/3. Basal cell carcinoma of the skin is not reportable. See page 11 in the SEER manual, http://seer.cancer.gov/manuals/2015/SPCSM_2015_maindoc.pdf. |
2015 |
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20150026 | First course treatment--Breast: When Lupron is given as cancer-directed treatment for metastatic breast cancer, should it be coded as Hormone Therapy or Other Therapy? See Discussion. |
Per the SEER*Rx Database, Lupron is coded as Other Therapy for breast cancer until such time that it receives FDA approval. However, SINQ 20021042 states Lupron should be coded as Hormone Therapy when given as cancer-directed therapy. These two sources contradict each other.
Information regarding hormone therapy for breast cancer in both the SEER*Rx Database and the National Cancer Institute's Cancer Topics website (http://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet) seem to indicate that the SINQ answer is the correct choice. The NCI Cancer Topics website states that Lupron acts to block ovarian function and is an example of an ovarian suppression drug that has been approved by the FDA. The SEER*Rx Database Remarks section states that a combination of letrozole and leuprolide (Lupron) "is considered standard treatment for metastatic breast cancer and is sometimes used for treatment of early stage breast cancer." But the Remarks go on to state that Lupron should be coded as Other Therapy until it receives FDA approval.
It is unclear how to code Lupron for breast cancers when the NCI website indicates that it is standard treatment while the SEER*Rx Database states both that it is and that it is not standard treatment. |
Code Lupron given for breast cancer in the "Other" treatment field using code 6 (other-unproven). Lupron is still not an approved hormone treatment for breast cancer and should not be coded in the hormone field.
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2015 |
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20150015 | Primary Site--Testis: What is the prmary site for a 38 y/o male diagnosed with testicular cancer in a formerly undescended testis that was treated with orchiopexy at age 10-11? See discussion. |
Should it be coded to where the testis was physically at the time of diagnosis (C621), or should it be coded to C620 to reflect the increased risk for developing malignancy in an undescended testis? |
Code the primary site C621 (descended testis). The primary site of this neoplasm is a scrotal (descended) testis. The history of orchiopexy can be noted in a text field, but does not change the primary site in this case. |
2015 |
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20150064 | Primary site--Head & Neck: When there is invasive in one subsite and in situ in another, do you code the subsite with the invasive only? Would the correct site be C320, C328, or C329? See discussion. |
LARYNGOSCOPY - ENDOLARYNGEAL EXAM WAS GROSSLY UNREMARKABLE EXCEPT THAT SHE APPEARS TO HAVE A T1A SQUAMOUS CELL CARCINOMA OF THE RIGHT TRUE VOCAL FOLD. IT EXTENDS FROM ALMOST THE ANTERIOR COMMISSURE ALL THE WAY BACK TO THE VOCAL PROCESS AND IS EXOPHYTIC IN NATURE. IT DOES NOT EXTEND INTO THE VENTRICLE OR ONTO THE FALSE VOCAL FOLD. NO SUBGLOTTIC EXTENSION IS SEEN. A. RIGHT POSTERIOR FALSE VOCAL CORD FOLD, BIOPSY: SQUAMOUS CELL CARCINOMA IN SITU. B. RIGHT POSTERIOR TRUE VOCAL CORD FOLD, BIOPSY: SQUAMOUS CELL CARCINOMA, SUSPICIOUS FOR INVASION. C. RIGHT MID TRUE VOCAL CORD, BIOPSY: SQUAMOUS CELL CARCINOMA, SUSPICIOUS FOR INVASION. D. RIGHT ANTERIOR TRUE VOCAL FOLD, BIOPSY: INVASIVE AND IN SITU SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED. |
See the Head & Neck Terms and Definitions for guidance on coding the primary site, pages 17-18, http://seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf
Based on the information provided, use the statement from the endoscopy report and assign primary site to right true vocal fold [cord], C320. |
2015 |
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20150017 | MP/H Rules/Histology--Head and Neck: What is the histology code for salivary duct carcinoma of parotid gland? |
Code salivary duct carcinoma to invasive ductal carcinoma (8500/3). Salivary duct carcinoma is an aggressive adenocarcinoma which resembles high-grade breast ductal carcinoma according to the WHO Classification of Tumors of Head & Neck. |
2015 | |
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20150027 | Date of diagnosis--Diagnostic confirmation: How are the diagnosis date and diagnostic confirmation coded when the pathology (needle biopsy followed by resection) reports GIST, NOS and the physician subsequently states this is a malignant GIST and treats the patient for a malignancy? See Discussion. |
Pathologists rarely diagnose a GIST as a malignant tumor. Per the AJCC, GISTs encompass a continuum in terms of biologic potential, with larger more mitotically active tumors landing on the "histologically sarcomatous" or malignant end of the spectrum. Because the pathologists generally do not categorize these tumors as benign or malignant, the judgement is typically made by the clinician in light of all the clinical and pathologic findings. Unless there are obvious distant metastases, the clinician usually decides whether a GIST is malignant and treats the patient as such.
In the case above, the patient underwent a gastric biopsy on 04/10/2014 that showed GIST. The subsequent resection on 04/12/2014 showed a 4.5 cm GIST, spindle cell type with 6 mitoses/5 square mm. The resection pathology report does not indicate the GIST is malignant, but does identify a large tumor with mitotic activity. After reviewing the evidence in this case, the clinician calls this a malignant GIST on 04/29/2014 and starts the patient on Gleevec.
Although neither the biopsy nor the resection call this a malignant tumor, should the date the GIST was first diagnosed (biopsy on 04/10/2014) be used to code the diagnosis date, since this is the date the tumor (ultimately felt to be malignant) was diagnosed? If the diagnosis date is coded as the date malignant GIST was first mentioned (04/29/2014), this would exclude surgery as treatment for this tumor.
Would this be a histologic diagnosis because the tumor was histologically confirmed to be GIST? Or must this be a clinical diagnosis because the diagnosis of malignancy was only made clinically (by the clinician's review of the clinical and pathologic findings)? |
Code the diagnosis date for this case as 04/10/2014. Code the diagnostic confirmation as histologically confirmed. The clinician is using all of the information available to determine the diagnosis, including the biopsy and resection. |
2015 |