Report | Question ID | Question | Discussion | Answer | Year |
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20180049 | Solid Tumor Rules (2018)/Histology--Lung: What is the difference between Lung Rules H7 and H8 (Single Tumor Module)? When would one use H8 rather than H7? See Discussion. |
Is Rule H8 a duplicate of Rule H7? Rule H7 instructs one to use Table 2 when there are multiple histologies and the combination is listed in Table 2 (or a combination code was received from Ask a SEER Registrar). Rule H8 states to code adenocarcinoma with mixed subtypes (8255) when there are multiple adenocarcinoma subtypes OR any combination of histologies which are not listed in Table 2. However, both conditions for Rule H8 are already included in Table 2 (the last row). How would one ever move past Rule H7 if all the conditions for both Rules H7 and H8 are covered first under Rule H7? Example: A resection pathology report proves invasive adenocarcinoma, acinar, solid and papillary types. Rule H7 seems to be the first H Rule that applies as there are multiple histologies (identified using a reportable term: type) AND the combination is listed in Table 2. The last row of Table 2 instructs one to code Adenocarcinoma with mixed subtypes (8255) when there are at least two of the subtypes/variants of adenocarcinoma listed in Column 1 (Required Terms). In this case, there were three subtypes/variants that are listed in Column 1 (acinar, solid and papillary). However, Rule H8 also instructs one to, Which rule applies here, Rule H7 or Rule H8? |
January 2019 update: The differences between H7 and H8 are H8 applies to tumors with multiple subtypes of adenocarcinoma while H7 applies to histology combinations other than adenocarcinoma such as adeno and squamous. |
2018 |
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20140069 | MP/H Rules/Histology--Kidney, renal pelvis: How would you code this histology: Renal cell carcinoma, clear and eosinophilic cell type? |
Kidney rule H5 applies, code the more specific histology which is clear cell renal cell carcinoma (8310/3). Per the WHO Tumors of the Urinary System, clear cell renal cell carcinoma contains both clear and eosinophilic cytoplasm. Eosinophilic is not a type or variant of renal cell carcinoma. |
2014 | |
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20230007 | SEER Manual/Reportability--Appendix: Is low-grade appendiceal mucinous neoplasm (LAMN) with peritoneal spread followed by evidence of extraperitoneal metastatic disease reportable prior to 2022? See Discussion. |
In 2021, the patient was diagnosed with a non-reportable appendiceal LAMN. Resection showed a tumor diffusely involving the appendix and perforating the visceral peritoneum, as well as extensive intraperitoneal metastasis. In 2023, a lung wedge resection revealed metastatic mucinous neoplasm involving lung parenchyma and pleura, consistent with metastasis of the known appendiceal primary. It is understood that intraperitoneal spread of an appendiceal LAMN does not make it reportable because the peritoneal disease is also non-invasive. Does extraperitoneal metastasis of an appendiceal LAMN diagnosed prior to 2022 make it invasive disease and therefore reportable? |
LAMN diagnosed prior to 1/1/2022 is not reportable even when it spreads or metastasizes according to our expert pathologist consultant. Spread of this neoplasm does not indicate malignancy. For this case to be reportable, the diagnosis must indicate “carcinoma” or “adenocarcinoma.” Pre-2022, LAMN is not reportable even when treated with surgery and chemotherapy. LAMN is reportable starting with cases diagnosed in 2022. |
2023 |
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20130195 | Laterality--Heme & Lymphoid Neoplasms: Is laterality coded to 0 [not paired] for all lymphoma cases including paired sites (e.g., breast, lung)? | Laterality coding for lymphomas is based on the primary site not histology. Laterality describes the side of a paired organ or side of the body on which the reportable tumor originated. Determine whether laterality should be coded for each primary.
Laterality coding instructions are located in the SEER Program Coding and Staging Manual. See pages 68-70 in the 2013 manual, http://www.seer.cancer.gov/manuals/2013/SPCSM_2013_maindoc.pdf. |
2013 | |
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20200071 | Solid Tumor Rules (2018)/Histology--Breast: Rule H13 of the 2021 Breast Solid Tumor Rules (a new H Rule added in the December 2020 revision) indicates metaplastic carcinoma is coded when both metaplastic carcinoma and carcinoma No Special Type (NST) are present. Should Rule H13 also address lobular carcinoma so the histology for a single tumor with metaplastic carcinoma and lobular carcinoma is correctly coded to metaplastic carcinoma (8575)? See Discussion. |
Rule H13 states to code the histology to metaplastic carcinoma when there is metaplastic carcinoma (or a subtype/variant) and invasive carcinoma NST. This rule makes no mention of lobular carcinoma. However, in Table 3, Note 2 for metaplastic carcinoma (8575) states metaplastic carcinoma, NOS and subtypes are almost always mixed with invasive mammary carcinoma, NST and at times lobular carcinoma. These tumors should be coded to metaplastic regardless of percent invasive mammary carcinoma or lobular carcinoma present. While Table 2 (the mixed histology code table) does include an entry for metaplastic carcinoma AND carcinoma NST OR lobular carcinoma, it is unclear why lobular carcinoma has not been added to Rule H13 as well. If a single tumor has metaplastic plus lobular carcinoma, Rule H13 does not apply and one has to continue through the rules. Unfortunately, the next rule registrars would be tempted to use is Rule H18: Code the histology that comprises greater than 50% of tumor when two histologies are on different rows in Table 3. This Rule does not state it does NOT apply to metaplastic carcinoma (only mucinous). So, if for some reason the lobular was greater than 50%, the incorrect histology would be coded (unless the registrar happened to remember Note 2 in the metaplastic carcinoma entry in Table 3). This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
Lobular carcinoma was unintentionally excluded from M13. It will be added in the 2022 update. It is important registrars learn to use the tables and read the notes. |
2020 |
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20200027 | Reportability--Ambiguous Terminology: Should either of the terms, strongly characteristic of or most certainly, be used to accession a case as reportable when they are used to describe a malignancy and no other information is available? See Discussion. |
SINQ 20130140 indicates a histologic diagnosis that is characteristic of a specified malignancy is reportable because this is equivalent to the term, diagnostic of. Does the same logic apply to a clinical diagnosis that is strongly characteristic of a malignancy on imaging? SINQ 20180104 indicates the term, almost certainly, is not a reportable ambiguous term. If a radiologist notes a mass was most certainly malignant, is this adequate to accession this as reportable? Is a clinically certain diagnosis equivalent to diagnostic of? Or are the modifiers almost and most irrelevant because the terms certainly and certain are not on the ambiguous terminology list? |
Look for more information. What is the plan for each of these patients? Consult with the physician and search for further information to assist with the decision. If no further information can be obtained, accession both of these cases based on the imaging reports. If more information becomes available later, review and revise as applicable. |
2020 |
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20180032 | Reportability--Appendix: Is low grade appendiceal mucinous neoplasm (LAMN) reportable for 2018? It is staged as pTis(LAMN) AJCC 8th ed by pathologist. |
Low grade appendiceal mucinous neoplasm (LAMN) is not reportable in 2018. See page 6, https://20tqtx36s1la18rvn82wcmpn-wpengine.netdna-ssl.com/wp-content/uploads/2018/02/2018-ICD-O-3-Coding-Table-Alpha-order-.pdf. Use cancer registry reportability instructions to determine reportability. Do not use the AJCC TNM manual to determine reportability. |
2018 | |
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20190049 | Lymph nodes/Melanoma: Is a single axillary lymph node regional or distant for a patient diagnosed in 2018 with metastatic melanoma to the brain found via imaging. The staging procedure was an single axillary lymph node excision that was positive for metastatic melanoma. The exact site of the primary was never determined; the primary site is coded to C449. See Discussion. |
The patient was diagnosed in 2018 with met melanoma to the brain found via imaging. The staging procedure was a single axillary lymph node excision which was positive for metastatic melanoma. The exact site of the primary was never determined and the site code is C449. Is the axillary lymph node regional or distant? This affects how I code regional lymph nodes positive, regional lymph nodes examined, and scope of regional lymph node surgery or surgical procedure other site. Similar question was asked in the past (question # 20091101) but I have not found this question restated since the 2018 changes and just want to verify this is still what we are to do. |
Lymph node mets from a melanoma of unknown primary site are presumed to be regional if the lymph node mets are confined to one area, as they are in this case. We are assuming there are no previous melanoma diagnoses for this patient. The workup should include examination of the skin areas that drain to the axillary area. |
2019 |
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20160032 | Reportability--Brain: Is benign lymphangioma of the brain (9170/0) reportable? It is not on the list of non-malignant blood vessel tumors in the National Program of Cancer Registries Clarifications for Central Nervous System (CNS) tumors. |
Lymphangioma of the brain or CNS is not reportable. Lymphangioma is a malformation of the lymphatic system. Even though it has an ICD-O-3 code, do not report it. |
2016 | |
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20240048 | Solid Tumor Rules/Histology--Breast: What is histology code of a breast tumor with ductal carcinoma, lymphoepithelioma-like carcinoma type? See Discussion. |
Example: 12/2023 Breast lumpectomy final diagnosis is Invasive ductal carcinoma, lymphoepithelioma-like carcinoma type. This is a single tumor with no in situ carcinoma present. Lymphoepithelioma-like carcinoma is not listed as a subtype/variant or synonym for breast carcinoma in the Solid Tumor Rules histology tables. |
Lymphoepithelial carcinoma is a subtype of SCC usually seen in skin or H&N sites and often associated with EBV. CPC SME review determined 8082/3 invalid for breast but did not recommend a substitute code. There were only 45 cases coded 8082 2001 to 2019. For this case, it's possible the lesion originated in the breast skin and progressed to breast tissue. SCC is a subtype of metaplastic breast carcinoma so one could argue it code be coded either 8575 or 8070. For this case, we recommend assigning 8500/3. Use text fields to record the details. |
2024 |