Report | Question ID | Question | Discussion | Answer | Year |
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20240004 | Reportability/Histology--Skin: Is a malignant spindle cell neoplasm consistent with atypical fibroxanthoma reportable for cases diagnosed 1/1/2023 and later, after thorough immunohistochemical work-up? See Discussion. |
Appendix E1 in both the 2023 and 2024 SEER Program Coding and Staging Manual (SPCSM) lists these malignant spindle cell neoplasms, consistent with atypical fibroxanthoma, as reportable when other tumors have been ruled out with immunohistochemistry. This contradicts both SINQ 20190102 and the Solid Tumor Rules (STRs) general instructions indicating ambiguous terminology (e.g., “consistent with”) cannot be used to code the more specific histology when there is a NOS (malignant spindle cell neoplasm, 8004/3) and a more specific (malignant atypical fibroxanthoma, 8830/3) histology. These tumors are typically diagnosed and treated in dermatology offices, so further chart review or confirmation by a physician is not possible for central registries. As non-melanoma skin primaries are included in the Other Sites schema, and this schema was updated for cases diagnosed 2023 and later, which instruction applies to 2023+ diagnoses? Should these continue to be collected per Appendix E1 despite the conflict with the STR Manual and SINQ? If these are reportable, should the SINQ and STR Manual be updated to reflect this? Or should these be non-reportable per the STR Manual and SINQ? |
Report malignant spindle cell neoplasms consistent with atypical fibroxanthoma as directed by Appendix E.1 of the 2023 and 2024 versions of the SEER Manual using 8830/3 (fibroxanthoma, malignant). We will update the answer in SINQ 20190102. While the Other Sites Solid Tumor Rules address coding an NOS and specific histology sub-type/variant, this situation is not specifically addressed. We will also review the rules. |
2024 |
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20240041 | Reportability--Brain and CNS: Is an optic nerve meningioma reportable if stated to arise in the “intraorbital segment” of the optic nerve meninges? See Discussion. |
Patient was diagnosed on imaging with enhancement along the right optic nerve intraorbital segment, displacing the optic nerve, most consistent with optic nerve sheath meningioma. Extracranial meningiomas are rare, however SINQ 20230052 does contain an exception for reportability in a different head and neck site because it is not an intracranial location. It is unclear if this portion of the meninges surrounding the intraorbital optic nerve is still “intracranial” and thus reportable. |
Report optic nerve sheath meningioma arising in the intraorbital segment. The optic nerve contains four segments, of which intraorbital is one. The WHO Classification of Eye Tumors, 4th edition, defines meningioma as a neoplasm originating from the meningothelial cells of the optic nerve leptomeninges. According to the Table 3 of the Non-malignant Solid Tumor Rules, all portions of the optic are reportable and meningiomas arising in the dura/meninges of an intracranial nerve are coded to cerebral meninges C700. |
2024 |
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20220013 | Reportability/Histology--Kidney: What is the histology and behavior of a papillary renal neoplasm with reverse polarity? See Discussion. |
Patient had a partial nephrectomy with final diagnosis of papillary renal neoplasm with reverse polarity. Diagnosis comment states: Papillary renal neoplasm with reverse polarity is currently considered to be a histologic variant of papillary renal cell carcinoma; however, recent studies suggest that it has a very indolent clinical behavior. |
Report papillary renal neoplasm with reverse polarity as 8260/3. According to the WHO Classification of Urinary and Male Genital Tumors, 5th edition, this is a distinctive pattern of papillary renal cell carcinoma that has been recently recognized. These tumors have recurrent mutations of KRAS, differing from typical papillary renal cell carcinoma. We recommend that you include with reverse polarity in your histology text to differentiate this entity from others classified in 8260/3. |
2022 |
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20200006 | Reportability--Retina: Is a diagnosis of retinal astrocytoma reportable? See Discussion. |
There is no specific ICD-O-3 code for a which resulted in abstractors assigning the malignant astrocytoma, NOS code. These lesions were previously called but we are seeing the new terminology more frequently. |
Report retinal astrocytoma. The WHO Classification of Tumors of the Eye, 4th edition, lists astrocytoma, NOS as 9400/3 with astrocytic hamartoma of the retina as a synonym. You may receive a site/type edit (IF25) which can be overridden. The changes in terminology, codes, etc. proposed in WHO 4th Ed Eye book were implemented for cases diagnosed 1/1/2018 forward. Apply this to retina astrocytomas and do not accession cases diagnosed with this histology prior to 1/1/2018. |
2020 |
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20210041 | Reportability/Behavior--Paraganglia: Is a 2021+ diagnosis of paraganglioma reportable if the grading of adrenal pheochromocytoma and paraganglioma (GAPP) score falls outside the stated requirements for malignancy? See Discussion. |
Patient was diagnosed with a retroperitoneal paraganglioma on April 2021 mass resection. Final diagnosis included the comment: Based on the modified grading of adrenal pheochromocytoma and paraganglioma (GAPP), the GAPP score is 1. Scores greater than or equal to 3 are malignant. We are aware that paraganglioma is classified as malignant for cases diagnosed in 2021+, however it is unclear how the pathologist's interpretation of the GAPP score may affect the behavior of this case. |
Report retroperitoneal paraganglioma based on ICD-O-3.2 histology/behavior that lists paraganglioma, NOS as 8680/3 for cases diagnosed 2021 and forward. While GAPP is a predictor of metastatic potential, it does not factor into behavior, thus reportability. |
2021 |
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20190041 | Reportability/Primary Site--Gastrointestinal (GI) Tract: Is a gastrointestinal stromal tumor (GIST) with a single nodule in the small intestine (C17_) and a nodule in the stomach (C16_) reportable per the 2018 SEER Coding Manual reporting instructions for GIST due to the multiple foci or do the multiple foci need to be in the same organ to be reportable? See Discussion. |
Example: Small intestine wedge resection with GIST, 1.8 cm in mid small intestine, single nodule. Stomach nodule biopsy: GIST, 0.3 cm. Pathology report comment section indicates the gastric GIST is not staged due to the small size and incidental nature. |
Report the GIST in the small intestine. The 2018 SEER Manual says to report GIST when there are multiple foci and to code the primary site to the site where the malignancy originated. Use text fields to record the details, including the stomach nodule. |
2019 |
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20180001 | Reportability/Date of diagnosis--Small intestine: Is this case reportable? Widely metastatic gastrointestinal stomal tumor (GIST) was diagnosed at an out-of-state facility in 2017 and referred back to a hospital in our state for chemotherapy where there is a history of a small bowel resection of GIST of uncertain malignant potential (8936/1) doneat the hospital in 2003. If so, is the diagnosis date 2003 or 2017? See Discussion. |
The hospital registrar reports that the case was identified at the hospital because of the referral for chemotherapy for the metastatic GIST. The records from the out-of-state hospital mentioned a history of a small bowel resection in 2003 for a borderline tumor. The registrar went back through the hospital's old records and found the surgery was done for GIST of low malignant potential at her facility. The question is whether to report the case or not, and if reported, is 2003 the diagnosis date. The rules say to change the behavior and backdate the diagnosiswhen a tumor is presumed benign and islater diagnosed as malignant. Another problem for this case is that the out-of-state hospital did not review the slides from the 2003 surgery. |
Report the case with a diagnosis date of 2017. The 2003 diagnosis was not reviewed, and there are no physician statements that cancer was present in 2003, or that the metastases are attributable to the 2003 diagnosis. Document the details of the case in text fields. |
2018 |
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20240021 | Solid Tumor Rules/Reportability/Histology--Digestive Sites: Is a diagnosis of “high grade dysplasia” (not specified to be squamous or glandular) reportable for esophagus, stomach, and small intestine for cases diagnosed beginning in 2024? If so, how should histology be coded? See Discussion. |
SEER Program Coding and Staging Manual indicates high grade dysplasia of esophagus, stomach, and small intestine are reportable. The ICD-O-3.2 does not include “high grade dysplasia” as equivalent to “high grade squamous dysplasia.” If reportable, would high grade dysplasia (NOS) that originates in the stomach and small intestine default to 8148/2, while esophageal high grade dysplasia (NOS) default to 8077/2? |
Report these high grade dysplasia of the following organs as stated below. Stomach: Assign code 8148/2 glandular intraepithelial neoplasia, high grade using the Other Sites Solid Tumor Rules, Table 6: Stomach Histologies and as described in the WHO Classification of Digestive Tumors, 5th edition. Small intestine and Esophagus: Assign code 8148/2 glandular intraepithelial neoplasia, high grade, using the Other Sites Solid Tumor Rules, Other Sites Histology Rules, Rule H4/H26. The following note is listed for both of these rules. Note: This list may not include all reportable neoplasms for 8148/2. See SEER Program Coding and Staging Manual or STORE manual for reportable neoplasms The Other Sites Solid Tumor Rules, Table 5: Esophagus Histologies and Table 7: Small Intestine and Ampulla of Vater Histologies will be updated to reflect this code as time permits. |
2024 |
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20220027 | Reportability/Heme & Lymphoid Neoplasms--CNS: Is ALK-positive histiocytosis, primary site Central Nervous System (CNS), reportable, and is the correct histology code 9750/3? See Discussion. |
2022 case: Surgical Pathology Report-spinal cord tumor, biopsies: ALK-positive neoplasm most consistent with ALK-positive histiocytosis. |
Report this 2022 case of ALK-positive histiocytosis using histology code 9751/3, Langerhans cell histiocytosis, disseminated. Use text fields to document that this is a case of ALK-positive histiocytosis. This term may be assigned a new code once the 5th edition of the Hematopoietic WHO Blue Book is released. |
2022 |
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20200044 | Reportability/Histology--Eye: Is conjunctival intraepithelial neoplasia, moderate to severe, reportable and if so, what are the histology and behavior codes? See Discussion. |
Left Eye Conjunctiva, biopsy (01/23/2018): Conjunctival intraepithelial neoplasia moderate to severe. Is intraepithelial neoplasia moderate to severe the same as coding 8077/2? |
Report this case as 8077/2. Our expert pathologist consultant reviewed this and confirmed it is reportable. Here is some of his rationale. The pathologist's designation as "moderate to severe" indicates there are areas of 2/3 of full thickness epithelial change, so the criteria to report are met. |
2020 |