Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20180082 | Summary Stage Manual 2018 "Lymphoma: SEER Summary Stage 2000 states: For lymphomas, any mention of lymph nodes is indicative of involvement and is used to determine the number and location of lymph node chains involved (see lymphoma scheme). This statement is not in SEER Summary Stage 2018. Does that mean we follow rules #4-7, pages 14-15, under Code 3: Regional Lymph Nodes only, for every site, including lymphoma? |
The following statement "Any mention of the terms including fixed, matted, mass in the hilum, mediastinum, retroperitoneum, and/or mesentery, palpable, enlarged, shotty, lymphadenopathy are all regarded as involvement for lymphomas when determining appropriate code," is included in EOD Primary Tumor and is applicable to Summary Stage 2018. The statement will be added as note 4 to the Lymphoma Summary Stage chapter. This will be included in the 2019 update (estimated release January 2019). |
2018 | |
|
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 |
|
20081052 | Histology: What is the histology code for a soft tissue thigh mass that was diagnosed as Ewing sarcoma/PNET, primitive neuroectodermal tumor? | The histologies stated for this case are Ewing sarcoma (9260) and PNET, primitive neuroectodermal tumor,(9364)*. Use the Other Site Rules, starting with H8. Stop at H17 and assign the higher histology code -- 9364/3 [Peripheral neuroectodermal tumor].
*The term "PNET" is used for two different tumors. One is primitive neuroectodermal tumor (9473) and pertains to brain tumors per ICD-O-3 review. The other is peripheral primitive neuroectodermal tumor (pNET or PPNET 9364) and pertains to bone or soft tissue tumors. This case is stated to be soft tissue and Ewing sarcoma, so it is 9364 rather than 9473. |
2008 | |
|
20091013 | Reportability--Skin: Is a "basal cell carcinoma of the skin of the lip with focal skin appendage differentiation" reportable? |
The histology code for basal cell carcinoma with skin appendage differentiation is 8098/3. Basal cell carcinomas (8090-8110) are not reportable to SEER. Skin appendage tumors are not reportable to SEER unless stated to be carcinoma or stated to be malignant. According to our pathologist consultant, basal cell carcinoma with focal skin appendage differentiation is basal cell carcinoma which exhibits adnexal (appendage) features, but it is still basal cell carcinoma. The case example above is not reportable to SEER. |
2009 | |
|
20071061 | Histology--Melanoma: How is a "malignant melanoma arising in a melanocytic nevus" coded? | The histology code is 8720/3 [malignant melanoma, NOS]. There is no specific code for melanoma arising in melanocytic nevus. According to our pathologist consultant, this is likely because nevi are so common, melanoma arising in association with them is common and appears to have no bearing on prognosis or treatment. Most pathologists do not include the nevus in the diagnosis of melanoma, even when they see it. Code melanomas arising in melanocytic nevi to the appropriate melanoma code, probably 8720, 8721, or 8743 in most cases. |
2007 | |
|
20110135 | MP/H Rules/Histology--Lung: Per SINQ 20110115, why is micropapillary adenocarcinoma of the lung coded to 8260 [papillary adenocarcinoma] rather than 8050 [papillary carcinoma]? |
The histology codes for lung tumors are based on the World Health Organization Classification of Lung Tumors. Chart 1 in the MP/H Lung Equivalent Terms, Definitions, Charts, Tables and Illustrations (2007 MP/H Rules Manual) illustrates the WHO Classification of Lung Tumors. Using Chart 1, note that papillary adenocarcinoma [8260] is located under the Adenocarcinoma (NOS) branch. The histology in question was stated to be "micropapillary adenocarcinoma" and not "papillary carcinoma." Papillary carcinoma, NOS [8050] is not actually located on the chart. However, papillary squamous cell carcinoma is listed under the Squamous Cell Carcinoma, NOS branch, histology code 8052. Next, look up papillary carcinoma [8050] in the Morphology - Numerical listing section of the ICD-O-3. Papillary carcinoma, NOS is a Squamous Cell Neoplasm. (Refer also to SINQ 20091040.) The key word used to determine the appropriate histology in this case is "adenocarcinoma." This is a papillary adenocarcinoma and not a papillary squamous neoplasm. |
2011 | |
|
20130089 | MP/H Rules/Histology--Breast: How is the histology coded when a pre-treatment core biopsy showed ductal carcinoma, but the mastectomy specimen following neoadjuvant chemotherapy showed lobular carcinoma? See Discussion. | 11/06/2012 Ultrasound-guided biopsy of the left breast and left axilla showed invasive ductal carcinoma. The patient underwent 6 months of chemotherapy. In 05/2013 the patient underwent a mastectomy that showed invasive lobular cancer, pleomorphic type, with 11 axillary lymph nodes negative. | The histology is coded to lobular carcinoma, NOS [8520/3] because the mastectomy (the most representative specimen) showed only lobular carcinoma.
The MP/H Rules state to code the histology from the most representative tumor specimen examined. Although this patient underwent neoadjuvant treatment, there is no indication that the ultrasound-guided biopsy contained more tumor than the mastectomy. The mastectomy is the most representative specimen and should be used to code the histology.
|
2013 |
|
20190001 | EOD 2018/Summary Stage 2018--Brain and CNS: What are the Extent of Disease (EOD) Primary Tumor, EOD Reg Nodes, and Summary Stage 2018 codes for intradural schwannoma of the lumbar spine (L2-L4)? See Discussion. |
Example: Patient diagnosed following a resection of a cystic mass at L2-4 that proved an intradural tumor excision with final diagnosis of schwannoma, WHO grade 1. Per new Solid Tumor Rules, the primary site in this case should be coded C476 (peripheral nerves of trunk, NOS) and histology is 9560/0 (schwannoma, NOS). However, there are currently no coding options in the Soft Tissue of Trunk and Extremities EOD schema relating to a benign tumor. Likewise there are no coding options in the Soft Tissue and Sarcoma Summary Stage 2018 schema relating to a benign tumor. How should EOD 2018 and Summary Stage 2018 be coded for reportable benign schwannomas of the spinal nerve roots? |
The instruction regarding C476 has been removed from the Solid Tumor rules. Benign and borderline neoplasms coded to C470-C479 are not reportable at this time. Assign C720 for an intradural schwannoma at L2-4. That should allow you to use the correct EOD and Summary Stage 2018 schemas. |
2019 |
|
20200063 | Solid Tumor Rules (2021)/Laterality--Melanoma: Will the table called Site for Which Laterality Code Must Be Recorded be updated in the 2021 SEER Program Coding and Staging Manual as C444 is not included? The 2021 Cutaneous Melanoma Solid Tumor Rules say that C444 requires laterality; it says (new) beside it on the new Solid Tumor Rules for 2021. |
The laterality table in the 2021 SEER manual will not be updated. Please follow the 2021 Cutaneous Melanoma Solid Tumor Rules and assign a laterality for C444. |
2020 | |
|
20180038 | Multiple Primaries--Heme & Lymphoid Neoplasms: How many primaries should be reported when a 10/10/2017 skin biopsy identified myeloid sarcoma with monocytic differentiation, clinically stated to be leukemia cutis is followed by an 11/2/2017 BM biopsy showing an evolving high grade myelodysplastic process with atypical monocytes, likely an early evolving acute myeloid leukemia (AML), clinically stated to be a therapy-related AML (9920/3)? See Discussion. |
Code 9920/3 is not included under rule M3. However, disease process knowledge would indicate that because the patient has an underlying AML subtype, the leukemia cutis is due to the AML cells that have migrated into the skin tissue. This appears to be a single advanced disease process essentially diagnosed simultaneously. |
The leukemia cutis is secondary to leukemia that is already present. This is multiple disease processes going on at the same time. Look for more information on this case. Is there any previous diagnosis of MDS, leukemia, or some other disease that would result in a treatment related AML? If no further information can be found, abstract one primary with 9920/3. |
2018 |