Report | Question ID | Question | Discussion | Answer | Year |
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20200072 | Solid Tumor Rules (2018)/Multiple Primaries--Breast: How many primaries are accessioned when there are multiple synchronous/non-contiguous tumors when one tumor is metaplastic carcinoma (with carcinoma No Special Type (NST) or lobular carcinoma) and another tumor is strictly carcinoma, NST? See Discussion. |
Is an M rule needed to address multiple tumors and Note 2 in Table 3? Does Note 2 in Table 3 apply when multiple tumors exist and one tumor contains only ductal carcinoma? The M Rules currently confirm that a metaplastic carcinoma (whether it is involved with ductal or lobular) and a separate ductal carcinoma are separate primaries because these histologies are on different rows in Table 3 (separate primaries per M14). There is no specific rule regarding metaplastic carcinomas in the Multiple Tumors (M Rules) module, so presumably, the presence of a separate ductal carcinoma is not lumped into Note 2 in Table 3 for metaplastic carcinoma. However, the note is confusing when there are multiple tumors involved because it appears to the registrars there are two options for coding the histology. To some registrars, the rules indicate it does not matter if the tumor is predominantly ductal carcinoma as long as some percentage of metaplastic carcinoma is present, code histology to metaplastic carcinoma. For other registrars, the presence of solely a ductal carcinoma in a second tumor is a separate primary from the separate metaplastic carcinoma. The M rules and Note 2 need to clarify this issue to promote consistency. This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The term "mixed" implies a single tumor comprised of metaplastic carcinoma or variants of metaplastic and duct or lobular. The metaplastic histology is coded regardless of whether it comprises the majority (greater than 50% of the tumor). M13 is the only rule specific to metaplastic and is in the single tumor module. This implies a single tumor with both histologies. When there are multiple tumors, one with metaplastic or a subtype/variant of metaplastic and another with a histology listed on a different row, continue to the Multiple Tumors module. M13 applies and there are two primaries. We will add "single tumor" to the note in Table 2 in the next update. |
2020 |
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20150034 | MP/H/Histology/neuroendocrine : How should the following histologies with neuroendocrine differentiation be coded?
1. Bladder - Invasive urothelial carcinoma with neuroendocrine differentiation
2. Nasopharnyx - Undifferentiated nonkeratinizing nasopharyngeal carcinoma with neuroendocrine differentiation
3. Ductal carcinoma in situ (with neuroendocrine features) cribriform and solid patterns
See discussion. |
We are starting to see more specific histologies with neuroendocrine differentiation. How are we to deal with these histologies and will this be addressed in the revised MP/H rules? |
The term neuroendocrine is often included with other histologies and usually means that neuroendocrine cells are present but not neuroendocrine tumor.
1. If the neuroendocrine cells are stated to be either small cell or large cell, code that histology; however, neuroendocrine, NOS mixed with urothelial does not have an applicable mixed code. Code histology to 8120.
2. Code histology to squamous cell carcinoma, nonkeratinizing, NOS (8072/3). The neuroendocrine component is not specified as either small cell or large cell.
3. Code to 8523/2 per MP/H Rule H6 as intraductal mixed with other types of carcinoma present.
Note that while neuroendocrine differentiation can be identified, it seems to have no prognostic implications. We have consulted with our site specific Subject Matter Experts on how best to capture neuroendocrine, NOS when combined with other histologies. These instructions will be included in the revision of the MP/H rules including the wording of MP/H breast rule H6. |
2015 |
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20180070 | Solid Tumor Rules (2018)/Histology--Lung: The Histology coding guidelines for lung cancer state to code histology when stated as type or subtype but not to code when described as pattern. How should the histology be coded (Adeno, NOS or Adeno, Mixed subtypes) if the College of Americal Pathologists Protocol of the pathology report lists the following: Histologic type: Adenocarcinoma, papillary (90%), lepidic (8%), and solid (2%) patterns? |
The term/modifier "patterns" is no longer allowed to code a specific histology according to the Lung Solid Tumor H rules. Disregard the papillary, lepidic, and solid patterns and code histology to adenocarcinoma, NOS (8140/3). |
2018 | |
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20041029 | Ambiguous Terminology/Reportability: Are the terms "bordering on" and "may represent" diagnostic of cancer? See Discussion. |
Pathology report states "...florid micropapillary hyperplasia, focally atypical with features bordering on low grade micropapillary ductal carcinoma in situ." |
The terms "bordering on" and "may represent" are not diagnostic of cancer. These terms are not on the list of ambiguous terms that constitute a diagnosis of cancer. The diagnosis in the example above is not reportable to SEER. |
2004 |
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20031021 | Primary Site--Head & Neck: What is the anatomical distinction among tonsillar fossa, tonsillar pillar, and tonsil NOS? | Operative findings describe a right tonsil three times the size of the left tonsil. Tonsil is dissected from the tonsillar fossa. There appeared to be no involvement of tumor below the tonsillar capsule. | The tonsil lies in an indentation called the tonsillar fossa. The tonsillar fossa is bordered on either side by the tonsillar pillars. The tonsillar pillars are part of the supporting structure of the throat opening.
Code C09.9 [Tonsil NOS] as the primary site for the case above. |
2003 |
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20240040 | First course treatment--Kidney: How should the different treatment fields be coded if surgery is planned but cancelled due to patient noncompliance, then the tumor is treated with ablation, and eventually surgery is given due to residual disease? See Discussion. |
Patient was diagnosed in July 2022 with biopsy confirmed left kidney renal cell carcinoma. Initially, partial nephrectomy was planned for February 2023 but canceled at the last moment due to the patient’s “history of narcotic use.” The details of that cancellation were otherwise unclear. It appears the treatment plan was changed due to patient non-compliance. Patient then had cryoablation of the tumor in May of 2023. Subsequent imaging in October found residual tumor, but no disease progression was noted. Again, additional ablation was offered but patient decided on surgical treatment which did not occur until December 2023. Is the cryoablation second course due to a change of plan if there is no disease progression, recurrence, or treatment failure? If the cryoablation is first course treatment, then would the partial resection also be first course treatment because it was documented as the treatment plan? |
The treatment with cryoablation is second course. Once the initial treatment plan is changed, everything after the change is no longer first course of treatment. If the cryoablation was not mentioned as part of the original treatment plan, it is second course. |
2024 |
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20041069 | Reportability--Brain and CNS: Is a meningioma invading the bone malignant and, therefore, SEER reportable if diagnosed prior to 2004? See Discussion. |
1. Meningothelial meningioma with prominent nuclear pleomorphism, infiltration into dura, calvarium, temporalis skeletal muscle. Microscopic: Multifocal infiltration by meningothelial tumor...extensive infiltration of trabecular spaces, extension through inner and outer calvarial layers by meningioma...mitotic activity in tumor noted but below the 4 per 10 high power field threshold for diagnosis of atypical meningioma. 2. Aggressive (invasive) transitional type meningioma, neuroimaging and histology imply extensive invasive meningioma involving bone and paraspinal soft tissues. Microscopy:...invaded bone...focal EMA positivity diagnostic of invasive transitional type meningioma... tumor invades bone. |
The two cases above are benign meningiomas and not reportable prior to 2004. According to an expert consultant, meningiomas are in the lining cells for the inner table of the skull and as such have an affinity for bone that allows them to penetrate adjacent bone without being "malignant." The WHO Nervous System Tumor Classification states malignant meningioma exibits histological features of frank malignancy far in excess of the abnormalities present in atypical meningioma (WHO grade II). Examples of the histologic features of malignant meningioma are obviously malignant cytology, or high mitotic index (20 or more mitoses per 10 high-power fields). They correspond to WHO grade III and are usually fatal. |
2004 |
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20091126 | MP/H Rules/Multiple primaries--Vagina: How many primaries should be abstracted for a patient with a complex history of multiple occurrences of vaginal intraepithelial neoplasia (VAIN III) between 2001 and 2008 and invasive squamous cell carcinoma (SCCA) of the vagina diagnosed in 2006 and again in 2008? See Discussion. | Patient had VAIN III in March of 2001. She had a partial vaginectomy and then continues to have laser surgery in 2002, 2003, 2005 and 2006 for recurrences. In 12/2006 she is diagnosed with SCCA of the vagina with microinvasion (new primary). Then in 2/2008 she has VAIN III again -- new primary according to rule M10 (more than 1 year later). An invasive SCCA of the vagina is again diagnosed in 9/2008. Is this another new primary per rule M15 (invasive after in situ)? Every instance in 2008 is called a recurrence, but we disregard that statement. | There are two primaries according to the information provided.
1. VAIN III March 2001. 2. SCCA of vagina Dec. 2006 (invasive tumor following an in situ
For cases diagnosed 2007 or later, the MP/H rules apply to new tumors, which means that there has been a disease-free interval at some point. In this case, the patient has never been declared disease-free (NED) using the information provided in the question. The consistent recurrence of VAIN is typical of this disease. |
2009 |
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20010012 | Surgery of Primary Site--Breast: What code is used to represent this field for a breast primary treated with a "bilateral mastectomy"? See discussion. |
Pt diagnosed with rt breast primary opted to be treated with rt modified radical mastectomy and lt simple mastectomy. Path revealed invasive ductal carcinoma on the rt and ductal carcinoma in situ on the lt. Path reported 14 axillary lymph nodes were found in the mastectomy specimen. |
There are two primaries. For cases diagnosed 1/1/2003 and after: For the rt breast, code Surgery of Primary Site to 51. The contralateral left breast malignancy is not involved with the right breast primary by either direct extension or metastasis. Codes 42 and 52 are used to capture prophylactic mastectomy of the opposite noncancerous breast. In this case, the opposite breast has cancer so these codes cannot be used. Code Scope of Regional Lymph Node Surgery to 5 and Surgical Procedure of Other Site to 0. For the lt breast, code Surgery of Primary Site to 41, Scope of Reg LN Surgery to 0, and Surgical Procedure of Other Site to 0. |
2001 |
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20160041 | First course treatment/Surgery of Primary Site--Skin: How are Surgery of Primary Site and Surgical Procedure of Other Site coded for an eyelid skin primary diagnosed by punch biopsy and treated with an orbital exenteration? See Discussion. |
Unlike most other sites, there is no specific code for a radical surgical procedure of a skin primary. In this case, the patient was diagnosed with a sebaceous cell carcinoma of the lower eyelid skin by punch biopsy. The tumor was large and an orbital exenteration was planned. Despite the extensive surgery performed, skin margins were less than 1 cm. Is an orbital exenteration a "major amputation" (code 60) in this case? Given that the margins were not greater than 1 cm, codes 45 - 47 (which includes a minor (local) amputation) don't seem to apply. However, if this procedure cannot be classified as "minor amputation" then doesn't it seem overkill to refer to the procedure as a "major amputation"?
An alternative would be to code Surgery of Primary Site to 32 for the skin resection (punch biopsy followed by a gross excision of the lesion, margins less than 1 cm) and code Surgical Procedure of Other Site to 2 (non-primary surgical procedure to other regional sites) to record the removal of the globe and orbit as part of the orbital exenteration. Which is correct? |
There is a similar question in the FORDS forum of the CoC CAnswer Forum. CoC is the curator for the surgery codes.
Surgical Procedure to Primary Site - Gross excision of the lesion, code in 30s series Surgical Procedure to Other Site (removal of eye) - code 4
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2016 |