Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20130021 | Histology--Heme & Lymphoid Neoplasms: When will the follicular lymphoma, grade 1 code [9695/3] ever be used? See Discussion. | The Abstractor Notes currently do not explain the histologic classification of follicular lymphoma [FL]. Frequently, FL grade 1 and 2 are not being separated and are described as "low grade" or "grade 1-2" in the pathology final diagnosis. The correct histology code would be 9691/3 [FL, grade 2] for these cases. Apparently, per the 2008 WHO Classification, grade 1 and grade 2 are being grouped together as grade 1-2 due to the minimal difference in patient outcome. If these histologies are grouped together, will histology code 9695/3 [FL, grade 1] ever be used? Should the Heme Database explain the classifications of follicular lymphoma grade 1, 2, and 3? | When the latest WHO classification for heme neoplasms was written in 2008, there was a lot of controversy about whether or not the FL grading system was useful or not. A number of papers have been written stating that grades 1 and 2 do not have a statistically different survival or transformation rate. Given that the controversy had not been settled by those in the clinical world, the WHO recommended analyzing grades 1 and 2 together. They did not, however, remove either grade 1 or 2 from their classification. When the WHO intend to change their classification (have both grades classified under one histology number), they omit one code from their book (make it obsolete) and change the definition for the other code. The 2008 WHO book did not make either ICD-O-3 code obsolete. Therefore, we continue to collect the cases as designated by the pathologist. If the controversy is settled before the next WHO classification, you may see changes in the codes.
Additionally, since the 2008 WHO book was written, there have been some clinical papers challenging the designation of grade 3. They contend that grade 3 can be mistaken for low-grade.
The grades for follicular lymphoma are based on the number of centroblasts per high powered field (HPF). The number of centroblasts for grade 1 is 0-5; for grade 2 is 6-15, for grade 3a and 3b is >15 centroblasts. 3a has centrocytes and 3b has no centrocytes. |
2013 |
|
20150019 | Reportability/Histology--Pancreas: Is well-differentiated neuroendocrine tumor (M8240/3) as stated on a pathology report reportable or can the clinical information be used as an adjunct to the path report, which further states the specific type of neuroendocrine tumor is an Insulinoma, therefore, NOT reportable (M8151/0)? See discussion. |
The diagnosis date is 2/24/14. The pathology report of the pancreas shows: Well-differentiated neuroendocrine tumor (NET), low grade (WHO G1 of 3). Addendum: Ki-67 confirms low grade of pancreatic endocrine tumor (less than 2% Ki-67/MIB-1 index). Chromogranin confirms the endocrine nature of the tumor. The Pre and Post Op Diagnosis is pancreatic neuroendocrine tumor consistent with insulinoma. AJCC Stage as noted on path report: pT1, pNX, pM.
The physician states: The patient has a well-documented insulinoma. Biochemistries confirmed the disease and it is localized in the tail of the pancreas.
The issue with NETs is that pathology report reflects what is seen or what is quantified under the microscope; often, there is a specimen without the accompanying medical history and clinical signs. Many of these NETs are specified on the basis of the hormone, as usually measured in the blood, that is overproduced, something not seen microscopically. All of the islet cell tumors are NETs. The insulinoma in the example above is a well-differentiated NET that is causing insulin to be over-produced. Thus, the diagnoses are not discordant; insulinoma is a more specific NET. |
When the pathology diagnosis is a neuroendocrine tumor (/3) and the clinical diagnosis is an insulinoma (/0), report the case. Although ICD-O-3 classifies insulinoma as /0, the most recent WHO classification lists it as /3. The pathologist and physicians for this case are likely guided by the WHO classification and as a result, would view both the NET diagnosis and the insulinoma diagnosis as malignant. You could report this case as 8240/3 or 8151/3. |
2015 |
|
20140063 | MP/H Rules--Histology: How is histology coded when a metastatic site is biopsy positive for adenocarcinoma, but the physician clinically states this is cholangiocarcinoma? See discussion. |
The patient underwent a PTA biopsy of a lytic mass showing metastatic adenocarcinoma. Imaging revealed a large hepatic mass consistent with cholangiocarcinoma. The physician's impression on a physical exam note was the PTA biopsy was most consistent with intrahepatic cholangiocarcinoma. However, the PTA pathology report was reviewed at this facility and the final diagnosis was not stated to be cholangiocarcinoma, only adenocarcinoma, NOS.
The priority order for coding histology rules in the MP/H Manual indicates pathology has priority over documentation in the medical record. Following the rules in the MP/H Manual, the histology would be coded as 8140 [Adenocarcinoma, NOS]. While this may be technically correct, it seems that intrahepatic cholangiocarcinoma is often diagnosed as adenocarcinoma on biopsy, but further stated to be cholangiocarcinoma by the physician once other primary sites have been excluded. By applying the rules in the MP/H Manual, cases that seem better characterized as cholangiocarcinomas are being collected as adenocarcinoma, NOS. Should the histology be adenocarcinoma [8140/3] or cholangiocarcinoma [8160/3] for these cases? |
When the physician has reviewed all of the pertinent information, and the physician's opinion is documented stating that the histology is cholangiocarcinoma, code cholangiocarcinoma.
A pathology report from a primary site has the highest priority for coding histology; however, there is no such pathology report in this case. We will review the histology coding instructions and add clarification in the next version. |
2014 |
|
20240055 | Update to the Current Manual/Tumor Size Summary—Neoadjuvant Treatment: Would you clarify instructions in the 2024 SEER Program Coding and Staging Manual (SPCSM) for Tumor Size Summary when a patient receives neoadjuvant treatment? There seems to be a conflict with the STORE Manual. See Discussion. |
Starting for cases diagnosed in 2024, the SPCSM manual no longer requires the data items for clinical and pathologic tumor size. Instead, it appears to align with the CoC data item of Tumor Size Summary. The two manuals contradict each other when it comes to coding tumor size summary for neoadjuvant chemotherapy (NAC) treated cancers. STORE states: "If neoadjuvant therapy followed by surgery, do not record the size from the pathologic specimen. Code the largest size of the tumor prior to neoadjuvant treatment; if unknown code size as 999." 2024 SPCSM states "If neoadjuvant therapy followed by surgery, do not record the size from the pathologic specimen. Code the largest size of the tumor prior to neoadjuvant treatment; if unknown code size as 999." It continues to state 12. Assign code 000 when…. (a) no residual tumor is found…(i) Neoadjuvant therapy has been administered and the resection shows no residual tumor & 14. Assign code 999 when...(d) Neoadjuvant therapy has been administered and resection was performed. Do not use a post-neoadjuvant size to code pathologic tumor size; however, you may use the clinical tumor size if available It seems that we will lose the value of the tumor size summary if we code 000 when NAC is administered and there is no residual disease. Example: Patient has a 90 mm triple positive breast tumor and is treated with neoadjuvant TCHP (docetaxel/carboplatin/ trastuzumab/pertuzumab). After completing neoadjuvant therapy, the patient has a mastectomy with no residual disease noted on the final pathology report. Using the 2024 SPCSM instructions, code 000 for Tumor Size Summary instead of 090 for the clinical tumor size of 90 mm tumor noted before NAC was administered. This has the potential to affect data analysis, research, and clinical trial accrual. |
When there is neoadjuvant therapy followed by surgery, do not record the size from the pathologic specimen. Code the largest size of the tumor prior to neoadjuvant treatment; if unknown code size as 999. We will remove Coding Instruction 12.a.i in the next version of the manual. |
2024 |
|
20220033 | When coding the Covid testing results, does SEER have any guidance on whether or not at home tests fall within reportability? For instance, if a medical provider says pt tested positive on an at home test, do we record that? |
When you have information about home COVID tests, record this information. For example, if the home test was positive record as follows: COVID-19 rapid viral antigen test POS 08/09/2022 |
2022 | |
|
20170019 | MP/H Rules/Histology--Testis: How should histology be coded for a mixed germ cell tumor that also includes choriocarcinoma now that non-seminomatous mixed germ cell tumors (9065) and seminomatous mixed germ cell tumors (9085) are collapsed for analysis? See Discussion. |
The MP/H Rules (Other Sites Terms and Definitions, Table 2) currently lists a separate mixed germ cell tumor code (9101) for germ cell tumors with choriocarcinoma plus teratoma, seminoma or embryonal carcinoma. Is this separate mixed germ cell tumor code still to be used now that all mixed germ cell tumors (9065 and 9085) have been collapsed into code 9085 for analysis per SINQs 20160056 and 20110013? The current WHO Classification for testis tumors does not list code 9101, but also collapses all seminomatous and nonseminomatous mixed germ cell tumors of more than one histologic type under code 9085. |
While WHO 4th Ed Tumors of Urinary and Male Genital System does not include 9101/3, this code has not been made obsolete. Follow the 2007 MP/H rules and code histology to 9101/3 per Other sites rule H16, Table 2. |
2017 |
|
20220030 | Histology--Lung: Is it acceptable to code histology as 8042/3 for a 2020 lung primary when the pathology report states only "oat cell carcinoma?" See Discussion. |
In the old 2007 Multiple Primaries/Histology rules, Lung Equivalent Terms and Definitions section, oat cell carcinoma (8042) was listed as one of the obsolete terms that was no longer recognized for small cell carcinoma. That note is not in the current 2018 Solid Tumor Manual lung chapter, and ICDO-3.2 lists oat cell carcinoma as the preferred term for code 8042/3. Would rule H4, Note 2 apply -- only one histology present, if not listed in Table 3 use ICD-O and all updates, to code oat cell carcinoma as 8042/3? |
While oat cell carcinoma is an outdated term, if that is all the pathology report states, code histology as 8042/3. Yes, Rule H4 applies: the diagnosis was a single histology. H4 instructs you to refer to the solid tumor H table, and if the term is not found there, check ICD-O and ICD-O updates. All possible histologic types that could occur in the lung may not be included in the table. |
2022 |
|
20190044 | Solid Tumor Rules (2018)/Histology--Colon: Is the term phenotype equivalent to type, subtype, variant for the purpose of coding histology? See Discussion. |
In our region, pathologists often describe histology using the term phenotype. However, the use of the term phenotype is not discussed in the Solid Tumor Manual. Example: Final Diagnosis of a colon tumor is invasive adenocarcinoma with a mixed phenotype, and the Diagnosis Comment states: The majority of the disease is poorly differentiated/signet ring cell phenotype. Would the histology be coded to 8490 (signet ring cell carcinoma), if the majority of the tumor is a more specific histology described by the term phenotype? |
While variant, type, and subtype can be used interchangeably according to the Solid Tumor Rules, SINQ 20170058 states that the Multiple Primaries/Histology (now Solid Tumor) Rules do not include coding phenotype. Code as invasive adenocarcinoma NOS (8140). |
2019 |
|
20200060 | First Course Treatment/Reportability: Are there situations for which a case with a class-of-case code in the 30's should be reported to the central registry? We know these are not reportable to the CoC, but should they be reported to the central registry? See Discussion. |
Example: 3/22/2017-26 year old white female seen in the emergency room with abdominal pain. Patient was diagnosed about a month ago with breast cancer. Impression: menstrual pain. In this example the patient is newly diagnosed with breast cancer, but the second hospital does not treat or diagnose the patient; pain management for a separate condition is received only. Is this patient reported due to the history of active disease? |
Work with your central registry to determine which cases they require you to report. In general, any case still undergoing first course of treatment, even if not given at your facility, should be reported to the central registry. Many central registries will appreciate knowing that the patient was seen at your facility to update date last seen and other data items. |
2020 |
|
20061111 | Reportability/Behavior--Skin: Is an "atypical fibroxanthoma (superficial malignant fibrous histiocytoma)" with an ICDO-3 histology code of 8830 reportable with a behavior code of 3 or is it nonreportable with a behavior code of 1? |
Yes, "atypical fibroxanthoma (superficial malignant fibrous histiocytoma)" is reportable. The information in parentheses provides more detail and confirms a reportable malignancy. |
2006 |