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| Report | Question ID | Question | Discussion | Answer | Year |
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20160064 | Behavior--Prostate: What is the correct behavior of intraductal carcinoma from a prostate biopsy with a Gleason score 4+4=8. While highly aggressive, but not suggestive of invasion, coding behavior as /2 seems inappropriate. |
WHO classifies intraductal carcinoma of the prostate 8500/2. According to WHO, "the hallmark of intraductal carcinoma of the prostate is a proliferation of prostate carcinoma cells that is within and may significantly expand the native prostatic ducts and acini, with the basal cell layer at least partially preserved." Further, differentiation between intraductal carcinoma and infiltrating high-grade carcinoma of the prostate may require basal cell stains. Under Prognosis, WHO states: " intraductal carcinoma of the prostate on prostate biopsies is often associated with high-grade cancer (with a mean Gleason score of 8) ." So while it may seem counter-intuitive, assign behavior code /2 when the diagnosis is intraductal carcinoma of the prostate. |
2016 | |
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20160050 | Reportability--Appendix: Is a mucinous cystic neoplasm with high grade dysplasia of the appendix reportable? See discussion. |
The language appears similar to the mucinous cystic neoplasm of the pancreas with high grade dysplasia (8470/2), which was clarified to be reportable in 2014. |
WHO does not list MCN as a histology for the appendix. This case should be clarified with the pathologist.
For pancreas specifically, the term "mucinous cystic neoplasm (MCN) with high grade dysplasia" replaced the term "mucinous cystadenocarcinoma, noninvasive" according to WHO. MCN with high grade dysplasia of the pancreas is reportable because it is used in place of the now obsolete terminology. If we did not make the new terminology reportable, trends over time could be affected.
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2016 |
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20250013 | Solid Tumor Rules/Multiple Primaries--Testis: How many primaries and what M Rule applies when metastatic seminoma is diagnosed greater than 40 years after a left testicular teratoma with yolk sac tumor and embryonal carcinoma? See Discussion. |
The patient was diagnosed with a left testis primary in the early 1980s that did not include a seminoma component per the information available. The slides were not available for review. In 2024, the patient was found to have a metastatic seminoma involving multiple pelvic lymph nodes and the prostate. The right testicular ultrasound was negative. The managing physician noted this was both a "relapsed seminoma" and a "Stage IIC seminoma." Should the new diagnosis of metastatic seminoma be accessioned as a new primary based on the histology differences? Or is this situation similar to SINQ 20160073 in which this is a single primary even though the metastases are a distinctly different histology? |
Without evidence of a new testicular tumor, record this as a single primary now with metastatic disease (seminoma). The seminoma may not have been identified in the original tumor and treatment was based on the histologies found. This allowed the seminoma to metastasize. |
2025 |
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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 |
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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 | |
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20000527 | Radiation: Is "consolidated" radiation therapy coded as part of first course therapy when there is no documentation of "planned treatment" and the radiation is done 4 months after the initiation of treatment? |
Yes, "consolidation" treatment is part of a planned treatment regimen. A treatment regimen may consist of the four following phases: 1. Induction (remission induction) 2. CNS preventive therapy 3. Consolidation/intensification 4. Maintenance |
2000 | |
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20160054 | MP/H Rules/Multiple primaries--Melanoma: How many melanoma primaries should be abstracted if, during the workup for a metastatic melanoma of an unknown cutaneous site, an in situ melanoma is also discovered? See Discussion. |
Patient has diagnosis of melanoma with spindle cell features found in a right lower lobectomy specimen. Chart notes indicate this is metastatic from a cutaneous primary of unknown site. Further work up includes a biopsy of the tip of the nose, which is diagnostic for in situ melanoma. Should this be abstracted as two separate primaries, one for an invasive melanoma of unknown primary site and the other for an in situ melanoma of the skin on the tip of the nose? Which MP/H Rule would apply? |
Yes, abstract this as two separate primaries, an invasive melanoma of unknown primary site and an in situ melanoma of the skin on the tip of the nose. Rule M3 applies. |
2016 |
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20160051 | Diagnostic confirmation: When a CT guided Fine Needle Aspiration is performed and the pathology report indicates smears and cell block were prepared, if the diagnosis is positive for cancer, can you code diagnostic confirmation as 2 (positive cytology) because of the cell block? |
Yes, assign diagnostic confirmation code 2 for diagnosis based on smears and cell block from CT guided FNA. This reply pertains to solid tumors. |
2016 | |
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20200050 | Surgery of Primary Site/Multiple primaries--Breast: Should the Surgery of Primary Site for the 2020 diagnosis be coded 51 (Modified radical mastectomy without removal of uninvolved contralateral breast) when a partial mastectomy and axillary lymph node dissection are performed for a 2011 right breast primary and a subsequent 2020 right breast primary is treated with a total mastectomy only? See Discussion. |
The patient underwent a partial mastectomy and sentinel lymph node biopsy, followed by an axillary lymph node dissection for the first right breast primary in 2011. The separate 2020 right breast primary was treated with a total mastectomy and removal of one involved axillary lymph node. The operative report only refers to this as a non-sentinel lymph node, with no mention of other axillary findings. Cumulatively, this patient has undergone a modified radical mastectomy since there were likely no remaining axillary lymph nodes. If the Surgery of Primary Site data item is cumulative, does the order of surgeries matter? It is unclear whether this question should be directed to SINQ (for coding in a SEER registry) or to CAnswer Forum because both have addressed similar surgery related questions in the past and and there is no guidance regarding this specific situation. |
Yes, assign surgery of primary site code 51 for the 2020 diagnosis in this case. Code the cumulative effect of all surgeries to the primary site. This means that for the 2020 primary, code the cumulative effect of the surgery done in 2011 plus the surgery performed in 2020. Use text fields on both abstracts to record the details. |
2020 |
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20150041 | MP/H Rules/Multiple primaries--Breast: Does rule M10 apply in this situation?
L breast biopsy = INVASIVE DUCTAL CARCINOMA
L breast simple mastectomy = 2.0 cm INVASIVE DUCTAL CARCINOMA with an incidental finding of separate 1.0 cm INVASIVE LOBULAR CARCINOMA; pathologist specifically states the tumors are morphologically different. The tumors are both pure Ductal/pure Lobular. |
Yes, Breast rule M10 applies. This case is a single primary.
Follow the MP/H rules even though the "pathologist specifically states the tumors are morphologically different" so that situations like this are reported consistenty accross cancer registries, regions, and states for consistent national reporting. |
2015 |
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