Report | Question ID | Question | Discussion | Answer | Year |
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20210078 | Solid Tumor Rules (2018/2021)/Multiple Primaries--Skin Cancer: How many primaries are assigned for sebaceous carcinomas using the Solid Tumor/Multiple Primaries/Histology Rules? Does this scenario represent eight separate primaries? See Discussion. |
Details 4/15/2018: Right abdominal wall mass excision: infiltrating sebaceous carcinoma. Noted to have a history of Muir-Torre/Lynch syndrome. 1/21/2019: Two left upper back mass excisions and two lower back (laterality not specified) mass excisions: infiltrating sebaceous carcinomas 8/7/2019: Excision of multiple sebaceous carcinomas from the right posterior back, left posterior thigh, left anterior abdominal wall, left anterior thigh, right scrotum, right lower abdominal fold, all positive for sebaceous carcinoma on pathology report 9/30/2020: Right gluteal mass, left gluteal mass, back (NOS) excisions: sebaceous carcinomas. 10/14/2020: Right back excision: sebaceous carcinoma. Op note: History of Lynch syndrome with multiple sebaceous carcinomas, recurrent back mass, site of prior mass resection. 10/18/2021: Right thigh excision: sebaceous carcinoma Proposed primaries using MP/H Other Sites Rules #1: 4/15/2018: C445-1 #2: 1/21/2019: C445-2, separate from #1 per M8, same as 1/21/19 C445-9 per M18 #3: 8/7/2019: C445-1, separate from #1 per M10, separate from #2 per M8 #4: 8/7/2019: C447-2, separate from #1 & #3 per M8, separate from #2 per M12 #5: 8/7/2019: C632, separate from #1 per M10, separate from #2-#4 per M11 #6: 9/30/2020: C445-2, separate from #1 & #3 per M8, separate from #2, #4 & #5 per M10 #7: 9/30/2020: C445-1, separate from #2, #4 & #6 per M8, separate from #1, #3 & #5 per M10; I do not think the back, NOS (C445-9) is a new primary per M18. #8: 10/18/2021: C447-1, separate from #2, #4 & #6 per M8, separate from #1, #3, #5 & #7 per M10 |
Assign the number of primaries following the Other Sites Solid Tumor Rules. Based on sites, laterality and or timing there are 8 primaries. This is similar to SINQ 20061112 that advised to follow the Multiple Primaries/Histology rules for sebaceous carcinoma. According to the WHO Classification of Skin Tumors, 5th edition, there is a 30-40% risk of local tumor recurrence, and 20-25% risk of distant metastasis. In only one instance did a physician refer this as a recurrence in the available notes. |
2021 |
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20200064 | Primary site--Heme &Lymphoid Neoplasms: What is the primary site of two extraosseous plasmacytomas, with positive pathology of right orbit and left lung. The patient's bone marrow biopsy, flow, and peripheral blood smear were negative. Is this coded as 9732/3, multiple myeloma (Primary Site and Histology Rule PH2) with the primary site as C809 (PH27)? Or is the primary site C421 since code 9732 says primary site is always C421, though bone marrow came back as negative? |
Assign the primary site to C421 since that is the only allowable primary site for plasma cell myeloma, even though the bone marrow was negative. According to the revised criteria from the WHO Blue Book for Hematopoietic and Lymphoid Neoplasms (2017), the presence of multiple plasmacytomas is plasma cell myeloma (9732/3). |
2020 | |
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20140062 | MP/H Rules/Multiple Primaries--Lung: Does lung MP/H Rule M6 apply to synchronous tumors only, metachronous tumors only, or both? See discussion. |
How many primaries should be reported when a patient has a history of RLL adenocarcinoma diagnosed on 10/8/2009 followed by diagnoses of LUL adenocarcinoma on 10/5/2012 and a RUL adenocarcinoma on 3/26/2014?
We applied Rule M6 to the 10/5/2012 diagnosis of LUL adenocarcinoma and reported an additional primary. However, we are unsure how to apply the MP/H rules for the 3/26/2014 RUL adenocarcinoma.
Should we apply Rule M8 because the RUL adenocarcinoma was diagnosed more than 3 years after the original RLL adenocarcinoma and then apply M6 because the RUL and LUL indicate a single tumor in each lung (resulting in a third primary); or does Rule M12 apply because there has been more than a single tumor in each lung (no new primary)? |
Assuming each of the three diagnoses is a single tumor and there are no other tumors in either lung, abstract two primaries: 1 in the RLL diagnosed on 10/8/2009 and 1 in the LUL diagnosed on 10/5/2012. Do not abstract the 3/26/2014 diagnosis as a new primary.
Rule M6 applies to the 2009 and 2012 diagnoses. Rule M12 applies to the 2012 and 2014 diagnoses. Do not compare the 2014 diagnosis to the 2009 diagnosis. Always compare the latest diagnosis to the most recent previous diagnosis in cases like this. |
2014 |
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20110110 | MP/H Rules/Multiple primaries--Head & Neck: If a 1991 neuroesthesioblastoma [9522/3] of the nasal cavity has subsequent recurrences of the same histology but later "recurs" in 2008 with "sarcoma, NOS, high grade" on a biopsy and a "high grade fibrosarcomatous transformation of esthesioneuroblastoma" [8810/3] on resection, should the subsequent tumor be reported as a new primary if the clinician continues to refer to the tumor as a "recurrence"? See Discussion. |
Are histologic transformations always recurrences of the original tumor? |
Assuming the same primary site for the 2008 lesion, according to the current MP/H rules the high grade fibrosarcoma [8810/3] is a new primary per Head & Neck MPH rule 11 because it is a different histology. The revised MP/H rules will include tables to define tumors that de-differentiate (transform) and recur with what is seemingly a different histology. Although the rules will be changed in the future, we must use the rules in place at this time for this case. |
2011 |
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20230012 | Solid Tumor Rules/Multiple Primaries--Prostate: How many primaries are accessioned when a 06/2022 diagnosis of prostate adenocarcinoma is followed less than one year later by a 01/2023 diagnosis of small cell carcinoma (SmCC)? See Discussion. |
Rule M4 was added to the Other Sites M Rules to address diagnoses of small cell carcinoma following prostate adenocarcinoma, but Rule M4 states the diagnoses must be greater than one year apart. In this situation, the diagnoses were less than one year apart and one must continue through the M Rules. The next M Rule that applies Rule M18: “Abstract multiple primaries when separate/non-contiguous tumors are on multiple rows in Table 2-21 in the Equivalent Terms and Definitions. Timing is irrelevant.” If one were to STOP at the first rule that applies, one would stop at Rule M18 which confirms the prostatic adenocarcinoma and small cell carcinoma are separate primaries, regardless of timing. If these are not to be accessioned as multiple primaries, does an Exception need to be added to M18? |
Assuming the smal cell is a seperate tumor, accession two primaries, adenocarcinoma (8140/3) of the prostate and SmCC (8041/3) of the prostate using Rule M18 of the current Other Sites Solid Tumor Rules. As these two tumors are less than a year apart, Rule M4 does not apply; however, Rule 18 does apply as these are two distinct histology types. It takes time for an acinar tumor to transform into the small cell and it is usually triggered by hormone and/or radiaiton treatment. |
2023 |
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20170075 | MP/H Rules/Behavior--Breast: How many primaries are to be abstracted for a patient with a history of left breast ductal carcinoma in situ (DCIS) diagnosed in 2014 and bone lesions showing metastatic carcinoma consistent with a breast primary in 2017? See Discussion. |
Patient was diagnosed with DCIS of the left breast in June 2014. The patient had a simple mastectomy with 2 axillary lymph nodes removed. The final diagnosis was intermediate to high grade ductal carcinoma in situ, predominantly micropapillary type, forming a 1.4 cm mass. No invasive carcinoma identified. Margins negative. In April 2017, the patient was found to have parietoccipital bone lesions, which were resected. The resulting diagnosis was metastatic carcinoma, morphologically consistent with breast primary " See Comment: The previous breast lesion is not available for review at the time of signout. However, the tumor is morphologically compatible with a breast primary. SINQ 20110111 would not make this is new primary. However, it seems that rule M8 might apply. An invasive tumor following an in situ tumor more than 60 days after diagnosis is a multiple primary. See Note 2: Abstract as multiple primaries even if the medical record/physician states it is recurrence or progression of disease. |
Assuming there were no other breast or any other tumors for this patient, change the behavior code to /3 on the original abstract for the 2014 breast primary. Similar to SINQ 20110111, there was likely a focus of invasion present in the original tumor that was not identified by the pathologist. The behavior code on the original abstract must be changed from a /2 to a /3 and the stage must be changed from in situ to localized. The MP/H rules do not apply to metastases. Therefore, rule M8 cannot be used. |
2017 |
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20160055 | Reportability--Bone: Is an "atypical cartilaginous tumor" reportable? See Discussion. |
Patient had a core needle biopsy of the right acetabulum. Final diagnosis on the path report is: Atypical cartilaginous tumor (formerly chondrosarcoma, grade 1).
Is this cell type reportable? If so, is it reportable only because the pathologist recorded clarifying text in parentheses? If the text in the parentheses was not available, is the histology "atypical cartilaginous tumor" reportable? |
Atypical cartilaginous tumor of bone is not reportable. The WHO terminology is "atypical cartilagenous tumor/chondrosarcoma grade I." WHO classifies this entity as low malignant potential (behavior code /1).
Chondrosarcoma grade II or grade III is reportable based on the WHO classification of malignant (behavior code /3). |
2016 |
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20190007 | Reportability--Skin: Is atypical intradermal smooth muscle neoplasm (AISMN) of the skin reportable? The comment on the path report states: Atypical intradermal smooth muscle neoplasm (AISMN) was previously termed "cutaneous leiomyosarcoma." |
Atypical intradermal smooth muscle neoplasm (AISMN), previously termed "cutaneous leiomyosarcoma," is not reportable. It is classified as a borderline, /1, neoplasm. |
2019 | |
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20150020 | Reportability/Primary site--Skin: Is a basal cell carcinoma of the lip "ever" reportable and if so, what would need to be documented or seen? See discussion. |
There is a 1988 case that hit the SEER edits for other reasons but not because of that site/histo combination (C000 and 8090/3); however, there is no text. Per a Dataminer query, there are 42 cases in the state database with C000-C009 and 8090. On review, a few did have a mention of the word "upper lip/mucosa" in the PE text or OP findings (not path because a lot of these are removed in the MD office and we don't see the path report). Other times, there is no mention but the abstractor used the C00 codes instead of C44 so the cases get through. SINQ #20031110 addresses this in relation to C000, Lip, NOS but we want to know if this answer meant you would never report a basal carcinoma lip case period (even if there is a mention of mucosa or any mention of mucosa in the path report). Are there any exceptions? It seems if you would never report a basal lip carcinoma, then SEER would block those cases from being reported/submitted and the wording would be stronger in the SEER manual. Right now the reportability only addresses if someone codes C44 but if someone decides to use C00 codes then it is allowed. Under Primary Site, there is even a listing under 12 for "absence of any additional information" and lists "Colored / lipstick portion of upper lip" as code C000. |
BCC of lip C00_ is rare and requires a statement that the tumor is on the vermilion border (rather than skin) to be coded C00_ and to be reported. Our expert pathologist consultant refers to an article in the Am Acad Dermatol 2004; 50(3): 384-387. |
2015 |
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20160005 | Reportability--Skin: Is this a reportable skin cancer? See discussion. |
Patient had a skin biopsy and this is the interpretation: NASAL SUPRATIP: INVASIVE BASAL CELL CARCINOMA OF SKIN WITH NEUROENDOCRINE DIFFERENTIATION
NOTE: The deep margin is positive for tumor; peripheral margins negative for tumor. The tumor has a basaloid appearance with focal areas appearing slightly squamoid, and it demonstrates myxoid/mucinous retraction from the stroma. It does not demonstrate peripheral palisading of cells within tumor nests and has nuclear chromatin which suggests neuroendocrine differentiation. Mitotic rate is more brisk than typical basal cell carcinoma as well. The differential diagnosis includes basal cell carcinoma with or without neuroendocrine differentiation, basal cell carcinoma with squamous differentiation, basaloid squamous cell carcinoma, Merkel cell carcinoma and metastatic small cell carcinoma. The tumor is further characterized per immunostains x 9 (controls work well). Tumor cells are positive for Ber EP4 and p63; focally positive for Chromagranin; while negative for EMA, CK20, CK7, TTF-1, CD56 and Synaptophysin. Overall, the staining pattern supports basal cell carcinoma with neuroendocrine differentiation. |
Basal cell carcinoma with neuroendocrine differentiation of the skin is not reportable to SEER.
In this case, the pathologist discussed several possible options, and determined that the final diagnosis is basal cell ca with neuroendocrine diff based at least partially on the immunostains. |
2016 |