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20230015 | Solid Tumor Rules/Multiple Primaries: Should two 2021 diagnoses be abstracted as two primaries? The patient has a history of thyroid cancer in 2008 with no evidence of recurrence/progression. In 2021, two abstracts were submitted with a diagnosis of C809, poorly differentiated malignant neoplasm and a C421, myeloproliferative disorder. See Discussion. |
2021-Right pleural fluid: Negative for carcinoma. 5/18/2021: Right iliac crest bone marrow core biopsy, aspirate smear, clot section and peripheral blood smear: Hypercellular bone marrow, morphological findings are suspicious for a myeloproliferative neoplasm. Flow Cytometry: Slight immunophenotypic abnormalities of the myeloid cells. No abnormal B cell, T cell, or NK cell populations identified. Normal female karyotype. KARYOTYPE: 46,XX[20]. Negative for deletion of 13q14.3 (D13S319) by FISH. Negative for deletion of 13q34 (LAMP1) by FISH. Negative for hyperdiploidy involving chromosome 9 by FISH. Negative for t(9;22)(q34;q11.2) by FISH. Negative for deletion of the EGR1 gene on 5q31 by FISH. Negative for monosomy 5 by FISH. Negative for deletion of 7q31 by FISH. Negative for monosomy 7 by FISH. Negative for deletion of 20q12 by FISH. Negative for trisomy of chromosome 8 by FISH. 6/4/21-Left adrenal; biopsy: poorly-differentiated malignant neoplasm with extensive necrosis. Immunohistochemical stains show the neoplastic cells to be negative for CK7, TTF-1 and p63. Negative CK7 and TTF-1 would argue against a lung primary. Correlation with clinical and radiological findings is advised. We are unable to contact the provider. |
Based on the diagnosis date for the unknown primary, use the 2007 MPH Other sites rules. Since the site codes differ for each primary, rule M11 applies, abstract two primaries. |
2023 |
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20220020 | Histology--Thyroid: What is the correct histology code for a thyroidectomy with final diagnosis of “Right lower lobe: papillary microcarcinoma, conventional type, 0.8 cm. Isthmus: papillary microcarcinoma, follicular variant, 0.2 cm. Left lobe: Papillary carcinoma, conventional, unencapsulated.” See Discussion. |
We were previously told that papillary microcarcinoma is coded to 8260 (papillary thyroid carcinoma) and not papillary microcarcinoma (8341). That is an area of confusion. |
Based on the information provided, code histology to follicular variant of papillary thyroid carcinoma (8340/3). The tumor is a mix of papillary and follicular variants. |
2022 |
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20140059 | Primary site--Bladder: What is the primary site for bladder tumor biopsy: invasive adenocarcinoma, enteric type favor urachal origin, stage III |
Based on the information provided, code the primary site to urachus (C677). Primary adenocarcinoma of the bladder accounts for less than 1% of all bladder malignancies. Of these, 20–39% are urachal in origin. |
2014 | |
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20220022 | Tumor Size--Pathologic--Anus: In 2019, the pathology report of an anal canal squamous cell carcinoma stated the tumor size is 2.5 cm from proximal to distal (3.5 cm in circumference). Is the pathologic tumor size tumor size 025 or 035? |
Based on the information provided, code the tumor size as 035. We asked an expert pathologist to review this question and she said to use the larger measurement. She also said "the pathologist usually cuts the anus and rectum open like a tube; the “circumference” would be measured flat." |
2022 | |
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20140061 | Primary Site/In Situ: How is primary site coded for an in situ carcinoma arising in a mucinous cystadenoma with ovarian stroma (focal) located in the right lobe of the liver? See discussion. |
The SEER Coding and Staging Manual instructs one to code the primary site to the location where the tumor originated, in this case the liver. However, there is no CS Extension code for in situ tumors found in the CS Manual Liver Schema. |
Based on the information provided, the primary site is liver. Submit the CS question to the CoC CAnswer Forum, http://cancerbulletin.facs.org/forums/content.php |
2014 |
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20140055 | Reportability--Heme & Lymphoid Neoplasms: Is this a reportable case and if so what codes would be used for the primary site and histology?
Lymph node flow cytometry and bone marrow biopsy revealed involvement by a low-grade B-cell lymphoproliferative disorder. Medical oncologist states monoclonal gammopathy, question marginal zone B cell lymphoma versus lymphoplasmacytic lymphoma/lymphoproliferative disorder. |
Based on the information provided, this case is not reportable. Low grade B-cell lymphoproliferative disorder is not reportable, nor is monoclonal gammopathy. There is no definitive diagnosis for marginal zone or lymphoplasmacytic lymphoma. The terminology used includes "question" and "versus" which are not acceptable ambiguous terms for reportability. If possible, follow up with the physician regarding the definitive diagnosis. |
2014 | |
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20130176 | Reportability--Ovary: Is an adult granulosa cell tumor of the right adnexa reportable if the left adnexa, diaphragm and paratubal tissue are reported to be consistent with metastasis? See discussion. |
Per the pathology report: Right adnexa: adult granulosa cell tumor. Left adnexa: Foci of metastatic granulosa cell tumor in paratubal tissue. Diaphragm smears: consistent with metastatic granulosa cell tumor. Comment: The morphology and immunoprofile of the cellular aggregates in the paratubal soft tissue are consistent with metastatic granulosa cell tumor. |
Based on the information provided, this case of adult granulosa cell tumor is malignant and reportable. According to our expert pathologist consultant, "though granulosa cell tumor NOS/ adult NOS is 8620/1, the presence of peritoneal implants or metastases, and/or lymph node metastases indicates the tumor is malignant, and it should be coded /3."
Note that the presence of implants or metastases does not indicate malignancy in the case of low malignant potential ovarian epithelial tumors. Our path expert explains "in contrast, by convention the behavior of borderline/LMP ovarian epithelial tumors is determined by the ovarian primary, and is /1, even though there may be peritoneal implants/metastases, or metastatic disease in lymph nodes. The treatment may vary in these circumstances, but to my knowledge the decision as to the tumor designation remains based on the primary tumor." |
2013 |
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20180109 | Date of diagnosis/Ambiguous terminology--Cervix Uteri: Is the date of diagnosis of a cervical pap smear done in December 2017, that states high-grade squamous intraepithelial lesion with features suspicious for invasion, followed by a cervical biopsy in 2018 positive for squamous cell carcinoma, in 2017? Is the ambiguous term used in the cytology in 2017 (suspicious for invasion) to determine diagnosis as the SEER manual states to use the ambiguous cytology as the date of diagnosis if confirmed later. |
Based on the information provided, this is a 2018 diagnosis. SEER has been asked to postpone implementing the instruction about using the date of the ambiguous cytology until 2019 or later. We will be removing that instruction from the draft 2018 SEER manual when it is finalized. |
2018 | |
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20170054 | MP/H Rules/Multiple primaries--Brain and CNS: How many primaries should be abstracted for a patient with a 2011 diagnosis of oligodendroglioma followed by biopsy of tumor which demonstrated progression in 2016 with pathology report Final Diagnosis indicating WHO grade III anaplastic astrocytoma? See Discussion. |
The clinical documentation clearly identifies residual tumor after the 2011 craniotomy. Scans demonstrated slow enlargement of the tumor over the years, which resulted in a repeat craniotomy. The pathologist noted in the diagnosis comment section of the pathology report that Is this a single primary per MP/H Rule M3 (A single tumor is always a single primary), or an additional brain malignancy per MP/H Rule M8 (Tumors with ICD-O-3 histology codes on different branches in Chart 1 or Chart 2 are multiple primaries)? |
Based on the information provided, this is a single primary. The 2011 tumor was not completely removed and progressed over the years. MP/H Rule M3 for malignant brain cancer applies. Do not change the original histology code. Use text fields to document the later histologic type of anaplastic astrocytoma, WHO grade III. |
2017 |
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20190038 | Solid Tumor Rules (2018)/Histology--Breast: How is the histology coded and which H Rule applies for a single tumor with final diagnosis of invasive mammary carcinoma and College of American Pathologists (CAP) synoptic report states, Histologic type: Invasive cribriform carcinoma with no mention of a tumor percentage? See Discussion. |
In the April 2019 Breast Solid Tumor Rules update, the Priority Order for Using Documentation to Identify Histology was changed, giving equal priority to the Final diagnosis / synoptic report as required by CAP (item 2B). There are technically two histologies documented for the case above; a Not Otherwise Stated (NOS)/No Special Type (NST) (invasive mammary carcinoma, per final diagnosis text) and subtype/variant (invasive cribriform carcinoma, per CAP report). If we do not use the synoptic report with priority over the final diagnosis, Rule H14 indicates the histology would be the NOS histology (invasive mammary carcinoma) because the percentage of tumor is not given for the subtype. However, SINQ 20180045 states, In the CAP protocol, the term Histologic Type is a label where the histology that corresponds to the largest carcinoma is collected. According to the CAP protocol for invasive breast cancer, the histologic type corresponds to the largest carcinoma. If the pathologist summarizes the findings in a synoptic report, should the specific Histologic Type identified have priority? |
Based on the synoptic report findings, code cribriform carcinoma using Breast Solid Tumor Rule H12 which says to code the histology when only one histology is present. The histologic type describes one histology and does not describe the components of an NOS/NST with a subtype, in which case a different rule would apply. The priority order for using documentation to identify histology gives equal weight to final diagnosis and synoptic report, secondary to addendum or comments. Use the more specific histology if either the final diagnosis or synoptic provides the additional information on the histology. |
2019 |
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