| Report | Question ID | Question | Discussion | Answer | Cancer Site Category | Data Item Category | Year |
|---|---|---|---|---|---|---|---|
|
|
20000493 | EOD-Clinical Extension--Prostate: For prostate cancer, can an elevated PSA be used to code metastasis? See discussion. | 5/31/98 PE: 30 gm prostate with nodularity, suspicious for CA. Final diagnosis: Stage D Ca of prostate with mets, NOS PTA IVP: Normal collecting system 5/11/98 CXR: NED PSA 86.3 Suggestive of prostate Ca per MD 5/13/98 TURP and bilat. orchiectomy: Plan was to perform orchiectomy as treatment of choice if biopsy was positive. Appears MD feels that the patient has mets, NOS based on the elevated PSA. 5/13/98 TURP Adenocarcinoma, PD |
For cases diagnosed 1998-2003, do not code the EOD-Clinical Extension field based on elevated PSA alone. If a recognized practitioner states that there is metastasis, then metastasis should be coded.
In this case, code the EOD-Clinical Extension field to 85 [Metastasis] because it is Stage D. But if you had D1 or D2 staging based on the involvement of lymph nodes, then that involvement would be coded under EOD lymph nodes and not under the clinical extension field. |
Prostate | N/A | 2000 |
|
|
20091024 | MP/H Rules/Multiple primaries--Urinary: Are diagnoses in bladder, ureter, renal pelvis, and other urinary made prior to 2007 used in determining multiple primaries? See Discussion. |
Per the General Information for MPH, Rule #3, the rules are effective for cases diagnosed January 1, 2007 and after. Do not use these rules to abstract cases diagnosed prior to January 1, 2007. Example: Is a 2006 diagnosis of a renal pelvis primary with the histology 8130/3 and a 2007 diagnosis of a bladder primary with histology 8130/3 "multiple tumors" or is the bladder tumor a new primary because it is a single tumor at the time of diagnosis in 2007? |
For cases diagnosed 2007 or later: Use the 2007 MP/H rules for urinary sites to assess tumors diagnosed in 2007 or later. For the example above, use the 2007 rules to determine whether or not the bladder tumor diagnosed in 2007 is a new primary. Use the Multiple Tumors module when comparing a 2007 or later diagnosis to an earlier diagnosis. Start with rule M3. Stop at rule M8. The 2007 bladder urothelial tumor is not a new primary since there is an existing 2006 renal pelvis urothelial primary. |
N/A | N/A | 2009 |
|
|
20021094 | EOD-Extension/EOD-Lymph Nodes--Testis: If the patient received chemo, should "bulky retroperitoneal adenopathy" be coded as involved lymph nodes in the EOD lymph node involvement field for a testicular primary treated with an orchiectomy that rendered a path diagnosis of "seminoma confined to the testicle"? See discussion. | Per an orchiectomy path diagnosis a seminoma was confined to the testicle. The only other workup, other than a scrotal ultrasound, was a staging CT scan that revealed bulky retroperitoneal adenopathy in abdomen and pelvis, as well as mediastinal adenopathy. There was also a peripheral pulmonary nodule. No final clinical diagnosis or stage was provided in the chart. Following the orchiectomy the patient was treated with chemo. Should we also have coded distant site lung involvement? | For cases diagnosed 1998-2003, code the EOD-Lymph Nodes field to 9 [unknown] because "adenopathy" is not used to code lymph node involvement. The physician varied from the usual treatment for a localized testicular carcinoma, which is an orchiectomy. The physician proceeded immediately to chemotherapy as further treatment. It is not clear whether the decision to treat with chemo was based on the nodes and/or lung being involved.
Search the record for the physician's opinion regarding distant metastasis. Do not code distant involvement based on a peripheral pulmonary nodule seen on CT without further proof. If no further information is available, code the EOD-Extension field to 99. |
N/A | N/A | 2002 |
|
|
20110047 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when a patient is diagnosed with NHL, large B-cell lymphoma in 3/2010 followed by a "recurrence of previously diagnosed" NHL per a 12/2010 liver biopsy? See Discussion. |
Are there timing rules related to the comparison of slides from a subsequent hematopoietic primary diagnosis to the slides from the original hematopoietic primary diagnosis that impact the number or primaries reported? For example, how many primaries are reported for a patient was diagnosed in 3/2010 with large B-cell lymphoma who underwent 7 rounds of chemo. Per 10/2010 PET scan, there was no evidence of disease. In 12/2010 a liver biopsy revealed, "features consistent with recurrence of previously diagnosed non-Hodgkin lymphoma." The pathologist did not compare slides to the original, but several immunoperoxidase stains were done to obtain the final diagnosis in 12/2010. Does timing or comparison to the original slides matter for Heme & Lymphoid Neoplasms? Is a comparison of slides needed as required for solid tumor "recurrences"? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. This case should be accessioned as one primary per Rule M15, 9680/3 [diffuse large B-cell lymphoma]. Per Rule M15 one is to use the Heme DB Multiple Primaries Calculator to determine the number of primaries for all cases that do not meet the criteria of M1-M14. The 12/2010 liver diagnosis of NHL, NOS [9591/3] is the same primary per the Multiple Primaries Calculator. There are no timing rules for lymphoma other than rules M8-M13 which deal with the timing of chronic and acute diagnoses. SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
Heme & Lymphoid Neoplasms | N/A | 2011 |
|
|
20010033 | Grade, Differentiation--Breast: 1) If Van Nuys nuclear grade 2 is the only grade given for an in situ breast primary, would it be coded as a 3-component system (e.g., 2/3 = 3)? 2) Is there a way of determining grade if only the total Van Nuys Prognostic index score is given (e.g., score 7/9)? |
1. Code Van Nuys grade 2 as code 2 [Grade 2] in the Grade, Differentiation field. 2. Code Van Nuys score of 7 as 9 [Cell type not determined, not stated or not applicable] in the Grade, Differentiation field.
Currently, there is no conversion from the total Van Nuys score to grade because "grade" represents only one of the three Van Nuys factors that make up the total score. The other factors are tumor size and margin. The grade represents from 1 to 3 points within the total Van Nuys score. The total score can be between 3 and 9. |
Breast | N/A | 2001 | |
|
|
20061062 | Reportability: Is a "pleomorphic hyalinizing angiectatic tumor of soft parts (PHAT)" reportable if the case has a TNM stage assigned and is stated by the pathologist to be a rare intermediate grade sarcoma? | Pleomorphic hyalinizing angiectatic tumors of the soft parts are not reportable. According to our pathologist consultant, PHAT is a borderline malignancy (/1). While the true nature of these tumors is under debate (reactive vs. neoplastic), so far none have metastasized. |
N/A | N/A | 2006 | |
|
|
20210031 | Reportability--Brain and CNS: Are lipomas of the spinal column reportable as a benign tumor of the central nervous system (CNS)? This is seen occassionally at our pediatric facility. |
Spinal cord tumors (including lipomas) are reportable when they arise in the spinal dura or nerve root. The tumor must be of the spinal cord itself or within the spinal cord dura. Spinal cord tumors are reportable when they arise in the intradural space. A reportable intradural tumor can be either intramedullary or extramedullary. Extramedullary intradural spinal tumors are reportable. A spinal tumor originating in the extradural space is not reportable. If it is outside the dura, it is not reportable because it would be outside the CNS. They are not reportable when they arise in the peripheral nerves. |
Brain and CNS | N/A | 2021 | |
|
|
20021187 | Reportability: When a hospital pathologist sends the slides from an original biopsy to two or more outside reviewers and the reviewers differ on whether or not the case is reportable, is the case SEER reportable? Does the decision to treat the patient have any bearing on whether the case would be reportable? |
Typically, the final diagnosis of the reviewing pathologist is the one used to determine whether the case is SEER reportable. If two or more reviewing pathologists disagree as to whether the case should be reportable, determine reportability based on the following priority order: 1) If the patient is treated for cancer, the case is reportable. 2) If the patient is not treated for cancer, use the amended diagnosis on the original pathology report if the hospital pathologist used the reviewing pathologists' opinions in establishing his new diagnosis. 3) If there is not an amended diagnosis for the original hospital pathology report, use the clinician's opinion regarding what the diagnosis is to determine whether the case is reportable. |
N/A | N/A | 2002 | |
|
|
20100054 | MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned if a pathology specimen reveals an infiltrating mammary carcinoma with mixed tubular and lobular features, 2.3 cm, low grade cribriform in situ ductal carcinoma, and Paget disease of the overlying skin with ulceration? See Discussion. | According to SINQ 20081134 the histology would be 8524 if this is one primary. | For cases diagnosed 2007 or later, this is a single primary.
In order to determine whether this case represents a single or multiple primary, you must first determine the correct histology code for the underlying tumor. Using rule H9, ignore the DCIS.
See Table 3 in the equivalent terms and definitions. Infiltrating lobular, tubular, and Paget are coded to a single histology code (8524/3). Our current multiple primary rules do not say infiltrating lobular and tubular and Paget are a single primary. This was an omission and will be corrected in a future revision. Thank you for bringing this omission to our attention. |
Breast | N/A | 2010 |
|
|
20160048 | Reportability--Kidney: Is renal cell neoplasm of oncocytosis reportable based on the pathology from a nephrectomy? See Discussion. |
The pathology diagnosis reads: Diagnosis Right Kidney, Laparoscopic Nephrectomy:
-Renal Cell Neoplasm of Oncocytosis (pT1a, pNX See Comment and Template).
-Surgical margins free of tumor.
Kidney, right, nephrectomy:
Tumor histologic type: Renal cell neoplasms of oncocytosis (see Note)
Sarcomatoid features (%) Not identified
Tumor size: 4 cm (greatest dimension largest tumor)
Other dimensions: 2.7 x 2.5 cm
Macroscopic extent of tumor: Limited to kidney
Focality: Multifocal
Number of tumors: 11 grossly visible, range 0.2 4 cm
Fuhrman grade: 2 of 4
Microscopic extent of tumor:
Perinephric fat invasion: Not identified
Renal sinus invasion: Not identified
Other: N/A
Renal vein involvement: Not identified
Adrenal gland present: No
Involved by tumor: N/A
Direct invasion or metastasis: N/A
Cancer at resection margin: Not identified
Location(s): N/A
Pathologic findings in nonneoplastic kidney: Multiple collections of oncocytic cells
Hilar lymph nodes present: No
Number of involved/number present: N/A
"Thank you for sending this fascinating case. In reviewing the H&E-stained slides, we recognize that multiple lesions of varying sizes are present within the specimen, some with features of oncocytoma, some with those of chromophobe RCC, and yet others with features of both. The immunohistochemical studies for CK7 performed at your institution serve to highlight this point with "mass #1" showing focal single cell staining typical of oncocytoma and "mass #2" showing a patchy and confluent staining pattern typical of chromophobe RCC. This second mass was also positive with special stain for Hales colloidal iron. As mentioned, the morphology varies somewhat in each tumor, however, every single mass is comprised of cells with eosinophilic (pink to bright red) cytopolasm. Some tumors show more tightly nested or sheet like growth, others are more tubular or microcystic. Another important feature, present on slides of renal cortex are microscopic tumorlets seemingly emanating from eosinophilic tubules. This finding, along with the presence of numerous oncocytic neoplasms is supportive of the above diagnosis. The absence of clinical features to suggest Birt-Hogg-Dube syndrome is noted. Although these tumors are not recognized in the current classification of renal tumors, we regard these neoplasms as being a distinct entity, unrelated to both oncocytoma and chromophobe renal cell carcinoma, and have applied the designation "renal tumor of oncocytosis" to such lesions (Gobbo S, et al. Renal cell neoplasms of oncocytosis have distinct morphologic, immunohistochemical, and cytogenetic profiles. Am J Surg Patholl 34:620-626, 2010). We concur that the expected behavior in these cases is one of indolence." |
Do not report Renal cell neoplasms of oncocytosis. According to our expert pathologist consultant, these neoplasms do not behave "in a malignant fashion." They are not currently classified as malignant and are not reportable to cancer registries. |
Kidney, renal pelvis | N/A | 2016 |
Home
