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| Report | Question ID | Question | Discussion | Answer | Year |
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20061136 | Primary Site: What site code best reflects the final diagnosis of a metastatic "pancreatobiliary" adenocarcinoma to the liver? See Discussion. |
CT showed multiple masses in the liver and lymphadenopathy in areas of gastrohepatic ligament, celiac axis, superior mesenteric and left periaortic regions. No mention of a mass in pancreas or common duct. When the term "pancreatobiliary" primary is stated in the final diagnosis, what site code should be used? |
Contact the physician for clarification of the term "pancreatobiliary." If no further information can be obtained for this case, assign code C249 [Biliary tract, NOS] based on the CT findings for the specific case in this question. When the primary is described as "pancreatobiliary" with NO FURTHER INFORMATION, assign C269. |
2006 |
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20170060 | MP/H Rules/Histology/Grade--Unknown & ill-defined sites: What is the correct histology and grade of a liver biopsy with metastatic neuroendocrine carcinoma low to intermediate grade if primary site is unknown? See Discussion. |
CT-guided liver biopsy, diagnosis: Metastatic neuroendocrine carcinoma. Diagnosis Comment: Cytology of the tumor appears to be low to intermediate grade. Would this case be coded as an atypical carcinoid tumor (8249/3) based on SINQ 20170033 and the statement of intermediate grade; or should this be 8240/3 (neuroendocrine tumor) per SINQ 20160023 because it is a metastatic site? More clarification is needed on when to code 8249/3 or 8240/3 for a neuroendocrine carcinoma or neoplasm seen in a metastatic specimen only when there is specified grade. |
Assign histology code 8246/3 and assign code 9 for grade. Since the primary is unknown and the type of NEC is not definitively stated, code neuroendocrine carcinoma, NOS based on the diagnosis. Code grade from primary tumor only. Assign grade code 9 when the primary site is unknown. See instruction 2.b. in the Grade Coding Instructions for 2014+. SINQ 20170033 and SINQ 20160023 provide instructions for coding the grade/differentiation field. Using these SINQ questions to code histology could lead to errors. |
2017 |
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20210061 | First course treatment/Update to current manual: Should the instruction regarding expectant management in the 2021 (and 2022) SEER Manual include how to code for the patient’s decision to proceed with expectant management? See Discussion. |
Currently, First Course Therapy instruction for expectant management (also referred to as active surveillance, watchful waiting, etc.) instructs one to code 0 or 00 (not done) for all data items when the physician opts for expectant management. We find that the treatment decisions can be driven by the patient, physician, or combination of both patient and physician depending on the options presented. |
Instructions for First Course of Therapy include using the documented first course of therapy (treatment plan) from the medical record. While a patient may weigh in on the treatment decision, the physician is responsible for developing and managing the treatment plan including closely watching a patient’s condition but not giving treatment unless symptoms appear or change. We can add language to a future manual to clarify. |
2021 |
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20180076 | Solid Tumor Rules (2018)/Histology--Head & Neck: Where does cytology rank on the Priority Order for Using Documentation to Identify Histology for Head and Neck primaries? See Discussion. |
Cytology is not listed in the Priority Order for Using Documentation to Identify Histology (Histology Coding Rules) in the Head and Neck schema. Other schemas do include cytology in the hierarchy below tissue from a biopsy or resection. Cytology is often less specific than histology, so one would expect cytology to be listed below tissue in this hierarchy. Was this an oversight? Or would cytology be equivalent to histology if it provided the most specific histology for the case? |
Instruction #5 in the Priority Order for Using Documentation to Identify Histology of the Head and Neck Solid Tumor Rules, Item 5.B., refers to cytology in the documentation though cytology is not listed before this. In H&N tumors, cytology is usually performed on lymph nodes and seldom on a primary tumor. Cytology will be added to H&N in the next update. |
2018 |
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20071056 | Reportability/Terminology--Prostate: Is the diagnosis of "atypical glands suspicious for adenocarcinoma" sufficient to report a prostate cancer if a note states that there is "insufficient atypia to establish a definitive diagnosis of malignancy"? See Discussion. | Date of report is July 2005. One positive specimen of 12. Specimen 6: Diagnosis = Prostate tissue with a small focus of atypical glands suspicious for adenocarcinoma. Note. There is insufficient cytologic and/or architectural atypia to establish a definitive diagnosis of malignancy. Negative basal cell staining with cytokeratin... in atypical glands is consistent with the diagnosis of suspicious for adenocarcinoma. In addition, the diagnosis is suppported by a positive staining for alpha-methyl COA racemase (P504S), a recently discovered marker that is preferentially expressed in prostate cancer... |
This case is reportable. The diagnosis states "suspicious for adenocarcinoma." "Suspicious for" is a reportable ambiguous term.
The additional stains supported this "suspicious" diagnosis. A more definitive diagnosis could not be made based on this specimen. |
2007 |
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20081062 | MP/H Rules/Date of Diagnosis/Behavior--Brain and CNS: How many primaries would be reported when a December 2004 MRI shows a pineal region mass with the major differential consideration being pineocytoma; a November 2007 MRI that shows the mass has almost tripled in size; and the December 2007 resection final diagnosis is consistent with pineoblastoma? How would diagnosis date[s] and behavior code[s] be coded? See Discussion. | Dec. 2004 MRI of brain: Pineal region mass. The major differential consideration given patient's gender, age group, and imaging characteristics is pineocytoma. The differential includes pineoblastoma or germ cell line tumor. These are felt less likely. Nov. 2005 MRI brain: stable exam since last MRI. No change in size. Nov. 2007 MRI studies: pineal mass has almost tripled in size. Dec. 2007 Surgical resection of pineal tumor: High grade (WHO Grade IV) pineal parenchymal neoplasm consistent with pineoblastoma. |
For cases diagnosed 2007 or later: Abstract as separate primaries:
Complete two abstracts when a previously diagnosed non-malignant tumor transforms or progresses to a malignancy. Refer to the CDC/NPCR guidelines for Data Collection of Primary Central Nervous System Tumors, 2004. Malignant transformation is discussed on page 50. |
2008 |
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20170033 | Grade--Appendix: What is the code and term to use for the grade/differentiation field for well differentiated, Grade 2 neuroendocrine tumor (NET)? See Discussion. |
Diagnosis: Fragmented appendix with: Goblet cell carcinoid tumor (typical goblet cell carcinoid): WELL DIFFERENTIATED neuroendocrine tumor; INTERMEDIATE GRADE (GRADE 2 NET). Size 3.5 cm according to surgical pathology report. Tumor infiltrates through appendiceal wall to subserosa. Tumor is present in what appears to be the wall of the appendix near the perforation site or in hemorrhagic tissue on the surface of the appendix. MAXIMUM MITOTIC RATE IS TWO (2) FIGURES PER 10 HIGH POWER fields (2/10hpf). (4/10 hpf according to report). WD indicates a 3- grade system (code 1 for WD) Intermediate grade indicates a 3- grade system (code grade 3 for intermediate grade), Grade 2 indicates a 2- grade system (code 2 for grade 2). Please advise. |
See SINQ 20160023 for NET grade coding instructions. Coding grade for NETs is slightly different from coding grade for other solid tumors. Since this diagnosis includes "Well differentiated" and "Grade 2," assign grade code 2, the higher grade. According to our expert pathologist consultant, "intermediate" fits best with grade 2. |
2017 |
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20130139 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded when the original slides are reviewed at a later date and the revised diagnosis changes the histology? See Discussion. | Diffuse large B-cell lymphoma [9680/3] diagnosed in 5/2010 and treated with chemotherapy. In 11/2012 a bone marrow biopsy revealed small lymphocytic lymphoma (CLL/SLL) [9823/3].
The 2010 slides were reviewed and showed, "a large cell lymphoid proliferation, many of the cells which appear to be prolymphocytes. There are background smaller lymphocytes that are consistent with CLL/SLL. In retrospect, the lymph node most likely represented a prolymphocytic conversion in SLL."
The medical oncologist is calling this a recurrent lymphoma. Should the original 5/2010 diagnosis be changed to 9823/3 [CLL/SLL]? Is this documented in the Heme Manual? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Change the histology of the original 2010 diagnosis to 9823/3 [chronic lymphocytic leukemia/small lymphocytic lymphoma] based on the review of the 2010 slides. The 2010 diagnosis was revised based on the review of slides and the histology should be changed accordingly. The closest example of this is located in the SEER Manual, Changing Information on the Abstract, instruction 3, example 4.
Histology code 9670/3 [SLL] is obsolete for cases diagnosed 2010 and later. All diagnoses of CLL/SLL, CLL, and SLL are now coded to histology code 9823/3 [CLL/SLL].
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. |
2013 |
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20230038 | Histology/Heme & Lymphoid Neoplasms--Mycosis Fungoides: What is the histology code for lymphomatoid papulosis that transforms initially to mycosis fungoides (MF)/cutaneous T-cell lymphoma (CTCL) and subsequently to CTCL with large cell transformation, and is it a new primary? See Discussion. |
Disease History 2018 - Lymphomatoid papulosis (non-reportable) 2020 - Transform to CTCL (and called Mycosis Fungoides specifically) (CTCL/MF same primary) 2021 - Transform to CTCL with large cell transformation |
Abstract a single primary and assign code 9700/3 for MF. According to our subject matter expert, this is all MF. When MF progresses, there can be large cd30 positive T cells. This is not the same as anaplastic large cell lymphoma. |
2023 |
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20110029 | DCO/Multiplicity Counter/Type of Multiple Tumors: How are these fields coded for an unknown primary reported as a DCO case? See Discussion. | Do DCO cases have default values for the Multiplicity Counter and Multiple Tumor Reported as One Primary fields? Should these fields be coded as 88 or 99?
In the data item pages for these fields, there is only a reference to see the NAACCR Death Clearance Manual. However, this manual does not provide an answer. There is guidance to use code 88 for unknown primaries but we noticed that SEER edits skip enforcing this requirement for DCO cases (see SEER IF205 and 206). |
For a DCO case reported as an unknown primary [C809], code Multiplicity Counter to 99 [Unknown if multiple tumors; not documented] and Type of Multiple Tumors Reported as One Primary to 99 [Unknown]. | 2011 |
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