Report | Question ID | Question | Discussion | Answer | Year |
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20021130 | EOD-Extension--Breast: If a negative bone scan is followed by a bone marrow biopsy that is positive for metastatic disease, is the bony involvement used when coding extension [85] or as progression of disease (ignore mets when coding extension)? See discussion. |
Pt diagnosed with ductal carcinoma of the breast in May. On June 1, oncologist recommended chemo and XRT and planned a metastatic workup. A June 6 marrow MR consistent with mets. June 8 bone scan showed scoliosis of the L-spine with scattered focal areas of increased activity probably related to degenerative changes in the spine. On June 29, biopsies were done of the T2 vertebra with path diagnosis of metastatic adenocarcinoma consistent with breast primary. Chemo started July 15. For cases diagnosed 1998-2003, is EOD extension code 85 correct? We felt that the bone mets was found within 4 months of diagnosis and is not progression of disease. |
For cases diagnosed 1998-2003: Code the EOD-Extension field to 85 [metastasis]. Bone metastasis was documented during the original metastatic workup. Metastasis to the bone was suspected soon after diagnosis and confirmed prior to the start of treatment. The length of time between the diagnosis and the confirmation of the bone metastasis was not used to code extension on this case. The pt was still being worked up as evidenced by the fact that treatment had not yet started. |
2002 |
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20010012 | Surgery of Primary Site--Breast: What code is used to represent this field for a breast primary treated with a "bilateral mastectomy"? See discussion. |
Pt diagnosed with rt breast primary opted to be treated with rt modified radical mastectomy and lt simple mastectomy. Path revealed invasive ductal carcinoma on the rt and ductal carcinoma in situ on the lt. Path reported 14 axillary lymph nodes were found in the mastectomy specimen. |
There are two primaries. For cases diagnosed 1/1/2003 and after: For the rt breast, code Surgery of Primary Site to 51. The contralateral left breast malignancy is not involved with the right breast primary by either direct extension or metastasis. Codes 42 and 52 are used to capture prophylactic mastectomy of the opposite noncancerous breast. In this case, the opposite breast has cancer so these codes cannot be used. Code Scope of Regional Lymph Node Surgery to 5 and Surgical Procedure of Other Site to 0. For the lt breast, code Surgery of Primary Site to 41, Scope of Reg LN Surgery to 0, and Surgical Procedure of Other Site to 0. |
2001 |
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20061141 | Reportability--Leukemia: Is the diagnosis "a minority abnormal T-cell population (2-3%) with phenotypic features of large granular lymphocyte leukemia cells" reportable if it is from a flow cytometry procedure performed on a non-diagnostic bone marrow biopsy specimen? See Discussion. | Pt had only a bone marrow Bx done at the hospital. Bone marrow biopsy and aspirate: Peripheral blood showing mild relative lymphocytosis and mild relative neutropenia. Normocellular bone marrow (50%) with mild eosinophilia. No conclusive morphologic evidence of a neoplastic process. Flow cytometry of the marrow shows a minority abnormal T-cell population (2-3%) with phenotypic features of large granular lymphocyte leukemia cells. PCR is positive for a clonal T-cell population. The significance of these findings is unclear. COMMENT: Flow cytometry, PCR and morphologic correlation were performed at [names removed]. The significance of a minimal, clonal, large granulocyte leukemia population absent absolute lymphocytosis is unclear. Positive results for a T-cell receptor PCR study in the setting of mild leukopenia alone is reportedly relatively common and usually regarded as nonspecific. In essence, this could be characterized as a small, monoclonal T-cell proliferation of uncertain significance associated with mild leukopenia. Appropriate follow up is suggested. |
For cases diagnosed prior to 1/1/2010:Do not report this type of case until there is a definitive reportable diagnosis. Based on the information provided, this case is not yet reportable. It could develop into a reportable case in the future. For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ. |
2006 |
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20100109 | Reportability--Ovary: Does the ICD-O-3 term "stromal endometriosis" [8931/3] always imply a reportable malignant disease process if the pathologist also states there is "no evidence of carcinoma" in the same report? See Discussion. | ROS Final Diagnosis: LSO: Ovary with an endometriotic cyst (1.2 cm) and stromal endometriosis with multifocal papillary syncytial eosinophilic, clear cell and tubal metaplasia, no evidence of carcinoma.
COMMENT: There is extensive endometriosis involving the ovarian stroma and the ovarian surface. The ovarian stroma contains multiple cystic endometrial glands and surrounding endometrial type stroma with variable amounts of hemorrhage. There are non-cystic foci of endometriosis comprised of small, irregular glandular structures within the stroma. The lining of larger cyst/cysts is involved by a single layer of cuboidal to columnar cells with markedly eosinophilic cytoplasm in areas of serous (tubal) metaplasia and papillary projections suggestive of papillary syncytial metaplasia. Within these areas there is epithelial tufting and stratification, raising the consideration of proliferative/borderline change (which we cannot entirely exclude), however, given the background of endometriosis and morphologic similarity to papillary syncytial metaplasia in the endometrium, we favor that this is a non-neoplastic reactive change. There is no evidence of carcinoma. |
This case is not reportable. The pathologist states that there is no evidence of carcinoma. The ICD-O-3 matrix system applies, giving the pathologist the final say on behavior. | 2010 |
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20200011 | Race: How should race information from linkages be incorporated into the coding of Race? See Discussion. |
Race information is provided in the Centers for Medicare and Medicaid Services (CMS) linkage results. Oftentimes it matches what is coded in the database, but other times it does not. In situations where the CMS (or other) linkage provides a race value that differs from the coded Patient set, are we to ignore the CMS stated race given the SEER Manual instructions indicating self-reported race has priority or should we add the different Race values from linkages as an additional race (ex. Race 02)? |
Use self-reported race as the priority when information on race is available. Use the associated text field to document why a particular race code was chosen when there are discrepancies in race information. Generally, race information is used from linkages when race data is missing or unknown, or to enhance data. We will add clarification on linkages in the next SEER Manual update. |
2020 |
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20061060 | CS Site Specific Factor--Prostate: How are SSF 5 (Gleasons Primary and Secondary Pattern Value) and SSF 6 (Gleasons Score) coded when there is a higher Gleason's pattern in less than 5% of the tumor? See Discussion. | Radical prostatectomy pathology states prostate adenocarcinoma "combined Gleasons score 3+3=6, with a small portion of Gleasons pattern 4 component comprising less than 5% of tumor volume." The WHO Classification of Tumors of the Urinary System and Male Genital Organs refers to "tertiary" Gleasons patterns in addition to the primary and secondary patterns. On prostatectomy, when this tertiary pattern is 4 or 5, WHO recommends that it should be reported in addition to the Gleasons score even when it is less than 5% of the tumor. |
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2. Record Gleason's pattern and score from the largest specimen, even if this is a lower number. Ignore the tertiary pattern for now. This may change when the AJCC 7th Edition is published, as there is much discussion regarding the tertiary patterns and when they should be utilized. If there is a change in AJCC, at that time there will be a change to CS. |
2006 |
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20130190 | Reportability: Is a thymoma, type B3 malignant and, therefore, reportable? See Discussion. |
Recent information received from a registrar/pathologist states the WHO classifies well-differentiated thymic carcinoma [8585/3] as a synonym for type B3 thymoma. |
For cases diagnosed prior to 2021 Thymoma, type B3 [8585/1] is not reportable. Well-differentiated thymic carcinoma [8585/3] is reportable. WHO lists well-differentiated thymic carcinoma as a synonym for type B3 thymoma, but indicates the behavior code differs as indicated above. See the applicable SEER manual for cases diagnosed 2021 and later. |
2013 |
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20130170 | MP/H Rules/Histology--Breast: What is the histology code for "invasive carcinoma of the breast, no special type" as the final diagnosis on a pathology report? See Discussion. |
Recently pathology reports for breast primaries are no longer listing invasive ductal carcinoma as the histology on many cases if the treating physician calls the cancer an invasive ductal carcinoma. The pathology report (final diagnosis and synopsis) state this is invasive carcinoma, no special type.
Upon inquiry to the pathology department, the response received stated, In 2012, the WHO got rid of ductal carcinoma as a specific type. So what would have been called Invasive ductal carcinoma, Not Otherwise Specified (NOS), is now being called Invasive carcinoma, No Special Type (NST). In the new WHO classification, lobular, tubular, cribriform, mucinous, etc. are the special types. But ductal is gone.
Is this a change in terminology? Should these cases be coded as 8500/3 [ductal carcinoma, NOS] or 8010/3 [carcinoma, NOS]? |
Code the histology to ductal carcinoma, NOS [8500/3] for a pathology report with a final diagnosis of "invasive carcinoma, no special type." Do not code the histology to carcinoma, NOS [8010/3].
The 4th Edition of the WHO Classification of Tumors of the Breast refers to invasive ductal carcinoma as invasive carcinoma, no special type. The ICD-O-3 code remains the same as invasive duct carcinoma [8500/3]. The next revision to the MP/H Solid Tumor Rules will clarify this issue. |
2013 |
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20200070 | Solid Tumor Rules (2018)/Multiple Primaries--Breast: The December 2020 revision to 2018 Breast Solid Tumor Rules, Rule M10, using behavior rather than timing to determine the number of primaries, has caused synchronous separate/non-contiguous tumors reported as invasive carcinoma, NST (8500/3) and lobular carcinoma in situ (8520/2) (or vice versa) to be reported as separate primaries per Rule M14. Should an invasive carcinoma NST and a synchronous, separate lobular carcinoma in situ be separate primaries per M14? See Discussion. |
Recognizing the addition of the behavior requirement into this rule is an attempt to stop non-synchronous ductal carcinoma and lobular carcinomas from being accessioned as a single primary (SINQ 20200022), the issue with using behavior rather than timing is that now, synchronous separate/non-contiguous tumors that are invasive carcinoma NST (8500/3) and lobular carcinoma in situ (8520/2) (or vice versa) are separate primaries per M14. Lobular and carcinoma, NST are separate rows in Table 3, so we cannot stop at M10 and code the mixed histology because there are two separate histologies with different behaviors. There is no rule that states we can just ignore the in situ tumors for the purpose of applying the M Rules. (We are instructed to ignore the in situ when coding histology only in certain circumstances.) The problem with Rule M10 appears to be related to timing. This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The original issue with M10 was with registrars being instructed that multiple in situ and invasive tumors were a single primary and then coding 8522/3 when one tumor was in situ and one was invasive. This incorrectly identified both components as being malignant (/3). Our effort to correct this misconception apparently did not work. M10 has been revised to state that yes, an in situ lobular or duct plus an invasive lobular or duct is a single primary with a new note that states: When a mixture of behaviors is present in carcinoma, NST, and lobular carcinoma, follow the H rules to determine the correct histology code. They will stop at H8 which instructs them to code the invasive histology. 8522/3 should only be used when both components are invasive. |
2020 |
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20170064 | Grade/Histology--Rectum: How should histology and grade be coded for high grade neuroendocrine tumor (NET) (WHO Grade 3) of the rectum? See Discussion. |
Rectal mass biopsy final diagnosis: High grade neuroendocrine tumor (WHO Grade 3). Neither SINQ 20170033 nor 20160023 address coding histology or grade for neuroendocrine tumors that are designated as high grade and/or WHO grade 3. |
Assign histology code 8246/3. Assign grade code 4 based on the description "high grade." A high-grade neuroendocrine "tumor" is actually a neuroendocrine "carcinoma" (NEC) according to WHO Classification of Tumors of the Digestive System. If possible, verify this interpretation with the diagnosing pathologist. Use text fields to document the details of this case. |
2017 |