Report | Question ID | Question | Discussion | Answer | Year |
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20200004 | Solid Tumor Rules (2018)/Multiple primaries--Lung: How are Primary Site and EOD Primary Tumor coded when a patient is diagnosed with four invasive tumors in the right lung that represent three separate primaries, but the not otherwise specified (NOS) tumor and one of the specific subtype/variants are in separate lobes? See Discussion. |
There are four invasive tumors in the right lung: Large cell undifferentiated carcinoma in the right lower lobe (8012/3, C343); Adenocarcinoma, acinar-predominant in the right lower lobe (8551/3, C343) that was 0.7 cm in size and limited to the lung; Mucinous adenocarcinoma in the right upper lobe (8253/3, C341) that was 0.9 cm and limited to the lung; Adenocarcinoma, NOS also in the right upper lobe (8140/3, C341) that was 1 cm and limited to the lung. The Lung M Rules confirm the large cell undifferentiated carcinoma is a separate primary from the three adenocarcinoma tumors (Rule M8). The acinar adenocarcinoma and mucinous adenocarcinoma tumors are separate primaries (Rule M6). The adenocarcinoma, NOS tumor is the same primary as both the acinar and mucinous are adenocarcinomas (Rule M7). How is Primary Site coded for both the acinar and mucinous adenocarcinomas if they represent multiple tumors reported as a single primary (when compared to the adenocarcinoma, NOS tumor)? Should the adenocarcinoma, NOS tumor also be included when coding EOD Primary Tumor for both the right lower lobe acinar adenocarcinoma and right upper lobe mucinous adenocarcinoma primaries? Further follow-up with the physician is not possible. |
Abstract three primaries using 2018 Lung Solid Tumor Rules, Rule M6 and M8 as these are multiple synchronous tumors. M6 (Subtypes in Column 3 of Table 3): Adenocarcinoma, acinar predominant: Primary Site: C343 (RLL) EOD Primary Tumor: 300 Mucinous adenocarcinoma Primary Site: C341 (RUL) EOD Primary Tumor: 300 M8 (Separate rows in Table 3): Large cell undifferentiated carcinoma: Primary Site: C343 (RLL) EOD Primary Tumor: 300 Note: The adenocarcinoma, NOS, along with the other subtypes, is on a different row than the large cell undifferentiated carcinoma and is already accounted for in Rule 6 as multiple synchronous tumors. Do not include the adenocarcinoma, NOS in EOD Primary Tumor for the reportable primaries. |
2020 |
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20190097 | Solid Tumor Rules (2018)/Multiple primaries--Lung: How many primaries are there and what M rules apply for multiple lung histologies in the left lower lobe (LLL) and right upper lobe (RUL) of the lungs? See Discussion. |
There is one tumor in the left lung that is acinar adenocarcinoma, 8551/3, and two tumors in the right lung, one of which is 8551/3 and a separate one that is mucinous adenocarcinoma 8253/3. 3/21/18- left robotic video assisted thoracoscopy with left lower lobe lobectomy: 2.5 cm adenocarcinoma, acinar predominant, margins negative 11/3/18- right upper lobe lobectomy: invasive mucinous adenocarcinoma, 1.7 cm, invasive adenocarcinoma, acinar predominant, 0.6 cm, margins negative If you start by comparing the 8551/3 left lung tumor to the 8253/3 right lung tumor, M6 applies and these would be separate primaries (seq 01 and seq 02). How would we handle the third tumor, 8551/3, in the right lung? Seq 01: 3/21/18- left lung primary 8551/3 Seq 02: 11/3/18- right lung primary 8253/3 Is the right lung tumor 8551/3 a third primary, and if so, which M rule applies? I cannot find a rule that seems to fit completely. Rule M6 may apply if you were comparing the right 8551/3 tumor to the seq 02 8253/3 tumor. But how would you know to use the seq 02 histology code 8253/3 or seq 01 histology code 8551/3 for the comparison? I think M9 was designed for situations where you have multiple tumors involving both lungs but they didn't biopsy all of them. Is that correct? If so, then we would be able to bypass M9. Would M11 apply since we already took care of two of the tumors with rule M6? If M11 doesn't apply, it seems like you would get to M14. |
Abstract two primaries applying Rules M6 and M9 s follows. First, assign a histology for each tumor. --LLL adenocarcinoma, acinar predominant 8551/3 --RUL invasive mucinous adenocarcinoma 8253/3 --RUL invasive adenocarcinoma, acinar predominant 8551/3 For the RUL, this is two primaries according to Rule M6, to subtypes in Column 3 of the histology table. For the LLL and RUL, this represents the same primary as these are the same histology according to Rule M9. |
2019 |
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20190073 | Solid Tumor Rules (2018)/Multiple primaries--Lung: How many primaries should be reported for a patient with a March 2018 diagnosis of non-small cell carcinoma with neuroendocrine differentiation on lung biopsy (single left upper lobe tumor only) who also has a prior history of left lung squamous cell carcinoma in 2016 (treated with chemotherapy/radiation)? See Discussion. |
The Solid Tumor Rules instruct us not to use differentiation for coding histology unless it is specifically listed in the table. The terminology non-small cell carcinoma with neuroendocrine differentiation is not in lung histology Table 2. However, SINQ 20150033, prior to Solid Tumor rules, indicates this diagnosis should be coded to 8574 (adenocarcinoma/carcinoma with neuroendocrine differentiation). This presentation appears to represent distinctly different histologies. However, because the 2018 histology diagnosis is not in the table and the prior SINQ appears to disagree with current instruction, it is not clear how to apply the M rules to this case. The outcome of the histology coding will affect the number of primaries reported in this case. |
Abstract separate primaries according to the 2018 Lung Solid Tumor Rules. Lung Table 3 is not an exhaustive list of lung histologies and the H rules instruct you to use the tables, ICD-O and/or ICD-O updates. Per ICD-O-3, carcinoma with neuroendocrine differentiation is coded to 8574/3; whereas, squamous cell carcinoma is coded to 8070/3. These represent distinct histologies on different rows in Table 3. |
2019 |
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20200055 | Solid Tumor Rules (2018)/Multiple primaries--Melanoma: Should a case with treatment delayed due to COVID-19 be abstracted as one or two primaries? It is uncertain if the invasive tumor would be a new tumor, or deeper extension/disease progression from the original tumor. See Discussion. |
11/18/2019 Left 1st Digit/Thumb Biopsy: Atypical Melanocytic Proliferation consistent with Early Acral Lentiginous Melanoma in situ. Margins Positive. (Not a reportable diagnosis for 2019.) 12/5/2019 Left 1st Digit Shave Biopsies: Malignant Melanoma in situ. Margins Positive. 1/15/2020 Started Aldara (treatment plan: use for ~3 months then Mohs/excision, but due to COVID could not get resection until 7/2020). 7/29/2020 Left Thumb Excision: Residual Melanoma in situ. Margins Positive. Treatment Plan: re-excision. 8/6/2020 Left Thumb Re-Excision: Atypical Lentiginous Melanocytic Proliferation at the 12-2 margin may represent the advancing edge of melanoma in situ. (8/19/2020 Plan to treat the 12-2 margin as positive with in situ; plan for re-excision). 8/20/2020 Left Thumb Re-Excision & Left Nail Plate Excision: Malignant Acral Lentiginous Melanoma with extensive melanoma in situ. Breslow 1.3mm. Margins Positive. Nail plate & bed epithelium with hemorrhage and a mild increase in melanocyte density likely represent melanoma in situ. 9/4/2020 Left thumb partial amputation & Left axillary Sentinel Lymph Node Excision: Residual Malignant Melanoma in situ. 0/3 sentinel nodes positive. |
Abstract a single primary using the Solid Tumor Rules for melanoma. Report this melanoma as invasive (/3) as documented in the information from 8/20/2020. The treatment delay does not influence the number of primaries to be reported. Registries in SEER regions: Report the COVID-related information as directed in the COVID-19 Abstraction Guidelines, https://seer.cancer.gov/tools/covid-19/. |
2020 |
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20180088 | Solid Tumor Rules (2018)/Multiple primaries--Prostate: How many primaries are abstracted and what M Rule applies when a patient is diagnosed with prostate adenocarcinoma in 2014, followed by liver mass biopsy showing neuroendocrine carcinoma, small cell type of the prostate in 2018? See Discussion. |
The patient has a history of prostate adenocarcinoma with lymph node metastases, status post prostatectomy and treatment by Lupron in 2014. The most recent prostate serum antigen measurement (April 2018) was normal. CT scan of the abdomen and pelvis revealed new hypodense liver lesions, a slightly enlarging lung right lower lobe nodule, and enlarging lobular mass in the prostatectomy bed. The core liver biopsy contains areas of metastatic tumor with a differential diagnosis on pathology of high-grade neuroendocrine carcinoma of the prostate (small cell type), which may have been seen in association with prostate adenocarcinoma, or metastatic small cell carcinoma of a different site. Clinically, the physician impression is that this represents metastatic castration-resistant prostate cancer. The Solid Tumor Rules note that the Multiple Primary Rules are not used for tumor(s) described as metastases. However, SINQ 20130221 indicates that, at least historically, these would have been accessioned as multiple primaries (histology 8140 & 8041 per Rule M10). Does the previous SINQ note still apply to these types of cases, and if so how would one know to move beyond the initial note indicating metastases are not new primaries? |
The guidance provided in SINQ 20130221 still applies. Accession two primaries, adenocarcinoma [8140/3] of the prostate [C619], followed by small cell (neuroendocrine) carcinoma [8041/3] of the prostate [C619] for each of the examples given per Rule M10 of the 2018 Solid Tumor Rules, Prostate. In each case, the second histology (because it is not adenocarcinoma) is a new prostate primary. Small cell carcinoma and small cell neuroendocrine carcinoma are not adenocarcinomas. As a result, they are not covered by Rule M3. For the case described in this SINQ submission, based on the findings of a lobular mass in the prostate bed, this is a second primary (there is residual prostatic tissue). This is unchanged from the 2007 Multiple Primaries Rules for Other Sites. |
2018 |
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20190083 | Solid Tumor Rules (2018)/Multiple primaries--Prostate: How many primaries should be reported when metastatic small cell carcinoma of the prostate is diagnosed at the same time as adenocarcinoma of the prostate? See Discussion. |
Patient has biopsy of prostate 12/28/2018 showing Gleason 5+5 adenocarcinoma. Liver biopsy on same date is metastatic small cell carcinoma consistent with prostate primary. Oncology consult states that liver biopsy is likely neuroendocrine conversion from prostate carcinoma. Patient also has bone metastasis and receives radiation, Lupron, Casodex, and chemotherapy of carboplatin and etopiside. Per Solid Tumor Rules, we code histology from primary site over a metastatic site. Thus, the small cell carcinoma, which appears to be the focus of the chemotherapy is lost. Is it correct to code this as a single primary with an adenocarcinoma histology? Both SINQ 20130221 and 20180088 instruct us to abstract multiple primaries when patient develops a metastatic small cell carcinoma of the prostate after being previously diagnosed with adenocarcinoma of the prostate. |
Accession two primaries, adenocarcinoma [8140/3] of the prostate [C619] and small cell neuroendocrine carcinoma [8041/3] of the prostate [C619] per Rule M17 of the Other Sites Solid Tumor Rules 2018, as these are different histologies with different histology codes at the second number. Adenocarcinoma of prostate often manifests as a small cell carcinoma following treatment or as a progression of disease. It is important to capture these tumors as new primaries. |
2019 |
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20200079 | Solid Tumor Rules (2018)/Primary Site--Brain and CNS: Should the updated note for optic nerve glioma be included in both the 2018 Solid Tumor Rules for Malignant Central Nervous System (CNS) and Peripheral Nerves, Note 6, and the Non-Malignant CNS Tumors, Note 5? See Discussion. |
Should the updated Note 5 from the Non-malignant CNS regarding optic nerve glioma also be incorporated into Note 6 for Malignant CNS rules (the pilocytic astrocytoma note)? This was one of the major issues identified in the SEER*Educate Workshop. Registrars have demonstrated they do not consistently think to look at the Non-malignant CNS schema when they see the term glioma and continue to misclassify optic nerve gliomas as malignant. This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The 2022 Solid Tumor Update will include a new note in the Terms & Definitions, Introduction section that will state: See the Non-malignant CNS rules when the primary site is optic nerve and the diagnosis is either optic glioma or pilocytic astrocytoma. The behavior is non-malignant and coded 9421/1. |
2020 |
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20210003 | Solid Tumor Rules (2018)/Primary Site--Head & Neck: The instructions for Table 9 of the Head and Neck Solid Tumor Rules instruct registrars to code the primary site to C479 (Autonomic nervous system) for paragangliomas that arise in the head and neck region, but the ICD-O-3.2 provides a site-associated code for most of these tumors (C754, Carotid body and C755, Paraganglion). Which primary site is correct? See Discussion. |
While we recognize that paragangliomas originate in the parasympathetic or sympathetic nervous system, these are endocrine tumors and endocrine glands/structures are not included in ICD-O site code C479 (Autonomic nervous system). Endocrine tumors of the paraganglia have their own site codes (C75_) per the ICD-O. Additionally, the ICD-O-3.2 provides specific sites for most of the paragangliomas included in Table 9. Per the ICD-O-3.2, carotid body paraganglioma is C754, and middle ear paraganglioma, glomus jugulare tumor, jugulotympanic paraganglioma, and paraganglioma (NOS) are C755. Why are paragangliomas not coded to the paraganglia sites (C75_) provided in the ICD-O? Should these sites be added to the Head & Neck schema for the specific paragangliomas arising in the head and neck? Obtaining consistency in coding primary site for these tumors will be difficult if registrars use the ICD-O provided site codes instead of the primary site statement preceding Table 9. Additionally, as most registrars may use the ICD-O provided site code, the Head and Neck schema in the Solid Tumor Rules would not apply, the Other Sites schema would apply to sites C754 and C755. |
Always code primary site to the site of origin. Look for information about where the neoplasm originated. Primary site should always be coded to reflect the site of origin according to the medical opinion on the case. Always code the primary site based on where the tumor arose / site of origin. Site of origin may be indicated by terms such as "tumor arose from," "tumor originated in," or similar statements. Refer to ICD-O-3.2 and ICD-O-3 for topographty codes that are associated with specific histologies whenthe medical documentation does not specify the primary site. |
2021 |
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20180064 | Solid Tumor Rules (2018)/Recurrence--Breast: Does any recurrence within the multiple primaries-stated timeframe count, not those just in the primary site? See Discussion. |
A patient has a left breast cancer diagnosed in 2011; then has a "recurrence" in her lymph nodes in 2017. In 2018, she has a new left breast mass that is the same histology and behavior as the 2011 cancer. Based on the 2017 "recurrence" in the lymph nodes, this is not a new breast primary, is that correct? |
This is a single primary using 2018 Breast Solid Tumor Rule M11. Rule M8 does not apply because the patient was not clinically disease free for 5 years. We are interpreting the 2017 diagnosis as lymph node metastasis from the 2011 breast cancer diagnosis. |
2018 |
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20210040 | Solid Tumor Rules (2018, 2021)/Histology--Breast: How is histology coded for a diagnosis ofmixed mucinous carcinoma? See Discussion. |
Patient was diagnosed with invasive ductal carcinoma with mucinous features in February 2021, left breast biopsies at 2:00 (3 cm from nipple) and 3:00 (8 cm from nipple) positions. Intraductal component was absent in those specimens. Subsequent left breast total mastectomy in March 2021, provided a final diagnosis of multifocal mixed mucinous carcinoma, grade 1, 27 and 8 mm and ductal carcinoma in situ (DCIS), low to intermediate grade, with focal mucinous features. The Staging Summary lists Histologic Type as mixed mucinous carcinomafor both foci of invasive carcinoma. DCIS is also noted as present negative for extensive intraductal component. There does not appear to be a clear instruction or code for this histology. As a central registry, we are unable to follow-up with the pathologist regarding this diagnosis. Just to be clear, there are 2 foci of invasive mixed mucinous carcinoma in this case measuring 27 mm and 8 mm. The DCIS component measured 56 mm. |
If the DCIS is separate from the mucinous, apply the breast M rules and abstract TWO primaries per M14. Since all we know of the “mixed mucinous” is there is mucinous present, code 8480/3. |
2021 |