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Report Produced: 10/16/2024 20:23 PM

Report Question ID Question Discussion Answer Year
20110081 MP/H Rules/Histology--Pancreas: What is the correct histology code for pancreatic neoplasia III (PanIN III) for cases diagnosed in 2007 and later?

Code histology for PanIN-III to 8148/2 [Glandular intraepithelial neoplasia, grade III]. The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology.

For cases diagnosed 2007 or later, the following steps are used to determine the histology code:

Open the Multiple Primary and Histology Coding Rules manual. For a pancreas primary, use the Other Sites Histo rules to determine the histology code because pancreas does not have site specific rules.

Go to the SINGLE TUMOR: IN SITU ONLY module, start at rule H1. Code 8148/2 [Glandular intraepithelial neoplasia, grade III]. There is only one histologic type identified.

In the next version of the MP/H rules, the H22 rule "Code 8148/2 (Glandular intraepithelial neoplasia grade III) for in situ glandular in sites such as the (PAIN III)" will be included under H2 as well. Currently the rule is only in the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY module and should also be include under the SINGLE TUMOR: IN SITU only module.

2011
20110080 Grade--Kidney, renal pelvis: How is this field coded for a non-invasive high grade papillary urothelial carcinoma of the renal pelvis? See Discussion. Per instructions in the 2010 SEER Manual, Appendix C, Coding Guidelines for Bladder, "Code grade 9 (unknown) for non-invasive urothelial (transitional) tumors." The Coding Guidelines listed under Renal Pelvis, Ureter are only for Kidney [C649]. Do the grade instructions under bladder apply to ALL non-invasive urothelial tumors, or are we to use the kidney grading instructions to code grade for renal pelvis and ureter malignancies? Code grade to 4 [high grade]. Follow the instructions in the main part of the 2010 SEER Manual under the data item Grade (pages 73 - 76). There are no specific instructions for coding grade for renal pelvis. Apply the general instructions in the absence of site-specific instructions. 2011
20110079 MP/H Rules/Histology: In the MP/H Manual, where is the documentation indicating "focal" is not a term that can be used to code histology? See Discussion. Example: neuroendocrine carcinoma with focal squamous differentiation. For the purposes of the MP/H rules, the term "focal" is not used to indicate a more specific histology. Terms that may be used to indicate a more specific histology are listed in the relevant histology rules. For example, see Breast histology rule H3. Notice the terms listed in the note for this rule are "type, subtype, predominantly, with features of, major, with ___ differentiation, architecture or pattern." The term "focal" is not included. This concept will be clarified in future revisions to MP/H rules. 2011
20110078 MP/H Rules/Histology--Bladder: What is the histology code for "high-grade urothelial carcinoma, plasmacytoid variant"? See Discussion. Per the MP/H Manual, Urinary Equivalent Terms & Definitions, Table 1, plasmacytoid is a specific type of Urothelial/Transitional Cell Tumor. What is the correct histology, and rule used, when a bladder resection pathology report states, "high-grade urothelial carcinoma, plasmacytoid variant"?

Code the histology to 8082/3 [urothelial carcinoma, plasmacytoid].

The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology for cases diagnosed 2007 or later. Unfortunately, in this case there is no current rule that directs you appropriately to Table 1 from Rule H7 to find this histology combination. We need to add an example under Rule H7 that instructs you to "See Table 1" for an urothelial carcinoma diagnosis that mentions a more specific cell type (e.g., plasmacytoid). We will add a reference to Table 1 in Rule H7 in the updates to MP/H Rules.

2011
20110077 MP/H Rules/Multiple primaries--Breast: How many primaries are to be reported if different recurrence scores are found on the Oncotype Dx studies performed for multiple tumors in the same breast if the clinician states the patient has two primaries but the pathologist does not address the issue? See Discussion. A patient has two separate lesions in the same quadrant with the same histology. According to the MP/H rules this is a single primary. However, Oncotype Dx studies were performed on both tumors and the DX recurrence was different for each tumor. The medical oncologist states the patient has two primaries. The pathologist does not indicate the number of primaries.

This is a single primary. The only rules used to determine the number of primaries are the MP/H rules for cases diagnosed 2007 or later. Do not use other information such as Oncotype Dx to determine the number of primaries for a patient. Oncotype is used to determine whether the cancer is likely to recur AND whether the cancer would benefit from chemotherapy.

The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules manual. Once in the manual, locate the Breast MP rules under one of the three formats (i.e., flowchart, matrix or text).

Start with the MULTIPLE TUMORS module, Rule M4. The rules are intended to be reviewed in consecutive order within the module from Rule M4 to Rule M13. You stop at the first rule that applies to the case you are processing.

The patient has two tumors in the same breast with the same histology. Abstract a single primary for this patient.

2011
20110075 Primary site--Heme & Lymphoid Neoplasms: How do you code primary site for a case of "leukemia cutis" when the bone marrow exam is negative for involvement with leukemia?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site to C421 [bone marrow] per Rule PH30 which states to use the to determine the primary site and histology when rules PH1-PH29 do apply. Leukemia cutis is the term for a leukemic infiltration of the epidermis, the dermis or the subcutis. This infiltration is easily identified as cutaneous lesions, but the primary site is still bone marrow. This is a type of "metastasis" or spread of the leukemia cells. The "conventional" definition for leukemia cutis is the infiltration of skin from a bone marrow primary. See the Hematopoietic & Lymphoid Neoplasm Coding Manual Glossary.

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.

 2011
20110074 First course treatment/Date therapy initiated--Breast: How is the Date of Initiation of Hormone Therapy field coded when a patient undergoes "Tamoxifen blunting" to achieve better MRI imaging after a biopsy but prior to definitive surgery which is followed by adjuvant Tamoxifen therapy? See Discussion. Patients are prescribed two weeks of "Tamoxifen blunting" to achieve better MRI imaging after biopsy confirmation of an ER/PR positive breast carcinoma. The Tamoxifen is subsequently discontinued and the patient has definitive surgery. Following surgery, maintenance Tamoxifen is initiated. Which date should be recorded for the Date of Initiation of Hormone Therapy field? Is it the first date when Tamoxifen blunting started or the post-surgical date when maintenance Tamoxifen is initiated? Use the post-surgical start date of maintenance Tamoxifen to code the Date of Initiation of Hormone Therapy field. The actual hormone treatment begins after surgery when Tamoxifen blunting was performed. The low dose administered prior to surgery does not affect the cancer. 2011
20110073 MP/H Rules/Multiple primaries--Sarcoma: Does a prior clinical diagnosis of a metastatic deposit for a previously diagnosed sarcoma have priority if the diagnosis on a subsequent resection (18 months later) indicates it is also a sarcoma but does not state it represents metastasis from the original sarcoma primary? See Discussion.

1/28/08 Patient was diagnosed with spindle cell sarcoma in the right gluteus muscle. Metastatic tumors were found in a vertebral body and in the lung. Chemotherapy was started.

4/22/08 PET scan done to evaluate response to chemo. The primary tumor had increased in size. New mass in the left thigh that was highly suspicious for metastasis found. (The left thigh tumor was not accessioned at that time as it was described as a metastatic tumor.)

7/3/09 Left thigh tumor was resected and path revealed spindle cell sarcoma. There was no mention that it represented metastasis.

Does the left thigh tumor represent a new primary per rule M12? Or does the previous clinical description of the left thigh tumor representing metastasis have priority?

this is a single primary per Rule M1. According to our expert pathologist, "if multiple solid tissue tumors are present (sarcomas), then almost always there is one primary and the rest are metastases. There are infrequent occasions of multifocal liposarcoma or osteosarcoma occurring, but the patient would be treated as a patient with metastatic disease."

The steps used to arrive at this answer are:

Open the Multiple Primary and Histology Coding Rules manual. For a soft tissue primary, use one of the three formats (i.e., flowchart, matrix or text) under the Other Sites MP rules to determine the number of primaries because soft tissue primaries do not have site specific rules.

Go to the UNKNOWN IF SINGLE OR MULTIPLE TUMORS module, Rule M1.

Rule M1 states, "It is not possible to determine if there is a single tumor or multiple tumors, opt for a single tumor and abstract a single primary." Given the information from the expert pathologist, this case should be reported as a single primary applying this rule.

2011
20110072 Multiplicity Counter/Date Multiple Tumors--Bladder: How are these fields coded when multiple tumors were present at the time of diagnosis and another tumor diagnosed a year later is determined to be the same primary? See Discussion. In November 2007, a nephroureterectomy showed an invasive TCC of the renal pelvis and a separate in situ TCC of the ureter. The Multiplicity Counter field is coded 02 and the Date Multiple Tumors is coded to November 2007. In December 2008, an in situ bladder tumor is found. Are the multiplicity fields to be updated to reflect the new bladder tumor?

Multiplicity Counter field was initially coded 02. Change the code to 03 because the subsequent, additional tumor was determined to be the same primary. Update the Multiplicity Counter field only once. If additional tumors are determined to be the same primary for this case, it is not necessary to update this field again.

Date of Multiple Tumors field was initially coded November 2007. Multiple tumors were present at the time of the initial diagnosis. Do not change the date of this field when additional tumors are subsequently diagnosed. This data item reflects the earliest date that multiple tumors were present. See example 2 under #3 on page 81 of the 2010 SEER manual.

2011
20110071 Primary site: How is this field coded for an adenocarcinoma arising in a chronic perianal fistula without extension to the anal canal, but stated to arise in "ectopic rectal tissue"? See Discussion.

The patient underwent a resection of a perineal mass. Per review of slides it was stated to be "primary mucinous adenocarcinoma arising in a chronic perianal fistula." The adenocarcinoma was invasive into the dermal connective tissue and skeletal muscle, but there was no extension into the anal canal. The discharge diagnosis from the reporting facility called this adenocarcinoma of "ectopic rectal tissue in perianal area."

Should the primary site be coded to skin based on the dermal involvement and lack of anal or rectal involvement? Or, should the primary site be coded to rectum based on the physician's assessment that this adenocarcinoma arose in ectopic rectal tissue?

For cases diagnosed 2007-2014:

Code the Primary Site field to C210 [Anus, NOS]. This is an unusual and rare presentation. According to our expert pathologist, "There is no ideal site code [for] this case. I would code to C210. In this location it can at least be located by anyone who wants to get a look at such lesions. Because of the unusual location of this tumor, I would like to be able to code it to perineum, but it will be totally lost in those site codes as they represent extensive areas beyond perianal (skin of trunk, soft tissue of pelvis, and pelvis, respectively)... I would not code to rectum [because it would be] lost among too many primary rectal carcinomas."

 2011