Report | Question ID | Question | Discussion | Answer | Year |
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20081127 | MP/H Rules/Histology--Thyroid: How would the histology "micropapillary carcinoma" of the thyroid be coded for cases dx'd 2007 and after? | For cases diagnosed 2007 or later, assign code 8260/3 [Papillary adenocarcinoma] according to rule H14. For thyroid cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult, usually less than 1 cm. in diameter. |
2008 | |
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20081126 | MP/H Rules--Brain and CNS: Are stigmata of neurofibromatosis in the brain reportable neurofibromatosis lesions? See Discussion. |
Reference: SINQ 20051108; SINQ 20061018 Three year old patient with history of neurofibromatosis 1. 3/05 MRI of the brain showed right optic nerve glioma. It also showed heterogeneous high t2 signal in the middle cerebellar peduncles and near the genu of the internal capsules bilaterally are stigmata of neurofibromatosis type I. 3/08 MRI showed new mass suspicious for glioma in the hypothalamus. Clinical diagnosis is benign glioma secondary to diagnosis of neurofibromatosis. How many primaries are to be accessioned for this patient? Should the matrix principle be invoked for the second glioma? Should the behavior code for the glioma be 0? |
For cases diagnosed 2007 through 2017 Accession NF (9540/1) when there is CNS tumor -- a glioma or some other intracranial/intraspinal tumor. Stigmata of NF are reportable when the stigmata themselves are reportable tumors. For example, glioma, or another intracranial/intraspinal tumor. Do not report sitgmata that are only termed "stigmata seen on MRI," for example, without other reportable terminology. Do NOT accession NF (9540/1) when there is only peripheral nerve/nervous system involvement. Accession the neurofibromatosis itself only once per patient. Accession any initial neoplasm in the CNS separately. Abstract and code any subsequent CNS neoplasms according to the multiple primary brain rules. Accession three primaries for the case described above.
--> Optic nerve gliomas associated with NF are pilocytic astrocytomas. Code pilocytic astrocytoma as 9421/3 in North America. For cases diagnosed 2018 or later See the 2018 Solid Tumor Rules for Non-Malignant CNS tumors. |
2008 |
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20081125 | Reportability: Is the following tumor(s) reportable? MRI of thoracic spine shows intramedullary hemangiomas in the bodies of T5 and T6. | Intramedullary hemangiomas in T5 and T6 are not reportable. These benign tumors originate in the bone, not spinal canal, cord or dura. Benign tumors of the bone are not reportable. According to WHO, the most common sites of involvement are the vertebral bodies, followed by craniofacial skeleton and long bones. |
2008 | |
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20081124 | CS Extension--Brain and CNS: How is CS Extension coded for a malignant meningioma that demonstrates extension into adjacent brain tissue? For malignant brain tumors, code 60 represents extension into the meninges. Would code 60 be the correct code for extension from a malignant meningioma into brain tissue? |
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.Assign CS extension code 60 for malignant meningioma with extension to adjacent brain tissue. According to the I&R, this section of CS was taken directly from SEER Summary Staging, since AJCC does not have a staging system for these tumors. |
2008 | |
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20081123 | Reportability--Brain: Is angiocentric glioma, WHO grade 1 of the right frontal lobe reportable? If so, how is histology to be coded? | Angiocentric glioma is reportable. The best histology code currently available is 9380/1 [glioma, NOS; uncertain behavior]. According to the WHO Classification of Central Nervous System Tumours, Angiocentric glioma has a behavior of /1. WHO defines it as an epilepsy-associated stable or slowly growing cerebral tumour primarily affecting children and young adults; histopathologicaly characterized by an angiocentric pattern of growth, monomorphous bipolar cells and features of ependymal differentiation. |
2008 | |
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20081122 | MP/H Rules/Histology--Breast: Patient has single invasive left breast tumor diagnosed in 2008. Final pathology diagnosis is "Invasive solid papillary carcinoma". No mention of ductal in report. What is histology? | For cases diagnosed 2007 or later: As of July 2010: Code the histology 8503 [Infiltrating papillary adenocarcinoma]. This is solid papillary, not solid AND papillary carcinoma. Solid is an adjective modifying papillary, in other words, a subtype of papillary. We do not have a code for solid papillary, so we code to the NOS, papillary using rule H14. |
2008 | |
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20081121 | Multiple primaries/Histology--Lymphoma: How many primaries should be abstracted and how should the histology field(s) be coded in this situation? How would the bone marrow involvement by only NHL be handled? Composite lymphoma (9596) as defined by SEER and ICD-O is NHL and HD in one node which fits the final impression on the removed cervical node. See Discussion. |
Patient presented with cervical, supraclavicular & superior mediastinal lymphadenopathy. A cervical node was excised for pathological review. The final impression on that node was Composite lymphoma characterized by (1) Nodular Lymphocyte Predominant Hodgkin Lymphoma [HD] (2) CLL/SLL [NHL]. Then, a bone marrow aspirate/bx was performed revealing CLL/SLL [NHL]. | For cases diagnosed prior to 1/1/2010:This is a single primary. The histology code is 9596/3 [composite Hodgkin and non-Hodgkin lymphoma]. According to the Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table, 9596/3 followed by 9670/3 is one primary. For cases diagnosed 1/1/10 and later, 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. |
2008 |
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20081120 | MP/H Rules--Sarcoma: How many primaries should be abstracted for chondrosarcoma of right toe in 2002, of right lower leg in 2006 and right tibia in 2007? See Discussion. | A patient had a myxoid chondrosarcoma of the right toe in 2002. This was amputated and staged as T2 - high grade. Patient had a recurrence in the lower right leg in 2006. At this time he had a below knee amputation. The tumor in 2006 was stated to be similar histologically to the 2002 tumor with pathologic comparison done. Then in 2007 the patient presents with pain in right knee and stump. CT says compatible with recurrent disease, but no copies of path sent. Patient then had an above knee amputation, with diagnosis of clinically recurrent chondrosarcoma of tibia. How many primaries should be abstracted? Is 2007 diagnosis a new primary? | For cases diagnosed 2007 or later: Abstract two primaries in this case, 2002 and 2007. The first primary was diagnosed in 2002. The 2006 diagnosis would not be a new primary according to the rules in effect at that time (2004 SEER manual, page 11, rule 5, exception 1). Use the current MP/H rules to compare the 2007 diagnosis to the 2002 diagnosis. Start with rule M3 and stop at rule M10. The 2007 diagnosis is a separate primary. |
2008 |
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20081119 | Reportability/Date of diagnosis--Liver: Does the final diagnosis of a scan have higher priority than the findings in the discussion in the body of the report? See Discussion. |
A patient with liver cancer becomes transplant eligible when the tumor is 2 cm in size. Frequently, liver tumors will be watched (no biopsy) for months until they meet the 2 cm size criteria. In the meantime, multiple scans will describe the tumor using variations of ambiguous terms that drift in and out of reportablility. One day the tumor is labeled "presumed hepatocellular carcinoma." Weeks later it is back to "worrisome for hepatoma." A single scan will use different terms in different sections of the report. Example case: Abdominal CT reveals a 1 cm liver lesion. Per the discussion portion of the scan, the lesion is consistent with hepatocellular carcinoma. Per final diagnosis: 1 cm liver lesion, possibly hepatocellular carcinoma. Is this report diagnostic of cancer? Would the date of this report be the date of diagnosis? (Patient did receive a liver transplant for hepatocellular carcinoma months later.) |
When a reportable ambiguous term is used in one part of a report or the medical record and a non-reportable ambiguous term is used in another part of the report or the medical record, accept the reportable term and accession the case. The example above is reportable. "Consistent with" is a reportable ambiguous term. Accept "consistent with" over the non-reportable term "possibly." The date of this report would be the date of diagnosis if this is the earliest report using reportable terminology. |
2008 |
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20081118 | Surgery of Primary Site--Brain and CNS: How is this field to be coded when a patient undergoes stereotactic biopsy of a brain tumor? Path specimen consists of four fragments of tissue measuring .7, .6 and .3 cm. | Assign code 20 [Local excision (biopsy) of lesion or mass. Specimen sent to pathology from surgical event 20]. | 2008 |