Report | Question ID | Question | Discussion | Answer | Year |
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20230050 | Reportability/Histology--Soft Tissue: Is a diagnosis of Myofibroblastoma with sarcomatous transformation a reportable malignancy? See Discussion. |
Patient was diagnosed in September 2022 via excision of a 12 cm pelvic mass with final diagnosis of Myofibroblastoma with sarcomatous transformation. Diagnosis comment states, “Most of the tumor is composed of conventional features of myofibroblastoma. However, a focal area demonstrates increased cellularity, fascicular growth and increased mitotic activity (up to 11 per 10 hpf), consistent with sarcomatous transformation (morphologically low to intermediate grade).” Is this sarcomatous transformation describing a malignant transformation from an otherwise benign histology? If so, how should histology be coded in this case? |
Do not report the case. The histology is 8825/0 based on the example provided and not reportable. Myofibroblastoma with sarcomatous transformation is a rare, benign condition, sometimes referred to as sarcomatous features. A malignant tumor would be referred to as a myofibroblastic sarcoma. |
2023 |
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20230049 | Update to Current Manual/Surgery of Primary Site 2023--Skin: Regarding the 2023 skin surgery codes for punch biopsy NOS (B220) and shave biopsy NOS (B230), how is Date of First Surgical Procedure coded for cutaneous lymphoma and Kaposi sarcoma when the punch or shave biopsy is not excisional? See Discussion. |
Now that there are specific surgery codes for shave and punch biopsies, are these biopsies always the Date of First Surgical Procedure (NAACCR Item #1200)? Or should we still be applying the Surgery of Primary Site 2023 instruction in the SEER Manual that states shave or punch biopsies are most often diagnostic; code as a surgical procedure only when the entire tumor is removed and margins are free/gross disease is removed? We are aware of the instruction for melanoma cases outlined in SINQ 20230034; however, it is unclear if this should also apply to cutaneous lymphomas and Kaposi sarcomas, or if the intent of the procedure is used for these specific types of skin cases that typically present with multifocal involvement. Example 1: Patient is diagnosed March 2023 with primary cutaneous T-cell lymphoma presenting as pink, tan patches on the trunk. Punch biopsy diagnosed CTCL and treatment was given via narrow band UVB phototherapy. Example 2: Patient is diagnosed February 2023 with Kaposi sarcoma presenting as widespread violaceous macules, papules, plaques on the torso, bilateral extremities, and abdomen. Punch biopsy diagnosed Kaposi sarcoma. |
Code the Date of First Surgical Procedure (NAACCR Item #1200) as the date the shave, punch, or elliptical biopsy was performed. This instruction applies to cutaneous lymphoma and Kaposi sarcoma as well. Beginning with cases diagnosed 2023 and after, shave, punch, or elliptical biopsies are coded as a surgical procedure regardless of margin status. The instruction in the 2023 SEER Manual that states "shave or punch biopsies are most often diagnostic; code as a surgical procedure only when the entire tumor is removed and margins are free/gross disease is removed" has been deleted from the 2024 SEER Manual. Refer also to the Appendix C Coding Guidelines for Kaposi Sarcoma of All Sites and Lymphoma for coding primary site. |
2023 |
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20230048 | Solid Tumor Rules/Histology--Uterine Corpus: How is histology coded for an epithelioid and myxoid leiomyosarcoma of the myometrium? See Discussion. |
Patient had a total abdominal hysterectomy-bilateral salpingo-oophorectomy performed in January 2023 with final diagnosis of myxoid and epithelioid leiomyosarcoma. Diagnosis comment states: The tumor is 15 cm per report. It grows in nests and poorly formed interanastomosing trabeculae and cords that are separated by abundant myxoid background. The cells have an epithelioid morphology with eosinophilic cytoplasm, large nuclei, and very prominent nucleoli. The mitotic activity is overall low ranging from 1 to 3/10 HPFs. Immunohistochemical stains performed at the outside hospital showed diffuse positivity for SMA, desmin, caldesmon, and PR. They are negative for CD10, claudin-4, calretinin, HBM45, MART1 (rare weakly positive cells), PANCK, and SOX10. This immunohistochemical profile supports a smooth muscle derivation of this neoplasm. As this tumor is extensively myxoid, diagnostic criteria differ from the spindle cell leiomyosarcoma. Per Solid Tumor Rules Other Sites, Table 16: Uterine Corpus Histologies, Epithelioid Leiomyosarcoma (8891/3) and Myxoid Leiomyosarcoma (8896/3) are both subtypes of Sarcoma, NOS (8800/3). Per Rule H21, use a combination code when there are multiple specific histologies AND the combination is listed in Table 2 OR there are coding instructions for the combination in the applicable histology Tables 3-21 OR you receive a combination code from Ask A SEER Registrar. Since there is no combination listed in Table 2 and there is no instruction for the combination in Table 16, how should the histology be coded for this tumor? |
Assign code 8891/3 (epithelioid leiomyosarcoma) as cells were described as have an epithelioid morphology; whereas, myxoid was used as a descriptive term and not a specific histologic type. |
2023 |
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20230047 | Reportability/Histology--Head & Neck: Is a 2023 mandibular biopsy showing “severe squamous dysplasia with microscopic focus suspicious for superficial invasion” reportable? See Discussion. |
Patient had a mandibular mucosal lesion resected in June of 2023, with a diagnosis of “atypical squamous proliferation” and case was forwarded to an expert in oral pathology for best classification. Subsequent slide review final diagnosis was “moderate to severe squamous dysplasia.” That slide review diagnosis goes on to state “microscopic focus suspicious for superficial invasion.” Currently there is no ICD-O code for severe squamous dysplasia, however it is unclear if this terminology is equivalent to high grade squamous dysplasia (histology code 8077/2). |
Report as squamous cell carcinoma (8070/3) on the basis of “microscopic focus suspicious for superficial invasion.” "Severe dysplasia" is equivalent to "high grade dysplasia" in the Head and neck. As such, "severe squamous dysplasia" would be coded to 8077/2. However, in combination with the statement of "with microscopic focus suspicious for superficial invasion,” report as squamous cell carcinoma (8070/3) based on “microscopic focus suspicious for superficial invasion.” The 2023 SEER Manual instructs us to code the behavior as malignant (/3) if any portion of the primary tumor is invasive no matter how limited, i.e., microinvasion. Use text fields to record the details. |
2023 |
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20230046 | Reportability/Histology--Tongue: Is high grade squamous dysplasia of the tongue reportable; and is it the same as carcinoma in situ (CIS), code 8077/2? |
High grade squamous dysplasia of the tongue is reportable as of 2021 and later as 8077/2. |
2023 | |
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20230045 | Reportability/Histology--Thyroid: Is a diagnosis of “angioinvasive oncocytic thyroid neoplasm with features worrisome for a poorly differentiated oncocytic carcinoma” reportable if the diagnosis comment states, additional immunostains were performed which demonstrate the carcinoma cells are positive for thyroglobulin and negative for calcitonin? See Discussion. |
Patient had a right thyroid lobectomy on 12/2022, with initial diagnosis of “thyroid carcinoma pending expert consultation for definitive classification.” The slide review documented in the addendum shows a final diagnosis of “Angioinvasive oncocytic thyroid neoplasm, see comment.” The subsequent comment states, “I would classify this lesion as an angioinvasive oncocytic thyroid neoplasm with features worrisome for a poorly differentiated oncocytic carcinoma.” The comment goes on to state, “Additional immunostains were performed which demonstrate the carcinoma cells are positive for thyroglobulin and negative for calcitonin. The diagnosis remains unchanged.” |
Do not report angioinvasive oncocytic thyroid neoplasm with features worrisome for a poorly differentiated oncocytic carcinoma based on the final, unchanged diagnosis. Worrisome is not a reportable ambiguous terminology. |
2023 |
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20230044 | First Course Treatment/Neoadjuvant Therapy--Breast: What pathology report descriptions are permissible to use in coding the Neoadjuvant Therapy Treatment Effect data item? See Discussion. |
1) In the SEER Manual's code definitions for Neoadjuvant Therapy - Treatment Effect, some sites specify the percentage of viable tumor. Pathology reports often list this along with the percentage of necrosis (e.g., 10% necrosis and 90% viable tumor). If only the percent necrosis is stated, is it acceptable to infer the percent viable tumor? For example, pathology report states only "treatment effect: present, necrosis extent: 30%" - could we then deduce that the percent viable tumor in this case would be 70%? 2) Can statements of Residual Cancer Burden (RCB) Class be used? For example, pathology report states Treatment Effect: Residual Cancer Burden Class II, with no further description of partial vs. complete response. It appears that RCB Class II is a "moderate burden" of residual tumor after neoadjuvant therapy; could this be interpreted as a partial response in the Neoadjuvant Therapy--Treatment Effect code definitions? |
1) Do not infer the percent of viable tumor if only percent of necrosis is provided. For the example, assign code 6 when Neoadjuvant therapy was completed and the treatment effect in the breast is stated only as “Present". 2) Do not use the residual cancer burden (RCB) score from the pathology report to code the Neoadjuvant Therapy--Treatment Effect field for breast cancer. We do not have a crosswalk from RCB to neoadjuvant Therapy--Treatment Effect. RCB index is an accurate and reliable tool to assess patient prognosis. RCB is estimated from routine pathologic sections of the primary breast tumor site and the regional lymph nodes after the completion of neoadjuvant therapy. The data item Neoadjuvant Therapy--Treatment Effect records information on the primary tumor only. Document information in a text field in both examples. |
2023 |
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20230043 | Solid Tumor Rules/Histology--Lung: What is the histology code for a lung tumor diagnosed as “Minimally invasive adenocarcinoma, mixed mucinous and non-mucinous, grade 1, lepidic-predominant”? See Discussion. |
The resection pathology report final diagnosis indicates this is both mixed mucinous and non-mucinous with a lepidic predominant component. The pathologist notes this is “Lepidic: 75%. Acinar: 25%.” The percentage of the mucinous component is not documented. Rule H1, Note 1, states “When mucinous carcinoma is mixed with another histology, such as adenocarcinoma and mucinous carcinoma, code mucinous ONLY when mucinous is documented to be greater than 50% of the tumor.” While mixed invasive mucinous and non-mucinous carcinoma is included in Table 2 (Combination/Mixed Histology Codes) without a required percentage, it is unclear whether one should move past Rule H7 and use Rule H8 to code this combination histology code. Rule H7 would instruct one to code the histology to lepidic adenocarcinoma (adenocarcinoma, lepidic predominant) based on the percentage of the lepidic component in the tumor. However, this does not address the mixed mucinous and non-mucinous diagnosis. Which H Rule and histology apply to this case? |
Assign histology code 8254/3 (mixed invasive mucinous and non-mucinous adenocarcinoma) to this lung tumor using Lung Solid Tumor Rules, Rule H4. This is a new code/term approved by IARC/WHO for ICD-O. Rule H4 instructs one to code the histology when only one histology is present. In this case, the pathologist indicates the tumor is mixed mucinous and non-mucinous histologies. The non-mucinous carcinoma that is seen in this mixed histology may be identified as: Adenocarcinoma in situ, minimally invasive adenocarcinoma, or lepidic predominant adenocarcinoma. In this case it is lepidic predominant adenocarcinoma. Lepidic is a recognized histology in lung. It is not unusual for the pathologist to indicate mixed non-muncinous and mucinous adenocarcinoma AND also list the non-mucinous subytpe. It is important to capture both mucinous and non-mucinous histologies which drives treatment, etc. |
2023 |
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20230042 | First Course Treatment/Surgery of Primary Site--Rectum: What surgery code should be used for laparoscopic C/T open low anterior resection with colorectal anastomosis, loop ileostomy in diagnosis year 2020, code 30 or 40? See Discussion. |
Can you provide clarification on Rectum primary surgical code 40 Pull through WITH sphincter preservation (colo-anal anastomosis)? Would this be code 30 or 40 due to the colorectal anastomosis? |
Assign code 40, Pull through WITH sphincter preservation (colo-anal anastomosis). The National Cancer Institute Dictionary of Cancer Terms defines coloanal anastomosis as a surgical procedure in which the colon is attached to the anus after the rectum has been removed. It is also called coloanal pull-through. |
2023 |
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20230041 | Solid Tumor Rules/Multiple Primaries--Breast: Is an in situ tumor followed by an invasive tumor a single or multiple primaries? See Discussion. |
In the examples below, are these a single or multiple primaries? Example 1: Tumor 1: C509/left breast, 8520/2 (in situ lobular carcinoma), dx date-01/10/2019 Tumor 2: C509/ left breast, 8500/3 (carcinoma NST), dx date-08/19/2021 Example 2: Tumor 1: C509, right breast, 8520/2, dx date 06/26/2014 Tumor 2: C508, right breast, 8500/3, dx date-05/23/2019 There seems to be some conflicting info on this. In the 2020 Breast Rules there was a note add to the revision history. “M10 Same behavior requirement re-added.” Which is not in the rules now, nor was it noted to the revision changes in the last two change logs. Inquiry 20200070 would seem to indicate that this is multiple primaries, but that contrasts with 20230010 which would seem to indicate a single primary, and an ASK A SEER Registrar question that we received a response to. I don’t see a scenario where rule M17, an invasive tumor DX more than 60 days after an in situ tumor would come into play. If behavior no longer applies to rule M10, at what point did that change get made? Please advise. |
Abstract a single primary when there are multiple tumors of carcinoma NST/duct and lobular using the current Breast Solid Tumor Rules, Rule M10, May 2023 Update, for cases diagnosed 01/01/2018 and forward in the examples provided. The rule also notes to follow the H rules to determine the correct histology code when a mixture of behaviors is present in carcinoma, NST and lobular carcinoma. Rule M5 does not apply as the timeframe is less than 5 years in both examples. The 2023 update for the Breast Solid Tumor Rules (released November 2022) states: The rules for determining single versus multiple primaries in tumors with carcinoma NST/duct and lobular carcinoma have been revised and now align with ICD-O-3.2. Applicable Histology Rules have also been revised to reflect ICD-O-3.2 histology terminology and corresponding ICD-O codes. |
2023 |