Report | Question ID | Question | Discussion | Answer | Year |
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20100019 | Histology--Ovary: How is histology coded for an ovarian mucinous neoplasm of low malignant potential (borderline mucinous cystadenoma) that shows extensive intraepithelial carcinoma and focal microinvasion? See Discussion. | At surgery a 25 cm left ovarian mass is found adherent to the anterior abdominal wall. The final diagnosis per the pathology report is, "Mucinous neoplasm (26 cm) of low malignant potential (borderline mucinous cystadenoma) with extensive intraepithelial ca and focal microinvasion. Right ovary, fallopian tubes, uterus, omentum, biopsies of diaphragm, 28 para-aortic and pelvic LNS and peritoneal fluid are all negative for malignancy." | Histology code 8470/3 [mucinous cystadenocarcinoma] is the best choice in this case. There is a mucinous cystadenoma [8470/0] with intraepithelial carcinoma and focal microinvasion. 8470/3 comes as close as possible to the description of the tumor. | 2010 |
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20100018 | Reportability/Heme & Lymphoid Neoplasms--Hematopoietic, NOS: Is light chain disease reportable if it is treated with chemotherapy agents? See Discussion. | A patient was diagnosed in 2010 with light chain disease based on SPEP and urine testing. Bone marrow aspiration and biopsy were done. Flow cytometry, cytogenetic studies and FISH for plasma cell disorders are all normal. Medical oncologist states diagnosis is light chain disease. Patient was started on Revlimid, dexamethasone and Velcade.
In reviewing the case reportability instructions, this seems to fall under Instruction 1, note 1. Immunoglobulin deposition disease, preferred term for light chain disease, is coded as 9769/1. This is normally a non-reportable diagnosis, but the patient was given cancer-directed treatment. Would this case be accessioned using the above morphology code and primary site of bone marrow [C42.1]? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case is not reportable. The histology is 9769/1 [light chain disease] in the Heme DB.
Light chains are produced in neoplastic plasma cells (multiple myeloma) and are called Bence-Jones proteins. The physician did the cytogenetic studies and FISH to rule out plasma cell disease. 50-60% of people with Light-chain deposition disease (LCDD) have an associated lymphoproliferative disorder, most commonly multiple myeloma. The remaining patients develop LCDD in the setting of progression of monoclonal gammopathy of unknown significance (MGUS) with no evidence of neoplastic plasma cell proliferation. This patient falls in this category, MGUS, which is not reportable. |
2010 |
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20100017 | MP/H Rules/Multiple primaries--Prostate: Does adenosquamous carcinoma found in the prostate represent a second primary in a patient previously diagnosed with adenocarcinoma of the prostate? See Discussion. | Patient was diagnosed many years ago with adenocarcinoma of the prostate and treated with hormonal and radiation therapy. The patient recently underwent a TURP and is found to have adenosquamous carcinoma of the prostate. The pathology report comment states squamous carcinoma of the prostate is rare and is often associated with a history of hormonal or radiation therapy. There is no information indicating a history of a squamous carcinoma in the urinary system that could have involved the prostatic urethra.
Would the MP/H rules make this a second primary with the histology of 8560/3 [adenosquamous carcinoma]? |
For cases diagnosed 2007 or later, based on the limited information available for this unusual case, abstract a second prostate primary and code the histology as adenosquamous carcinoma. Rule M3 does not apply in this case. Apply rule M10. | 2010 |
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20100015 | Type of Multiple Tumors/Multiplicity Counter--Breast. Are the data items "Type of Multiple Tumors Reported as One Primary" and "Multiplicity Counter" related? How should they be coded for breast cases in which there are multiple measured invasive tumors, plus DCIS which is not measured nor stated whether it is separate from the invasive tumors? See Discussion.
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For example, path report states only "multifocal invasive ductal carcinoma, 1.5 cm and 0.8 cm, and low-grade DCIS." The Multiplicity Counter instructions tell us to ignore/do not count foci that are not measured. Should we interpret this to mean, count only the two invasive foci and ignore the DCIS? Should Type of Multiple Tumors then be coded 30 or 40, because only the invasive tumors are coded in Multiplicity Counter? | Code Type of Multiple Tumors 30 [in situ and invasive]. The code in Type of Multiple Tumors may or may not reflect the tumors that were counted in Multiplicity Counter. For this case, it is correct to code 02 in multiplicity counter. | 2010 |
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20100014 | Reportability: Are there criteria other than a pathologist or clinician's statement that a registrar can use to determine reportability of gastrointestinal stromal tumors (GIST)? See Discussion. | Per SINQ 20091021 and 20021151, GIST cases are not reportable unless they are stated to be malignant. A pathologist or clinician must confirm the diagnosis of cancer. There are cases that are not stated to be malignant in the pathology report or confirmed as such by a clinician; however, these cases do have information that for other primary sites would typically be taken into consideration when determining reportability. The final diagnosis on the pathology report for all 16 cases is "GIST." The additional comment(s) for each of the 16 different cases is reported below. Are any of the following cases reportable?
1) Pathology report indicates that the bulk of the tumor is submucosal. It extends through the muscularis propria and abuts the serosa. 2) Pathology report states tumor extends to serosal surface of transverse colon, but not into muscularis propria. CD 117 and CD 34 are positive. 3) Pathology report indicates that tumor invades through the gastric wall to the serosal surface. 4) Pathology report indicates that tumor invades pericolic fat tissue. 5) No further information in pathology report, however, scans indicate omental caking. 6) No further information in pathology report, however, scans indicate hepatic metastases. Hepatic metastases are not biopsied. 7) Tumor stated to be unresectable and extends into pancreas. Chemotherapy given. 8) Pathology report states tumor is low to intermediate grade and involves serosal (visceral peritoneum). 9) Tumor size is 17.5 cm. Pathology report states "malignant risk". 10) Pathology report states tumor "into muscularis propria" or tumor "involves muscularis propria" or "infiltrates into muscularis propria". 11) Pathology report states, "high malignant potential; omentum inv by tumor." It is not stated in path report or final diagnosis to be malignant GIST. 12) Pathology report states that tumor arises from wall of small bowel and extends into thin serosal surface. 13) Pathology report states minimal invasion of lamina propria; does not penetrate muscularis propria. 14) Pathology report states, "high mitotic activity >10/50 HPF; high risk for aggressive behavior; moderate malignant potential." 15) Pathology report states tumor size is >5 cm. Intermediate risk for aggressive behavior; CD117+ KIT exon 11+. 16) Pathology report states "high risk of malignancy." |
For GIST to be reportable, the final diagnosis on the pathology report must definitively state that the GIST is malignant, or invasive, or in situ. Case 6 is the only exception. It would be reportable assuming the scan actually states "hepatic metastases." Based only on the information provided, none of the other examples are reportable. The type of extension and/or invasion mentioned in the other examples are not sufficient to confirm malignancy. Borderline neoplasms can extend and invade, but do not metastasize. Only malignant neoplasms metastasize. | 2010 |
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20100013 | Reportability--Lymphoma: Should a December 2008 diagnosis of in situ follicular lymphoma be accessioned? See Discussion. |
Patient with mesenteric lymphadenopathy had a biopsy. Consult supports original pathology findings: The histologic and immunophenotypic findings represent what has been referred to in the literature as "in situ follicular lymphoma." The oncology assessment states, "At this point the patient has no other obvious evidence of other disease. ...no hepatosplenomegaly...no peripheral adenopathy...no significant abnormalities on PET scan to suggest active lymphoma." No treatment is planned at this time. The patient will only be monitored. |
Do not report in situ lymphoma at this time. Currently, lymphoma cannot be reported with a behavior code of in situ (/2) and it would be incorrect to abstract in situ lymphoma as a /3.
It is true that this is a recently identified pathologic entity. Our experts say that there is still some controversy to be ironed out regarding the criteria for identifying an in situ lymphoma. Their recommendation was to wait until clear guidelines had been established for the pathologists before we start collection of in situ lymphomas. We anticipate collecting these entities in the future. |
2010 |
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20100012 | Date of diagnosis--Breast: How is the date of diagnosis coded when a mammogram describes only "suspicious calcifications" with a BIRADS category of 4 assigned and the suspicious calcifications are subsequently proven to be malignant on biopsy? See Discussion. | The date of diagnosis is the date when cancer was first diagnosed by a recognized medical practitioner, whether clinically or microscopically confirmed. Ambiguous terminology used to determine reportability is listed in part I of FORDS pages 3-4. No BIRADS categories are included and, therefore, should not be used by the registrar to determine the earliest date of diagnosis. In addition, the term "suspicious for calcification" is not reportable, because calcification is benign condition, unless the physician describes it as malignant. Reference 46637, 12/29/2009 FORDS - In the last paragraph there is a statement that no BIRAD categories are listed...cannot be used to determine earliest date of diagnosis. Does the SEER Program follow this guideline? | The date of diagnosis for this case is the date of the biopsy. There is no reportable diagnosis on the mammogram. | 2010 |
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20100011 | Reportability: Should a benign gangliocytic paraganglioma [8683/0] be a reportable (malignant) tumor based on the presence of lymph node metastases? See Discussion. |
"Resection, periampullary duodenum: Gangliocytic paraganglioma, with metastasis to one large periduodunal lymph node. Six other small lymph nodes negative. COMMENT: The primary tumor in the duodenum is made up mainly endocrine cell component. This component appears to have metastasized to a periduodenal lymph node." |
This neoplasm is reportable because it is malignant as proven by the lymph node metastases. Code the behavior as malignant (/3) when there are lymph node metastases. |
2010 |
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20100010 | MP/H Rules/Multiple primaries--Ovary: How many primaries are to be abstracted when a patient is diagnosed with serous cystadenocarcinoma [8441] of the right ovary and clear cell adenocarcinoma [8310] of the left ovary? See Discussion. |
Patient had bilateral ovarian tumors. The right ovary had serous cystadenocarcinoma and left ovary had clear cell adenocarcinoma. The pathology COMMENT section stated, "Based on the histologic differences of the tumors within each ovary, feel these represent two distinct separate primaries. Lymph node metastases are clearly serous ca." The physician staged the right ovary as T2a N1 M0 and left ovary as T1c N0 M0. Do we accession one primary per rule M7 [Bilateral epithelial tumors (8000-8799) of the ovary within 60 days are a single primary]? What is intention of Rule M7? If the histology in each ovary is different but within the range (8000-8799), is that supposed to be accessioned as one primary? Or is the intention of Rule M7 that tumors in both ovaries must have the SAME histology within that histology range to be a single primary? |
For cases diagnosed 2007 or later, apply rule M8 and abstract this case as multiple primaries. Rule M7 does not apply when each ovary has a distinctly different histology, even when both histologies are with the specified code range. This clarification will be added to the next version of the rules. |
2010 |
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20100009 | MP/H Rules/Multiple primaries--Bladder: Is a new primary accessioned for a 2009 diagnosis of transitional cell carcinoma of the bladder when the patient has a history of invasive bladder cancer NOS diagnosed? See Discussion. | A patient has a history of invasive bladder cancer diagnosed several years ago in another state. In 2009, the patient was admitted and found to have a positive biopsy for transitional cell carcinoma of the bladder.
Is this a new primary because the histology of the previous bladder cancer is unknown? When the histology of a previously diagnosed bladder cancer is unknown, should we assume the previous tumor was urothelial carcinoma? |
For cases diagnosed 2007 or later, apply rule M6. The 2009 diagnosis is not a new primary. Transitional cell carcinomas account for more than 90% of bladder cancers. If the patient actually had a rare small cell, squamous cell, or adenocarcinoma of the bladder in the past, it is highly likely it would be mentioned in the medical record. | 2010 |