Report | Question ID | Question | Discussion | Answer | Year |
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20170077 | First Course Treatment: Should the definition in the 2016 SEER Coding Manual be revised for first course of treatment following disease progression for patients who complete the initial first course treatment plan without alteration but had one or more treatment modalities given after disease progression was identified? See Discussion. |
The FORDS Manual (pg. 22) states: The first course of treatment includes all methods of treatment recorded in the treatment plan and administered to the patient before disease progression or recurrence. The instructions in the FORDS Manual and clarification from multiple CAnswer Forum posts indicates the planned first course treatment stops following disease progression, even when the first course treatment plan is not altered or changed. SEER, on the other hand, instructs registrars to do the opposite. The SEER Manual instructs registrars to code all completed treatment given as part of the initial first course treatment plan, even after disease progression, provided the treatment plan is not changed or altered. (See 2016 SEER Manual, Section VII First Course of Therapy, Treatment Timing, Rule 1 and Example 1.) For consistency in data collection, shouldnt the standard setters use the same guidelines to define first course treatment? Given that the majority of cases are reported to SEER by registrars in CoC facilities, who may not be abstracting treatment modalities that occur after progression, the SEER expectation is likely not able to be performed consistently. Wont this difference in standard setter data collection expectations negatively impact the treatment data reflected on our files? |
The example cited above will not be included in the 2018 edition of the SEER manual. Removing this example will improve the consistency in recording first course of treatment for cases diagnosed 2018 and later. |
2017 |
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20170076 | MP/H Rules/Histology--Brain and CNS: Is meningioma with atypical features coded as meningioma (9530/0) or atypical meningioma (9539/1)? See Discussion. |
Pathology report microscopic description: The tumor is a meningothelial neoplasm (EMA+; BCL-2 and CD34 negative) with prominent collagen deposition. Necrosis and prominent nucleoli are present; no other atypical features are seen. Mitoses are present, up to 2 per 10 high-powered fields. Final Diagnosis: Dura, bicoronal craniotomy (specimen A): Meningioma with atypical features. There is no rule in benign brain and CNS section of Multiple Primary/Histology (MP/H) Rules stating to code the most specific histologic term when the diagnosis is (something less specific, i.e., adenocarcinoma). This rule is in other site chapters of MP/H but appears missing in the benign brain and CNS section. |
Code as meningioma, NOS (9530/0). This lesion has some of the features of an atypical meningioma (necrosis and prominent nucleoli), but it does not fit the definition of atypical meningioma in WHO Classification of Tumors of the Central Nervous System. Use text fields to document the details. |
2017 |
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20170075 | MP/H Rules/Behavior--Breast: How many primaries are to be abstracted for a patient with a history of left breast ductal carcinoma in situ (DCIS) diagnosed in 2014 and bone lesions showing metastatic carcinoma consistent with a breast primary in 2017? See Discussion. |
Patient was diagnosed with DCIS of the left breast in June 2014. The patient had a simple mastectomy with 2 axillary lymph nodes removed. The final diagnosis was intermediate to high grade ductal carcinoma in situ, predominantly micropapillary type, forming a 1.4 cm mass. No invasive carcinoma identified. Margins negative. In April 2017, the patient was found to have parietoccipital bone lesions, which were resected. The resulting diagnosis was metastatic carcinoma, morphologically consistent with breast primary " See Comment: The previous breast lesion is not available for review at the time of signout. However, the tumor is morphologically compatible with a breast primary. SINQ 20110111 would not make this is new primary. However, it seems that rule M8 might apply. An invasive tumor following an in situ tumor more than 60 days after diagnosis is a multiple primary. See Note 2: Abstract as multiple primaries even if the medical record/physician states it is recurrence or progression of disease. |
Assuming there were no other breast or any other tumors for this patient, change the behavior code to /3 on the original abstract for the 2014 breast primary. Similar to SINQ 20110111, there was likely a focus of invasion present in the original tumor that was not identified by the pathologist. The behavior code on the original abstract must be changed from a /2 to a /3 and the stage must be changed from in situ to localized. The MP/H rules do not apply to metastases. Therefore, rule M8 cannot be used. |
2017 |
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20170074 | Reportability--Kidney: Is a renal cell neoplasm stated to be multilocular clear cell renal cell neoplasm of low malignant potential a reportable tumor if the physician refers to the tumor as renal cell carcinoma in a follow-up note after surgery? If reportable, how is histology coded? See Discussion. |
The partial nephrectomy final diagnosis is renal cell neoplasm. The College of American Pathologists (CAP) Summary lists histology as: multilocular clear cell neoplasm of low malignant potential. The diagnosis comment adds: This neoplasm currently termed multilocular clear cell renal cell neoplasm of low malignant potential (WHO 2016), was previously termed cystic renal cell carcinoma. |
For now, report the case and code to 8310/3. In the 3rd Ed WHO Tumors of the Urinary System, multilocular clear cell RCC is coded as 8310/3, however the recent 4th Ed WHO Tumors of Urinary System notes this term is obsolete and a synonym for multilocular cystic renal neoplasm of low malignant potential (8316/1) which would be non-reportable. Per WHO 3rd Ed these tumors never recur or metastasize which may be why the behavior code is shown as /1. The standard setters must review this terminology change in relation to reporting the case as it may impact incidence rates. |
2017 |
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20170073 | Histology/Behavior--Brain and CNS: How are histology and behavior coded for a diagnosis of pineal anlage tumor in an infant? See Discussion. |
Patient is an 11 month old with brain biopsy showing final diagnosis of pineal anlage tumor. How are behavior and histology coded for this rare tumor? |
Assign 9362/3 for pineal anlage tumors. According to the WHO Classification of Tumors of the Central Nervous System, 4th edition, pineal anlage tumors, while extremely rare, share features with pineoblastoma. Although they have a distinct morphology, there is no other ICD-O-3 code for pineal anlage tumors. |
2017 |
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20170072 | Reportability--Heme & Lymphoid Neoplasms: Is the diagnosis of large granular lymphocyte syndrome or large granular lymphocyte disorder a reportable synonym for T-cell large granular lymphocytic leukemia? See Discussion. |
The physician consult in this case further specifies that the large granular lymphocyte disorder represents an autoimmune disease of autoimmune T-cell mediated mechanism. Is this a reportable diagnosis? |
Report large granular lymphocyte disorder (9831/3). Alternate names for T-cell large granular lymphocytic leukemia (9831/3) listed in the Hematopoietic and Lymphoid Neoplasms Database include but are not limited to Chronic large granular lymphocyte lymphoproliferative disorder, large granular lymphocytosis, NOS, and T-cell large granular lymphocytosis. |
2017 |
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20170071 | Reportability/Brain and CNS: Is incidentaloma reportable from brain and central nervous system (CNS) imaging? See Discussion. |
We are seeing the term "incidentaloma" on magnetic resonance imaging (MR) reports of head and also with physician statements. For example, this MR of the head: Impression--Suboptimal study due to motion degradation. Heterogeneously enhancing pituitary gland without evidence of acute abnormality. A 3 mm focus of relative hypoenhancement in the left gland is favored to represent an incidentaloma. Advise correlation with clinical findings. Also, there are cases where the scans show meningioma and then at a later date it is stated to be an incidentaloma in physician notes. Is the term "incidentaloma" alone reportable, if the term "tumor" for CNS cases is never stated? When I googled the term, it is stated to mean "tumor." |
The term "incidentaloma" alone is not reportable. Look for a reportable term elsewhere or in later information. When the term "incidentaloma" is used on a magnetic resonance imaging (MR) report, it refers to "a disease or physical condition found as a secondary by-product of capturing the necessary volume of tissue within the field of view of the MR examination" (http://radsource.us/incidentaloma). It is not necessarily neoplastic. |
2017 |
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20170070 | Primary Site/Histology--Urinary: Is a urethral lesion showing intraductal carcinoma of the prostate reportable? What is the primary site and histology code? See discussion. |
Pathology report diagnosis: Urethral lesion: Intraductal carcinoma of the prostate, see microscopic. Clinical Information: Urethral Lesion/Hematura. Microscopic Description: The biopsy shows dilated ductal structures filled with anaplastic epithelium showing areas of comedo-type necrosis. The tumor cells have enlarged nuclei prominent nucleoli and mitoses are identified. Surrounding benign prostatic tissue is also present. Immunostains show that the tumor cells stain for PSA, PSAP, P504s but are negative for GATA-3. The other components of the PIN 4 stain CK5/14 and P63 stain the basal cells surrounding the tumor confirming the intraductal nature of the process. Intraductal carcinoma should not be confused with high grade PIN as the former is usually associated with high grade invasive tumor. Is this C619 and 8500/2? |
The primary site is prostate, C619, and the histology is intraductal carcinoma, 8500/2. Further workup on this case is likely. If more information is received, review this case and update if needed. |
2017 |
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20170068 | MP/H Rules/Histology--Lung: What is the histology of a lung tumor described as solid predominant with mucin production, 8230/3 (Multiple Primaries/Histology (MP/H) Rule 5) or 8255/3 (MP/H Rule 6)? See Discussion. |
Pathology report: Left lower lobe lung, Tumor Size: Greatest dimension: 3.0 cm Additional dimensions: 2.5 x 2.0 cm; Tumor Focality: Unifocal; Histologic Type: Invasive adenocarcinoma Solid predominant with mucin production; Histologic Grade: G3: Poorly differentiated. Is the correct histology for this case 8230/3 (rule H5) or 8255/3 (rule H6)? |
Code histology as 8230/3, solid adenocarcinoma with mucin formation, using MP/H Rule H3 as one histologic type is identified. All of the histologic terms (solid, mucin production) are covered by 8230/3. Therefore, rule H3 applies. Use the first rule that applies, and stop. |
2017 |
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20170066 | Primary Site/Corpus uteri: Is the primary site C541 (endometrium) or C543 (uterine fundus) when the histology states endometrial adenocarcinoma, endometrioid type, but tumor site states fundus? See Discussion. |
Pathology--Final description: Uterus, cervix, bilateral fallopian tubes and ovaries, total hysterectomy and bilateral salpingo-oophorectomy: Endometrial adenocarcinoma, endometrioid type, well differentiated, FIGO 1/3. Myometrial invasion: focal myometrial invasion (30% of myometrium) Tumor size: 2 x2 cm Tumor site: Fundus, exophytic/polypoid lesion Gross description: The 3.0 cm in length by 2.5 cm in diameter triangular endometrium is tan-red and smooth with a 2.0 x 2.0 cm tan-pink, exophytic fundic mass which extends on to both anterior and posterior aspects, 4.1 cm from the os. |
We recommend coding endometrium, C541, as the primary site for this case. While coding to fundus would not be incorrect, according to our expert pathologist consultant, "it is more appropriate in a setting in which the region of the uterus is of importance, e.g. with a myoma or a myosarcoma, or if the endometrioid carcinoma were NOT in the endometrium but arising in a focus of adenomyosis within the fundic myometrium " |
2017 |