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20170012 | Primary Site/Sarcoma--Breast: How should the primary site and stage be coded for osteosarcoma of breast? Is C509 correct or should the code be a different primary site? When assigning C509, the Collaborative Stage (CS) still pertains to breast cancer and AJCC stages it as a breast cancer and not as a sarcoma. |
Code primary osteosarcoma of the breast to breast, C500-C509. Not all site and histology combinations can be staged in CS or AJCC. 9180/3 of breast cannot be staged using the CS breast schema. Breast (C500-C509) cannot be staged using the CS soft tissue schema. The same is true for AJCC. You can stage this case using SEER Summary Stage. Important: Do NOT change the primary site or histology code based on whether or not the case can be CS or AJCC staged. We need to know how many cases are unable to be staged because of their primary site and histology combinations. |
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20170055 | First Course of Treatment/Surgery of Primary Site--Corpus uteri: Do you code total hysterectomy or radical hysterectomy when a specimen indicates the uterus, cervix, ovaries, fallopian tubes, and right and left parametrium were resected, but shows no portion of the vagina. See Discussion. |
AFS1-AFS2-frozen section control, endomyometrium; AFS3-frozen section control, subserosal intramural mass; A4-anterior cervix; A5-posterior cervix; A6-anterior cervical endometrial junction; A7-posterior cervical endometrial junction; A8-A10-anterior endomyometrium, including tumor; A11-A13-posterior endomyometrium, including tumor and adjacent mass; A14-random section subserosal mass; A15-left parametrium at margin of resection; A16-right parametrium at margin of resection; A17-A18-left ovary and fallopian tube; A19-A20-right ovary and fallopian tube. The final diagnosis includes Endometrial adenocarcinoma, favor serous carcinoma, with papillary and solid areas. Tumor involves: Cervix present, Right ovary, Left ovary, Right fallopian tube, Left fallopian tube, Right parametrium, Left parametrium. |
Assign code 50 for total hysterectomy. According to Appendix C Surgery Codes for Corpus Uteri of the 2016 SEER Coding and Staging Manual, total hysterectomy is surgery to remove the entire uterus, including the cervix; whereas, radical hysterectomy includes the vagina. |
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20170063 | Reportability/Behavior--Ovary: Is adult granulosa cell tumor a reportable malignant tumor if the primary ovarian tumor ruptured intraoperatively, the peritoneum was contaminated, and the patient underwent adjuvant treatment with chemotherapy given the increased risk of recurrence due to intraoperative tumor spill? See Discussion. |
Per SINQ 20130176 and 20140034, adult granulosa cell tumors of the ovary are reportable malignant tumors when there are peritoneal implants or metastases. The SINQ responses describe how these adult granulosa cell tumors are different from low malignant potential (LMP) epithelial ovarian tumors. Would these SINQ scenarios apply to a case with intraoperative tumor rupture that resulted in peritoneal tumor? In this case, the pathologist indicated these excised peritoneal specimens were favored to be intraoperative contamination with adult granulosa cell tumor. However, the oncologist went on to treat this patient as high risk with chemotherapy. The oncologist only described one of the pelvic peritoneal implants as possibly contamination due to the rupture. The oncologist never indicated the tumors were definitely peritoneal implants. Should the behavior of this tumor be /1 because the peritoneal tumor appears to be contamination, or /3 because the oncologist treated this patient as high risk? |
If the "implants" were due to intraoperative contamination and were not present prior to surgery, do not interpret them as indicative of malignancy. The behavior of this tumor is /1. |
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20170020 | Size of tumor--Breast: Please clarify guideline #7 if the only size you have is from a CORE biopsy specimen and imaging only states nonspecific sizes, like "architectural distortion" or "calcifications" and a core biopsy pathology reports invasive tumor spans 5mm. Do you use the core biopsy size, or use 999 for clinical tumor size? See discussion. |
SEER Program Coding and Staging Manual 2016 states: Record size in specified order using a. The largest measurement of the primary tumor from physical exam, imaging, or other diagnostic procedures before any form of treatment. See Coding Instructions 7-9 below. b. The largest size from all information available within four months of the date of diagnosis, in the absence of disease progression when no treatment is administered. #7 Priority of imaging/radiographic techniques: Information on size from imaging/radiographic techniques can be used to code clinical size when there is no more specific size information from a biopsy or operative (surgical exploration) report. It should be taken as a lower priority, but over a physical exam. |
Do not code size of tumor based on the size of the core biopsy. If the statement "invasive tumor spans 5mm" from the core biopsy report represents the surgeon's assessment of tumor size, use this information to code tumor size when no other information is available. |
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20170027 | MP/H Rules/Multiple primaries--Melanoma: Is a melanoma with an unknown laterality a different laterality for the purposes of applying Multiple Primaries/Histology Rule M4? See Discussion. |
8/1/2016 Left Abdomen biopsy: Early melanoma in situ (C445-2, 8720/2). 9/2/2016 Upper back: Superficially invasive malignant melanoma (C445-9, 8720/3). Does rule M4 apply and multiple primaries should be reported or does rule M8 apply and a single primary should be reported? |
Abstract multiple primaries following Multiple Primary Rule M4. Unknown laterality is a different laterality for the purposes of applying the MP/H rules for melanoma. NOTE: This answer applies to cases diagnosed prior to 2018. As of 1/1/2018, early melanoma is not reportable. |
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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. |
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20170058 | MP/H Rules/Histology--Lung: What is the correct histology code for an initial biopsy of non-small cell carcinoma with neuroendocrine phenotype, possible large cell neuroendocrine carcinoma with a subsequent re-biopsy showing poorly differentiated small cell carcinoma after chemotherapy with no response? See discussion. |
Patient had a biopsy in April 2014; pathology was reported as non-small cell carcinoma with neuroendocrine phenotype, possible large cell neuroendocrine carcinoma. The patient had five cycles of cisplatin/etoposide with no response. In May 2015, a re-biopsy at a referral institution reports poorly differentiated small cell carcinoma and states "feels that this could have been the histology all along and why patient has failed multi lines of chemo." |
Code to 8041, small cell carcinoma, because the medical opinon confirms that this was the correct histology from the begining. "Possible" is not an ambiguous term used to code histology. The MP/H rules do not include coding phenotype. That leaves non-small cell (8046/3) at time of diagnosis. Chemotherapy does not alter cell type so its likely the tumor was small cell all along only now proven with additional testing. Page 14 of the SEER Coding Manual gives examples of when to change the abstract's original codes and here is one example: When better information is available later. Example 1: Consults from specialty labs, pathology report addendums or comments or other information have been added to the chart. Reports done during the diagnostic workup and placed on the chart after the registrar abstracted the information may contain valuable information. Whenever these later reports give better information about the histology, grade of tumor, primary site, etc., change the codes to reflect the better information. |
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20170051 | Reportability--Liver: Is intraductal papillary mucinous neoplasm (IPMN) of the liver a reportable diagnosis? See Discussion. |
Pathology shows: Right liver lobe, partial hepatectomy " intraductal papillary neoplasm with high grade dysplasia. |
Intraductal papillary mucinous neoplasm (IPMN) of the liver with high grade dysplasia is reportable. While most IPMNs arise from the pancreas, there exists a subset of IPMN of the biliary tract (BT-IPMN). Code as 8453/2. For more details, see the Reportability section of the SEER manual, https://seer.cancer.gov/manuals/2016/SPCSM_2016_maindoc.pdf |
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20170037 | Primary site--Other and Unspecified Urinary Organs: What is the topography code for a Skene's gland adenocarcinoma? |
The most appropriate available topography code is C681, paraurethral gland. Skene's gland is also referred to as paraurethral gland. |
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20170031 | MP/H Rules/Multiple primaries--Penis: How many primaries should be reported for a diagnosis of invasive squamous cell carcinoma (SCC) of the penis in 6/2011, treated with excision and fulguration followed by 10/2014 penile lesion found to be SCC with basaloid features focally highly suspicious for invasion? Clinically, the 2014 tumor is stated to be in situ and recurrent penile cancer and follow-up in 2/2015 indicates there was no evidence of tumor following treatment. Subsequently, in 3/2016 the patient has another penile lesion biopsy showing SCC in situ suspicious for invasion, clinically stated to be recurrent. See Discussion. |
At the central registry, we have accessioned this scenario as three primaries per Multiple Primaries/Histology (MP/H) Rule M10 (diagnosed more than 1 year apart), as the patient was stated to be disease free between each occurrence. However, the diagnosing/treating facility is not reporting these cases due to clinical statements of recurrent disease. This is an example of a case type identified on casefinding audits conducted by our central registry in which we have learned SEER's expectation of MP/H rule application does not match hospital reporting. Can the 2018 version of the MP/H rules more clearly address how this type of clinically recurrent (multiple times) case should be handled? |
Accession three tumors as the tumors were each diagnosed more than one year apart according to the MP/H Rule M10 for Other Sites. And, as you have noted, the patient was free of disease after each diagnosis. The MP/H rules have very clear instructions regarding the word "recurrence." See page 10, specifically A.7., https://seer.cancer.gov/tools/mphrules/2007_mphrules_manual_08242012.pdf SEER will evaluate the MP/H rules in the upcoming revision. |
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