Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20100026 | Multiplicity Counter--Kidney, Renal Pelvis: How many times is this field updated after an invasive primary is originally diagnosed? Should subsequently diagnosed in situ tumors to be included in this field? See Discussion. | How should the Multiplicity Counter be coded when a patient has a renal pelvis primary [C659] diagnosed 1/23/08. The patient had one tumor, invasive grade 3 of 3 papillary urothelial carcinoma arising in the depth of a calyx in mid portion of kidney. In 6/1/09, a TURBT showed three separate high grade urothelial carcinoma in-situ lesions on the right side of the bladder, the largest tumor being 7mm. In 2/8/10, another TURBT showed one lesion on the left side of bladder, high grade urothelial carcinoma in-situ, tumor was 4mm. These are all a single primary per rule M8. | Code multiplicity counter 04. Count both invasive and in situ tumors.
Multiplicity counter would have been coded 01 in 2008. Add the three in situ tumors diagnosed in 2009 to the first tumor and update multiplicity counter to 04. Make only one update to multiplicity counter. Because the multiplicity counter was updated once, the fifth tumor diagnosed in 2010 does not need to be added. |
2010 |
|
20100103 | Reportability--Corpus uteri: Is gestational trophoblastic neoplasia reportable if there is no mention of metastasis but the patient has been treated with chemotherapy? See Discussion. | Per SINQ 20021106, for tumors diagnosed prior to 2007, a clinical diagnosis of metastatic gestational trophoblastic disease was to be coded to histology 9100/3 [Choriocarcinoma]. "Gestational trophoblastic neoplasia includes the diagnosis of choriocarcinoma." |
Do not report gestational trophoblastic neoplasia unless stated to be malignant. | 2010 |
|
20100059 | Surgery of Primary Site--Brain and CNS: How should this field be coded when the procedure is stated to be a "stereotactic CORE biopsy" of a brain tumor? See Discussion. | The most recent version of the Brain Site Specific Surgery schema has a note that states "Assign code 20 [Local excision of tumor, lesion, or mass, excisional biopsy] for stereotactic biopsy of brain tumor." Does this also apply to a stereotactic CORE biopsy?
SINQ 20081118 also states that a stereotactic biopsy should be coded as Surgery of Primary Site code 20. |
Assign code 20 [Local excision of tumor, lesion, or mass, excisional biopsy] for a stereotactic core biopsy of brain tumor. | 2010 |
|
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 |
|
20100090 | MP/H Rules/Histology: How is histology coded for a diagnosis of "poorly differentiated endometrioid adenocarcinoma intermixed with osteoid sarcomatous component, consistent with malignant mixed mullerian tumor with heterologous (osteosarcoma) elements"? Is malignant mixed mullerian tumor synonymous with carcinosarcoma? See Discussion. | Given that there is no mixed code for these histologies, can the numerically higher code be used per H17 (malignant mixed mullerian tumor [8950/3]) using the logic of the MP/H rule for other sites? If so, should this histology be coded as 8980/3 [carcinosarcoma] rather than 8950/3 [malignant mixed mullerian tumor]? | For cases diagnosed 2007 or later, code histology to 8980/3 [carcinosarcoma]. Recent literature states that carcinosarcoma is synonymous with mixed mullerian tumor. Mixed mullerian tumor is an obsolete term and should not be used. | 2010 |
|
20100093 | MP/H Rules/Multiple primaries: Please clarify how rule M10 for Other Sites was developed and how a "recurrence" of the tumor after one year was determined to be a new primary? See Discussion. |
What is the expected outcome or result of rule M10? Specifically, for soft tissue sarcomas, why is a recurrence after one year a new primary instead of a recurrence? |
For cases diagnosed 2007 or later: Rule M10, tumors occurring more than one year apart are multiple primaries, was developed to differentiate a new primary from a recurrence. The rule was developed with the concurrence of the CoC site-specialty physicians and the SEER consulting pathologist. There was agreement between all of the CoC site teams and the consulting pathologist that statements of recurrence should not be relied upon to rule out a new primary. The time limits for each site were set based on information from peer-reviewed articles on tumors occurring in the same site and studies using molecular studies to confirm whether or not the tumors were histologically similar. Determination of the time limit for the "other sites" rules was probably the most difficult because so many sites are involved. However, the specialty-physicians felt that one year was an appropriate length of time to apply to these sites. |
2010 |
|
20100094 | Primary site--Heme & Lymphoid Neoplasms: Is a peripheral blood equivalent to bone marrow biopsy for the purposes of Rule PH26 and code the primary site to C421 [Bone marrow] for a marginal zone lymphoma found in peripheral blood when there was no additional workup (e.g., scans, etc.) for this case? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Code the primary site to C421 [bone marrow]. Our hematopoietic specialty physicians state that involvement of peripheral blood is equivalent to bone marrow involvement because the marrow produces blood. In the absence of any other involvement, per Module 7 (Coding primary sites for lymphomas) Rule PH26, it states to code the primary site to bone marrow when the only involvement is bone marrow. SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
2010 | |
|
20100052 | Reportability/Primary Site: What is the reportability status and primary site for a papillary carcinoma of thyroid tissue arising in an otherwise benign mature monodermal cystic teratoma (struma ovarii)? See Discussion. | Final diagnosis on the pathology report states, "One ovary showing mature monodermal cystic teratoma composed of thyroid tissue (struma ovarii)." The pathology COMMENT section states, "There is a 0.1 cm focus of thyroid tissue within the struma ovarii showing cytologic features of papillary carcinoma. This finding is likely of no clinical consequence." | A papillary carcinoma of thyroid tissue in benign struma ovarii (mature cystic teratoma) is reportable.
These ovarian tumors contain a diversity of tissues including hair, teeth, bone, thyroid, etc. This reportable malignancy arose in thyroid tissue within the ovarian tumor. Code the primary site to ovary. Code to the actual organ in which the cancer arose. This will keep the case in the appropriate category for surgery coding, regional nodes, staging, etc. |
2010 |
|
20100035 | MP/H Rules/Multiple primaries--Colon: How many primaries are accessioned for a patient with two colon carcinomas in different segments of colon when there is no documentation that either tumor arose in a polyp, there is no statement indicating the presence of adenomatous polyposis coli and the resected pathology specimen indicates the presence of over 200 polyps? See Discussion. | The first MP/H rule that applies for this case is M4 [tumors in different segments of the colon]. Following rule M4, the case would be counted as two primaries and the histology would be coded per Rule H11. As these are multiple primaries, Rule H17 [Code 8220 (adenocarcinoma in adenomatous polyposis coli) when there are > 100 polyps identified in the specimen] would never apply, because H17 applies to multiple tumors abstracted as a single primary. However, Rule H17 seems to fit this case. Should Rule M3 be expanded to include a statement about > 100 polyps so these cases are not accessioned as multiple primaries?
Example: Total colectomy: 1) Distal tumor: - ulcerating moderately differentiated colonic adenocarcinoma, 3.2 cm in greatest dimension. Tumor invades through the muscularis propria into the subserosa (pt3). 2) Proximal tumor: exophytic moderately differentiated colonic adenocarcinoma, 2.9 cm in greatest dimension. Tumor invades submucosa (pt1). Multiple tubular adenomas present throughout the colon, approximate count greater than 200. |
For cases diagnosed 2007 or later, use rule M3 for this case and abstract as a single primary. The case information makes it clear that this is adenomatous polyposis coli. Clarification will be added to rule M3 in the next revision of the rules. | 2010 |
|
20100096 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a 9/30/10 biopsy diagnoses follicular lymphoma, grade 1 and the patient is subsequently diagnosed on a 10/11/10 biopsy with large B-cell lymphoma which is stated to be a transformation of the prior lymphoma? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule M11, this case is to be accessioned as two primaries; follicular lymphoma, grade 1 [9695/3] and diffuse large B-cell lymphoma (DLBCL) [9680/3]. The case represents a chronic neoplasm (follicular lymphoma, grade) and an acute neoplasm (diffuse large B-cell lymphoma) diagnosed within 21 days of one another and there is documentation of two biopsies, one confirming the chronic disease and the other confirming the acute disease.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
2010 |