Report | Question ID | Question | Discussion | Answer | Year |
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20110015 | Primary site/Histology: Do the 4/1/09 changes in the ICD-O-3 Site/Type Validation table regarding the coding of primary site for intestinal type adenocarcinoma mean that the former valid site/histology combinations are now impossible and require review from a given diagnosis date forward? See Discussion. | Per the SEER Errata for ICD-O-3 Site/Type Validation List, April 1, 2009, adenocarcinoma, intestinal type, was removed as a valid site/histology combination for the following primary sites: C150-C155, C158-C159, C170-C173, C178-C179, C180-C189, C199, C209, C210-C212, C218. |
The site/type edit identifies unlikely combinations of primary site and histologic type. |
2011 |
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20110044 | MP/H Rules/Histology--Corpus uteri: What are the histologies for the primaries to be reported when the endometrium contains two separate tumors composed of adenocarcinoma with multiple differentiations as well as a separate small focus of clear cell carcinoma? See Discussion. |
The resected specimen showed, "Adenocarcinoma of endometrium with the following features: Histologic type: Endometrioid with squamous and focal clear cell differentiation. A second focus of endometrial adenocarcinoma is present in the fundus with admixed complex atypical hyperplasia in a polypoid, non-invasive mass. The second tumor is endometrioid with secretory differentiation. COMMENT: The tissue in between the two tumors is sampled, and contains foci of endometrial adenocarcinoma that is superficially present within the endometrium, as well as a small focus of clear cell carcinoma measuring 0.2 cm." Per MP/H rules M17, this is counted as multiple primaries because the histology codes differ at the third digit: 8323/3, 8382/3, 8310/3. The Multiple Primary rules make no reference to the histology tables. There is also no rule to ignore the in situ tumor. In addition, the histology table in the 2007 MP/H Rules Manual for Other Sites does not include "secretory differentiation" as a type of GYN malignancy. |
After consultation with our expert pathologist, the decision is report this case as a single primary. There was some confusion about how to apply the current MP/H rules to this pathology report given 1) the definition of M16 and M17 and 2) the likelihood for a single endometrial primary to present with several differentiations. According to our expert pathologist, "I would regard this case as a single endometrial primary with extensive endometrial involvement and several types of differentiation, all of which are seen in endometrial carcinomas." Next, the Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology for cases diagnosed 2007 or later. The following steps are used to determine the histology code. Open the Multiple Primary and Histology Coding Rules manual. For an endometrial primary, use the Other Sites Histo rules to determine the histology code because endometrium does not have site specific rules. Start with the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY module, Rule H18. The rules are intended to be reviewed in consecutive order within the module from Rule H18 to Rule H31. You stop at the first rule that applies to the case you are processing. Code the appropriate combination/mixed code (Table 2) when there are multiple specific histologies. GYN malignancies with multiple types of adenocarcinoma have histology coded to 8323/3 [mixed cell adenocarcinoma] per rule H30. |
2011 |
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20110046 | MP/H Rules/Multiple primaries--Stomach: If there is no statement of recurrence, how many primaries are to be abstracted when a patient is diagnosed with multiple gastric carcinoid tumors between 12/2003 and 3/2009? See Discussion. |
Are the multiple primary rules applicable when a patient has multiple gastric carcinoid tumors? The patient was diagnosed with carcinoid tumors starting in 12/2003 through 3/2009. According to the 2004 SEER Manual, rule 5, if a tumor with the same histology is identified in the same site at least two months after the original diagnosis, this is a separate primary. The physician does not indicate that the pre-2007 carcinoid tumors were recurrent. The patient does not have familial polyposis syndrome. Should each of the following tumors be a separate primary? 12/2003 - Gastric Polyp Removal - Path: Gastric carcinoid tumor 05/2004 - Stomach body polyp removal - Path: Carcinoid Tumor (endocrine cell tumor) 09/2004 - Single polyp in body removal - Path: Gastric carcinoid 03/2005 - Multiple gastric body polyps removed - Path: Carcinoid tumor 07/2005 - 3 small polyps in fundus removal - Path: Carcinoid tumor 02/2007 - Localized nodularity in lesser curvature - Path: Carcinoid (neuroendocrine) tumor 03/2009 - Stomach body polypectomy - Path: Carcinoid tumor |
Code as a single primary. The histology is carcinoid. Our expert pathology consultant replied as follows: "This patient clearly has a condition driving the proliferation of neuroendocrine cells. Possibilities include hypergastrinemia from a gastrinoma or from response of antral gastrin cells due to achlorhydria from long standing chronic atrophic gastritis, or multiple endocrine neoplasia (MEN1) syndrome (genetically driven). How should these cases be coded given we do not have a way to code the inciting situation. (I suspect the gastroenterologist knows what it is, but we haven't obtained that information.) We do not have an ICD-O-3 code for the underlying condition, MEN1 or hypergastrinemia. Therefore, the only choice is to code the resulting tumor, carcinoid [8240/3]." |
2011 |
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20110103 | MP/H Rules/Histology/Ambiguous terminology: Can synonyms of listed terms, such as "variety" for the list termed "type," be used to code a more specific histology? See Discussion. | The list of terms denoting a more specific histology does not include "variety." During MP/H training sessions there was an emphasis placed on only using terms listed to code a more specific histology. However, the results of an audit indicated that because "variety" is a synonym for "type" it could be used to code a more specific histology. Are synonyms of listed terms to be used to code histology? | No. Synonyms of listed words used in the MP/H rules (e.g., "variety" for the listed term "type") cannot be used to designate a more specific histology. | 2011 |
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20110093 | Residence at dx: After living elsewhere (Florida) and traveling around the country in an RV with his spouse, is a patient a resident of this area for either primary if he was diagnosed with his first primary less than a month after arriving in the area and a second primary more than a year after parking his RV here? |
Use the patient's usual residence to determine residency. If the usual residence is not known or the information is not available, use the residence the patient specifies at the time of diagnosis. The SEER rules for determining "usual residence" match the rules used by the US Census Bureau. |
2011 | |
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20110057 | MP/H Rules/Behavior--Appendix: How do you code mucinous cancers of the appendix? Is a "low grade mucinous appendix tumor/neoplasm" with peritoneal spread reportable? See Discussion. |
Low grade mucinous neoplasms can spread to the peritoneal cavity and in that sense are metastatic but histologically have bland/benign features (may be a benign cystadenoma that ruptured and spread by rupturing) are not a carcinoma. Thus, some have termed this group as DPAM (diseminated peritoneal adenomucinous) and not a true carcinoma. Others indicate that if you have metastasis the tumor is a carcinoma. |
For cases diagnosed 2007 or later, low-grade mucinous tumors of the appendix are a /1, borderline/uncertain behavior, and not reportable. These tumors do spread to the peritoneal cavity (pseudomyxoma peritonei). This spread, or deposits, or implants are also borderline/uncertain behavior and do not make the appendiceal tumor reportable. By contrast, a high-grade mucinous tumor of the appendix may produce malignant/invasive pseudomyxoma peritonei. When the pseudomyxoma peritonei are diagnosed as invasive or malignant, the mucinous tumor in the appendix is reportable as a /3. |
2011 |
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20110129 | MP/H Rules/Histology--Lung: How many primaries are accessioned if a pathology report for a right upper lobectomy with a chest wall resection describes the disease as 1) two foci of poorly differentiated non-small cell carcinoma, 2) mixed adenocarcinoma and non-mucinous bronchioalveolar carcinoma, each present as a separate focus? See Discussion. |
This case was abstracted as two primaries, adenocarcinoma, acinar and papillary types [8255/3] and non-mucinous bronchioloalveolar carcinoma [8252/3] per Rules M5 and M10. If this is reported as only two primaries, what is the stage for each tumor? The non-small cell tumors were the most invasive, but they were not a separate primary per Rule M10. Final pathology diagnosis for a RUL lobectomy and chest wall resection: Carcinoma of the lung with the following features: 1. Non-small cell carcinoma, poorly differentiated (see comment). Two foci in same lobe: 10 cm and 3 cm (largest dimensions of each tumor). Invades pleura (PL3), main bronchus and chest wall invasion present. 2. Adenocarcinoma and bronchioloalveolar carcinoma (see comment). Histologic subtype: Acinar and papillary (adenocarcinoma); non-mucinous (BAC). Two foci in same lobe: up to 1.0 cm. Pleural invasion absent, chest wall invasion absent. 3. Metastatic carcinoma in 5/7 peribronchial LN's. Two histologically distinct neoplasms identified in the lobectomy/chest wall resection specimen: Poorly differentiated non-small cell carcinoma, present as two foci; and adenocarcinoma and non-mucinous bronchioloalveolar carcinoma, each present as a separate focus. |
SEER will answer the question about the number of primaries to accession. Submit questions about stage to the CoC CAnswer Forum. For cases diagnosed 2007 or later: Accession two primaries: a mixed adenocarcinoma, acinar and papillary types [8255/3] and a bronchioloalveolar carcinoma, non-mucinous [8252/3]. The steps used to arrive at this decision are: Determine the histology code for each tumor prior to applying the Multiple Primary Rules to determine the number of primaries to accession. There are two non-small cell carcinomas, NOS; the histology code for these two tumors will be 8046/3. There is a single adenocarcinoma with acinar and papillary subtypes tumor, the histology for this tumor will be 8255. There is a single bronchioloalveolar carcinoma, non-mucinous subtype tumor; the histology for this tumor will be 8252/3. Open the Multiple Primary and Histology Coding Rules manual. Choose one of the three formats (i.e., flowchart, matrix or text) under the Lung Multiple Primary rules to determine the number of primaries. Start at the MULTIPLE TUMORS module, Rule M3, because this patient has multiple tumors. The rules are intended to be reviewed in consecutive order within the module (from Rule M3 to Rule M12 in this case). Stop at the first rule that applies to the case you are processing. This patient's adenocarcinoma with acinar and papillary subtypes [8255/3] and non-mucinous bronchioloalveolar carcinoma [8252/3] are multiple primaries. Perform a second pass through the Multiple Primary rules to determine whether the two non-small cell carcinomas [8046/3] are multiple primaries or manifestations of the same primaries identified in Step 3. Start at Rule M3 again because this patient has multiple tumors. Again, these rules are intended to be reviewed in consecutive order within the module (from Rule M3 to Rule M12 in this case). Stop at the first rule that applies to the case you are processing. This patient's non-small cell carcinomas, NOS [8046/3] are a single primary when compared to the adenocarcinoma with acinar and papillary subtypes [8255/3] and non-mucinous bronchioloalveolar carcinoma [8252/3]. Both of these histologies are more specific types of non-small cell carcinoma per the Lung Histology Groups and Specific Types Chart (Chart 1). You can also apply Rule M10 for both non-small cell carcinoma, NOS [8046/3] compared to adenocarcinoma with acinar and papillary subtypes [8255/3] and non-small cell carcinoma, NOS [8046/3] compared to non-mucinous bronchioloalveolar carcinoma [8252/3]. |
2011 |
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20110045 | Reportability--Ovary: Is immature teratoma of the ovary reportable if a subsequent comment states that "the teratoma shows immature neuroepithelium, but no malignant elements"? | There is conflicting information for this case. The final diagnosis conflicts with the comment. Go back and check with the physician to clarify his/her intent. If no further information can be obtained, the final diagnosis is preferred over the comment. This case is reportable based on the final diagnosis: "immature teratoma." | 2011 | |
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20110099 | Primary site--Heme & Lymphoid Neoplasms: How is primary site coded for bilateral pelvic lymph node involvement for lymphoma primaries? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. The PH rules for coding lymphomas (Module 7) refer to a lymph node region as defined by the ICD-O-3. Per the Appendix C, , the ICD-O-3 lymph node region for "pelvic" is C775. In this case, there is one lymph node region involved (bilaterally). Per Rule PH20, code the specific lymph node region when multiple lymph nodes within the same lymph node region (as defined by the ICD-O-3) are involved, C775. Per Note 1 under Rule PH20, use this rule when there is bilateral involvement of lymph nodes. This same table in Appendix C also provides information on how left and right pelvic lymph nodes are categorized by AJCC for purposes of coding stage. If the left and right pelvic lymph nodes are positive for lymphoma, it is involvement of two regions. The case is coded as Stage II. Keep in mind that the ICD-O-3 definition of regions is used to code the primary site, while the AJCC definition of regions is used to code stage. 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. |
2011 | |
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20110061 | Primary site/Histology--Heme & Lymphoid Neoplasms: Should the primary site and histology codes be updated when a patient with a history in 2005 of a bone marrow diagnosis of chronic lymphocytic leukemia later presents in 2010 with lymph node biopsy diagnosis of small B-cell lymphocytic leukemia? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Per Rule M2, this is a single primary because there is a single histology. Code histology to 9823/3 [CLL/SLL]/ The distinction of CLL vs. SLL cannot be made on bone marrow biopsy in isolation. The pathologist cannot make a diagnosis of CLL vs SLL without having peripheral blood counts available for review. If the patient was treated for CLL in the past, that may alter the peripheral counts seen in 2010 (e.g., lymphocytosis). The distinguishing feature is peripheral lymphocytosis in CLL (not seen in SLL). The disease looks the same and both will often have bone marrow involvement and lymph node involvement. If the patient had true CLL in 2005, then any subsequent lymph node (or other) biopsy consistent with CLL/SLL remains consistent with the original diagnosis of CLL. I would not change the original CLL code. I agree with the previous response. We have to assume the 2005 diagnosis included a peripheral blood supporting that diagnosis. Otherwise, CLL and SLL look the same in nodes and marrow. The interplay between the two "diseases" is expected. This is why they are considered a single 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. |
2011 |