Report | Question ID | Question | Discussion | Answer | Year |
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20120059 | Primary site/Reportability--Breast: Is a "right nipple skin" biopsy that demonstrates squamous cell carcinoma reportable using a primary site of C500? See Discussion. | In the 2011 SEER Manual Reportability Examples, example 3, it states a "biopsy-proven squamous cell carcinoma of the nipple" is reportable when the subsequent resection shows "no evidence of residual malignancy in the nipple epidermis." However, this example does not specify the biopsy is from the nipple skin and the ICD-O-3 does not list nipple skin as a synonym for code C500. | Because the site is specifically stated to "skin" of nipple [C44.5], this case is not reportable.
If possible, you may wish to confirm the type of biopsy performed. If the biopsy was done by FNA or needle biopsy, the biopsy tissue should contain a full-thickness of skin and subcutaneous breast (nipple) tissue. If that is the case, this tumor would likely be a reportable squamous cell carcinoma of nipple [C50.0]. If, however, this was a punch biopsy it is more likely a non-reportable squamous cell carcinoma of the skin [C44.5]. |
2012 |
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20120034 | Primary site--Brain and CNS: How is the primary site to be coded if a clinician used an MRI to diagnose a left cerebellar venous angioma? See Discussion. |
According to the WHO Classification of Brain/CNS Tumors, code 9122/0 (venous angioma) does not appear under tumors of the cerebellum (C716). |
Venous angiomas (9122/0) are not reportable wherever they arise. The primary site for venous angioma arising in the cerebellum is C490. The combination of 9122/0 and C490 is not reportable. Venous angioma is a venous abnormality, currently referred to as a developmental venous anomaly (DVA). |
2012 |
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20120038 | Reportability/Histology--Heme & Lymphoid Neoplasms: Is Monoclonal B-lymphocytosis of uncertain significance (MLUS) reportable? If so, what is the correct histology code? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Appendix F, monoclonal B-lymphocytosis of uncertain significance (MLUS) is not reportable.
Some papers point out that a lymphocyte count less than five thousand is equivalent to monoclonal B-lymphocytosis of uncertain significance (MLUS) or monoclonal B-cell lymphocytosis (MBL). A lymphocyte count of five to thirty thousand could be smoldering chronic lymphocytic leukemia (CLL). The diagnosis of MLUS is a benign process that does not meet the criteria for CLL.
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. |
2012 | |
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20120092 | MP/H Rules/Multiple primaries/Recurrence -- Lung: How many primaries are accessioned if a diagnosis of squamous cell carcinoma of the lung is followed three years later by a diagnosis of adenocarcinoma of the lung if the pathologist reviews all the slides and states the subsequent diagnosis is a recurrence? See Discussion. | 7/12/2007 Left upper lobe lung lobectomy: Squamous cell carcinoma.
3/09/2010 Left lung completion pneumonectomy: Adenocarcinoma, predominantly acinar. The diagnosis comment on the pathology report indicates the previous lobectomy specimen from 2007 was reviewed and "there are areas that appear histologically similar to the current neoplasm. Thus, the findings are most compatible with recurrence."
Despite the difference in histology, is this a single primary per the MP/H Coding Rules, General Information instruction 7 because the pathologist did refer to the 3/9/2010 diagnosis as a "recurrence" of the 7/12/2007 diagnosis after reviewing the slides? |
For cases diagnosed 2007 or later, accession a single primary, left upper lobe squamous cell carcinoma diagnosed 7/27/2007.
The steps used to arrive at this decision are:
Go to the General Information notes for Determining Multiple Primaries for Solid Malignant Tumors in the Multiple Primary and Histology Coding Rules Manual.
General Information Rule 7 states "Use the multiple primary rules as written unless a pathologist compares the present tumor to the "original" tumor and states that this tumor is a recurrence of cancer from the previous primary."
Accession a single primary. Do not apply the Multiple Primary rules because the pathologist compared the 2007 and 2010 slides and determined this was a recurrence and not a new primary. |
2012 |
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20120024 | MP/H Rules/Histology--Breast: How many primaries are abstracted and what histology codes are used when a patient has two tumors, one reported as duct and lobular carcinoma and another reported as pleomorphic lobular and duct carcinoma? See Discussion. |
The pathology report indicated two tumors in the upper outer quadrant of the breast. One tumor has duct and lobular carcinoma and the other tumor has pleomorphic lobular and duct carcinoma. Per a web search, pleomorphic lobular carcinoma is a recently recognized subtype of lobular cancer. According to the MP/H Rules, Breast Equivalent Terms, Definitions, Tables and Illustrations, "pleomorphic carcinoma" is a specific type of duct carcinoma [8022/3]. This is not listed as a combined histology in Table 3. Should this be abstracted as a single primary per Rule M10, with the histology coded 8523/3 [infiltrating duct mixed with other types of carcinoma]? Or should this be abstracted as two primaries per Rule M12, with the histologies coded as 8022/3 [pleomorphic carcinoma] and 8522/3 [infiltrating duct and infiltrating lobular carcinoma]? |
This is a single primary with the histology coded as infiltrating duct and infiltrating lobular carcinoma [8522/3]. For cases diagnosed 2007 or later, the steps used to arrive at this decision are: Open the Multiple Primary and Histology Coding Rules manual. For a breast primary, start with the Breast Multiple Primary Rules because there are site specific rules for breast primaries. Start at Rule M4 because this patient has multiple tumors in the same breast. The rules are intended to be reviewed in consecutive order within the applicable Module. Abstract a single primary as tumors that are lobular [8520] and intraductal or duct are a single primary. Use the Breast Histology Coding Rules to determine the correct histology for these multiple tumors abstracted as a single primary. Start at Rule H20 as there were multiple tumors present but it is a single primary. Code the histology to 8522 [duct and lobular] when there is any combination of lobular [8520] and duct carcinoma. The Note for Rule M10 indicates Table 1 and Table 2 are used to identify specific intraductal and duct carcinomas. Referring to Table 2 (Duct 8500/3 and Specific Duct Carcinomas) note that pleomorphic carcinoma is listed as a specific type of duct carcinoma. Pleomorphic is a word that describes the cellular appearance rather than a specific histology. It is coded when that is the only description/diagnosis given (pleomorphic carcinoma/pleomorphic duct carcinoma). In this case, both duct and lobular are describing the actual histologic types. Ignore the term "pleomorphic" and code the actual histologic descriptors, ductal and lobular. We will make appropriate changes to the breast rules in the MP/H revisions so this distinction is clear. |
2012 |
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20120054 | Histology/Behavior--Brain and CNS: What is the histology and behavior code for a "giant cell astrocytoma"? See Discussion. | The pathology report stated, "The giant cell astrocytoma should be considered at least grade 3." There is not a code in the ICD-O-3 for giant cell astrocytoma, NOS; there are only codes for astrocytoma, NOS [9400/3] and subependymal giant cell astrocytoma [9384/1]. | Code the morphology as giant cell glioblastoma [9441/3]. Glioblastoma and astrocytoma are both types of astrocytic tumors per the Brain and CNS Terms and Definitions, Chart 1, in the 2007 MP/H Rules Manual. | 2012 |
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20120045 | Primary site--Heme & Lymphoid Neoplasms: What is the primary site of a diffuse large B-cell lymphoma described on a PET and an abdominal CT scan as a large pelvic mass displacing bladder and uterus, inseparable from anus, right pelvic sidewall, cervix and bilateral ovaries and per the clinician as stage IIE? See Discussion. | PET: large pelvic mass displacing bladder and uterus, inseparable from anus, right pelvic sidewall, cervix and bilateral ovaries. Diffuse abnormal uptake within this mass as well as the adjacent structures. No regional hypermetabolic adenopathy is noted and no imaging evidence of distant metastatic disease. The PET also demonstrated diffuse abnormal uptake within the pelvic mass as well as the adjacent structures.
CT abdomen: large pelvic mass invading vagina and inseparable from the anus, right pelvic sidewall, cervix and bilateral ovaries.
MD states: "stage IIE with invasion of vagina." |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule 18, code the primary site to C775 [pelvic lymph nodes]. Per Rule PH18, code the primary site to the specified lymph node region when the site of lymphoma is described only as a mass. This rule also indicates that the Code pelvic lymph nodes [C775] when the lymph nodes are described as a pelvic mass.
This rule has been effect for SEER for over 20 years. It is based on the fact that a number of lymphomas that originate in nodes are not diagnosed until those nodes become matted or fixed. The presentation is then one of a "mass" in those nodal regions.
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. |
2012 |
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20120008 | MP/H Rules/Recurrence--Ovary: How many primaries are accessioned if a patient was diagnosed with ovarian serous carcinoma four years ago and currently has sacral and pelvic masses positive for serous carcinoma on biopsy? Should this be disease progression or a new primary? See Discussion. |
Should this be a new primary per the MP/H Rules (Other Sites, Rule M10) because the diagnoses were made more than one year apart? Or is the new disease metastasis? The pathologist did not compare the subsequent mass biopsies with the original pathology. Is a pathologist's comparison of slides the only criteria for determining recurrent disease? This case seems to fit the definition of metastatic disease rather than a recurrence, and therefore would not be a new primary. |
Accession a single primary, the original ovarian serous carcinoma. The MP/H Rules do not apply to metastases. Metastases: When cancer cells appear in other nodes or organs that are not the primary site they are metastatic cells. Discontinuous (separate from the primary tumor) masses or cells in regional lymph nodes, distant lymph nodes, or distant sites are always metastases. In this case, the sacral and pelvic masses are distant metastases. The pathologist does not have to compare cells to the original tumor slides; the discontinuous tumor mass/cells in any site other than the primary site are metastases. Recurrence: For a disease to recur there are several criteria that must be met. First and most important, the patient must have had a disease-free interval (a tumor cannot recur if it has always been present). The other criteria are: the "new tumor" has to occur in the original primary site, it must be the same histology as the original tumor, AND must meet the timing requirements in the MPH rules for that organ/site. |
2012 |
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20120055 | Surgery of Primary Site--Kidney, renal pelvis: How do you code a laparoscopic renal mass core biopsy followed by cryoablation of the tumor? See Discussion. | The note under the local tumor destruction codes states "No specimen sent to pathology from this surgical event 10-15." The patient had a pathologic specimen submitted from his core biopsy, but this was not a tumor excision or excisional biopsy [codes 20, 26-27]. Is the correct surgery code 13 [cryosurgery] because the tumor was only ablated and not excised, or surgery code 23 [any combination of 20 or 26-27 with cryosurgery] because a pathology specimen was submitted? | Code for Surgery of Primary Site to 13 [Cryosurgery]. While the core biopsy provided a pathology specimen, it is not coded as surgery of the primary site. | 2012 |
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20120089 | MP/H Rules/Histology--Colon: The final diagnosis on a path report for a colon specimen says: Is a colon specimen final diagnosis of carcinoma in situ in a serrated adenoma coded to 8010/2, 8210/2 or 8213/2? | For cases diagnosed 2007 or later, code the histology as 8213/2 [carcinoma in situ in a serrated adenoma].
The steps used to arrive at this decision are:
: Apply ICD-O-3 rule F (Matrix principle) and assign the behavior code /2 when the behavior assigned by the pathologist differs from the usual behavior as given in the ICD-O-3.
: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text) and go to the Colon Histology rules.
: Start at the SINGLE TUMOR module, Rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at rule H4. Code the histology as 8213/2.
Note: The histology 8213 (adenocarcinoma in serrated adenoma) will be added to rule H4 in the next revision. |
2012 |