Reportability/MP/H Rules/Histology: Is this kidney tumor diagnosis reportable? If so, what is the correct histology? See discussion.
Left radical nephrectomy: Tumor histologic type: Renal angiomyoadenomatous tumor (see Note). Note: The a clear cell papillary renal cell tumor and a renal angiomyoadenomatous tumor (""RAT"") (reval cell carcinoma with angioleiomyoma-like stroma). Although some authors consider RAT tumors to represent a pattern of clear cell papillary RCC we believe that this represents a dstinct entity. The combined findings ...confirm the diagnosis of renal angiomyoadenomatous (RAT) tumor. These tumors are also known as renal cell carcinoma within angioleiomyoma-like stroma. To date none of these tumors have developed metastases. Given the small number of reported cases we would consider these to have at worst a low malignant potential.
According to our expert pathologist adviser, renal angiomyoadenomatous tumor ("RAT") is not reportable. He states "l would be reluctant to consider the entity malignant. The authors of the papers describing it do not seem ready to call it malignant either. I agree with calling it LMP, or in this case uncertain malignant potential."
MP/H--Bladder: Are 8130 and rule H12 correct for this case? Bladder with papillary urothelial carcinoma with squamous cell differentiation.
Rule H8 applies, code the histology with the numerically higher ICD-O-3 code which is papillary transitional cell carcinoma, 8130.
Based on the information provided, there is a single bladder tumor, papillary urothelial carcinoma with squamous cell differentiation. Urinary sites rule H12 does not apply because this is a single tumor, not multiple tumors. In the single tumor H rules, H3 does not apply as this rule does not include papillary transitional cell carcinoma. Rule H4 is papillary carcinoma or papillary transitional cell carcinoma and refers you to Table 1. Table 1 does not list papillary urothelial carcinoma with squamous cell differentiation because there is no ICD-O-3 code for this histology. Table 1 does list transitional cell carcinoma with squamous differentiation as code 8120, however, the papillary transitional cell carcinoma is the higher code, 8130. We will review this situation for the next version of the rules.
Reportability--GIST: The 2014 SEER Program Coding and Staging Manual and the answer to SINQ 20100014 appear to conflict with respect to reporting GIST cases. The manual states (p.5, exception 1) that we are to accession the case if the patient is treated for cancer. However, the patient in Example #7 in the SINQ discussion is receiving chemotherapy, but is deemed not reportable. This is a problematic issue in our area, as pathologists prefer using the NCCN “Risk Stratification of Primary GIST by Mitotic Index, Size and Site” table rather than stating whether the tumor is benign or malignant. Although they tell us that moderate or high risk should receive treatment, they will not characterize them as malignant.
Determining reportability for GIST is problematic because of the reluctance of pathologists to use the term "malignant" for GIST cases. If you can document the pathologist's terminology and case characteristics (e.g. treatment) that correspond to "malignant" for your registry as part of the registry's policies and procedures, you can report those cases as malignant.
The exception cited above in the SEER manual pertains to a clinical diagnosis with a negative pathology report. Normally, the negative pathology report would override the clinical diagnosis and the case would not be reportable. However, if the patient is treated for a malignancy in spite of the negative pathology, report the case.
Surgery of Primary Site--Corpus uteri: What is the correct surgery code to assign for dilation and curettage (D&C) for an in-situ endometrium (C541) primary? The code to use for the cervix uteri (C530-C539) is specified, but not for the corpus uteri (C540-C549).
Assign code 20 for endometrial D&C for in situ cancer of endometrium.
Primary site--Bladder: What is the primary site for bladder tumor biopsy: invasive adenocarcinoma, enteric type favor urachal origin, stage III
Based on the information provided, code the primary site to urachus (C677). Primary adenocarcinoma of the bladder accounts for less than 1% of all bladder malignancies. Of these, 20–39% are urachal in origin.
MP/H Rules/Histology--Kidney, renal pelvis: How would you code this histology: Renal cell carcinoma, clear and eosinophilic cell type?
Kidney rule H5 applies, code the more specific histology which is clear cell renal cell carcinoma (8310/3). Per the WHO Tumors of the Urinary System, clear cell renal cell carcinoma contains both clear and eosinophilic cytoplasm. Eosinophilic is not a type or variant of renal cell carcinoma.
Primary Site/In Situ: How is primary site coded for an in situ carcinoma arising in a mucinous cystadenoma with ovarian stroma (focal) located in the right lobe of the liver? See discussion.
The SEER Coding and Staging Manual instructs one to code the primary site to the location where the tumor originated, in this case the liver. However, there is no CS Extension code for in situ tumors found in the CS Manual Liver Schema.
Based on the information provided, the primary site is liver. Submit the CS question to the CoC CAnswer Forum, http://cancerbulletin.facs.org/forums/content.php
Summary Stage 2000--Melanoma: How should Summary Stage 2000 be coded for 2014+ diagnosed melanoma cases with satellite nodules or in transit metastases? See discussion.
The SEER SS (SSS) 2000 Manual indicates satellite nodules (NOS or less than/equal to 2cm from primary tumor) are regional by direct extension (code 2) and in-transit metastasis (satellite nodules greater than 2 cm from primary tumor) are coded as involvement of regional lymph nodes (code 3). However, CSv0205 indicates mapping for satellite nodules/in transit metastasis (coded in CS LN) was changed to Regional, NOS (code 5). There are no definitions listed for code 5 in the SSS 2000 Manual.
Our staff independently code SSS 2000. Should we code the existence of satellite nodules and in transit metastases according to the current definitions in the SSS 2000 Manual or using the mapping information from CSv0205?
Code the existence of satellite nodules and in transit metastases according to the current definitions in the SSS 2000 Manual. Do not use the mapping information from CS to code SSS.
First course treatment: When a patient has a Haplo bone marrow transplant, is this coded as an allogenic bone marrow transplant since part of his marrow was used in addition to a donor?
Use code 12 in the Hematologic Transplant & Endocrine Procedures data field. Per the NCI, this procedure is an allogeneic transplant.
Rather than wiping out a patient’s immune system before transplanting donor bone marrow, doctors administer just enough chemotherapy to suppress the immune system, which keeps patients from rejecting the donated marrow without harming their organs. The procedure requires just a half-match, meaning that a patient’s parents or children could be suitable donors. AKA: Half-match transplants.