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20150038 | Reportability/MP/H Rules/Histology: Is malignant perivascular epithelioid cell tumor (PEComa) reportable, and if so, what is the histology code? |
Malignant perivascular epithelioid cell tumor (PEComa) is reportable because it is malignant. Assign 8005/3 to malignant PEComa.
We consulted an ICD-O-3 expert who explained that some PEComas such as angiomyolipoma and lymphangiomyomatosis have specific ICD-O codes and their malignant counterparts may be coded to 8860/3 and 9174/3 respectively. There are no separate ICD-O codes for other specific PEComas, e.g., clear cell “sugar” tumor of lung, clear cell myomelanocytic tumor of the falciform ligament and some “unusual” clear cell tumors occurring in other organs—or for PEComa, NOS. These PEComas may therefore be coded to 8005 as clear cell tumors NOS; in other words as clear cell tumors that are not clear cell variants of carcinomas, sarcomas, or other specific tumor type.
Please note, PEComa is non-specific as to behavior. Unless the pathologist states that it is malignant, (as was the case for this question), the default code is 8005/1 (non-reportable). |
2015 | |
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20150057 | Reportability--Brain and CNS: Is this diagnosis reportable? If this neoplasm originated in the spinal cord, it is reportable, correct?
Specimen is described as a 'spinal cord mass.' The final diagnosis is 'fragments of adipose tissue demonstrating vascular proliferations consistent with angiolipoma. No histologic evidence of malignancy.' The microscopic description says: Sections of the spinal mass reveal bone, cartilage, fibrous tissue and adipose tissue. The adipose tissue demonstrates increased vascularity with thin walled blood vessels seen with islands of delicate fibrous stroma. The histologic findings are compatible with fragments of angiolipoma. |
The neoplasm is reportable if it originated in the spinal cord or is intradural (within the spinal dura; spinal nerve roots are intradural). If there is not enough information to determine the exact site of origin, do not report the case. |
2015 | |
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20150065 | First course treatment/Chemotherapy/Drug category: Instructions in SEER*Rx state that Ibrance should be coded as chemotherapy. They also state that it is an endocrine-based therapy. Local physicians refer to Ibrance as hormone therapy. Please clarify. |
For cancer registry data collection, follow the instructions in SEER*Rx. It is important for all data collection to be consistent for reporting of cancer information.
Per the FDA: Ibrance is a chemotheraputic agent which was approved for use WITH Letrozole. Letrozole is a hormonal drug which may be why the physicians are stating the patient is receiving hormones. Ibrance should not be given alone to treat breast cancer. This drug will not be changing categories in SEER*Rx. |
2015 | |
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20160067 | MP/H Rules/Histology--Skin: What histology code and MP/H Rule apply to a skin primary with the final diagnosis, ? See Discussion. |
The patient had an upper arm shave biopsy with final diagnosis of basaloid carcinoma with squamous and neuroendocrine differentiation. The pathologist also comments: Further resection was negative for residual malignancy.
Would SINQ 20150033 apply, thus resulting in final histology of carcinoma with neuroendocrine carcinoma (8574/3)? |
Assign 8574/3 according to Other Sites rule H17 for basaloid carcinoma with squamous and neuroendocrine differentiation.
There is no combination code that includes basal cell, squamous, and neuroendocrine. We can combine basal cell with squamous, 8094/3, or carcinoma with neuoendocrine differentiation, 8574/3. Rule H17 directs us to assign the higher code, 8574/3. |
2016 |
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20160017 | Surgery of Primary Site--Melanoma: Please further explain the SEER Note under Melanoma surgery codes 30-36 for these two examples. Are both examples coded 31? 1. Shave bx: +melanoma in situ, +microscopic margins Wide excision: no residual melanoma in situ 2. Shave bx: melanoma, +microscopic margin Wide excision: Melanoma, margins negative (margin status negative but distance not stated) |
Revised answer: Assign surgery code 30 for both examples based on the SEER Note on the top of page 2 in the Surgery of Primary Site Codes for Skin: If it is stated to be a wide excision or reexcision, but the margins are unknown, code to 30. |
2016 | |
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20160073 | MP/H Rules/Multiple primaries/Histology: What histology and how many primaries are coded for a mixed germ cell tumor with a somatic type malignancy (rhabdomysarcoma) if the patient was diagnosed with seminoma of the testis in 2009 followed by a 2015 metastatic germ cell tumor in a retroperitoneal lymph node, stated to be a recurrence of the testicular cancer? See Discussion. |
In September 2009 the patient was diagnosed with seminoma, classical type, following an orchiectomy. Testicular mass recurrence in 2014 was treated with chemotherapy. Then in April 2015 a retroperitoneal dissection of a peri-aortic LN was positive for mixed germ cell tumor with somatic type malignancy (rhabdomyosarcoma) involving 1/11 nodes. Path Comment: major component of tumor is teratoma, rhabdomyosarcoma represents <5% of mass. Now in October 2016, the patient has a retroperitoneal mass biopsy positive for spindle cell sarcoma with rhabdomyosarcomatous differentiation. The comment section of the pathology report states, "Given the history of a germ cell tumor w/ rhadbomosarcomatous component, the findings are consistent with a recurrence of rhabdomyosarcomatous component of germ cell tumor." Can a seminoma transform to a mixed germ cell tumor with a somatic type malignancy (see SINQ 20140082 - testicular teratoma with somatic type malignancy)? |
According to our expert pathologist consultant, yes, seminoma could transform to a mixed germ cell tumor with a somatic type malignancy. He advises us to code this case as 9061/3. From our expert pathologist consultant: This occurs as "reprogramming" of the initial germ cell tumor/seminoma cell. The process is not understood, but genetic studies support this progression concept. Most often the next step is teratoma. It is out of the teratoma that the somatic malignancy usually comes. I do wonder about the possibility that this was really an embryonal carcinoma which resembles a seminoma - occasionally this can be a difficult separation. I wonder if they radiated the scrotum following the orchiectomy, also, given the scrotal recurrence. |
2016 |
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20160019 | Reportability--Lung: Is a case of pulmonary metastatic leiomyoma (favored) vs. low grade leiomyosarcoma reportable, and if so, what is the primary site and histology code? See Discussion. |
Patient presents with an abnormal chest x-ray. PET reveals 4.6 cm left lower lobe mass and several additional bilateral nodules measuring up to 1.6 cm. Biopsy was recommended and is positive for metastatic histologically benign smooth muscle neoplasm. ER/PR are positive. Mayo consult on biopsy agrees with histology. The differential diagnosis includes benign metastasizing leiomyoma and low grade leiomyosarcoma. Comment: If these nodules remain small and do not progressively grow would consider this metastasizing leiomyoma. Physicians state bilateral pulmonary metastatic leiomyoma (favored) vs low grade leiomyosarcoma. Tamoxifen was started. Patient has a history of uterine fibroids. Several months later, imaging reveals stable bilateral multi pulmonary nodules and left lower lobe mass but persistent. Surgery was recommended but cancelled due to insurance. |
This case is not reportable based on the information provided. The histologic diagnosis is "metastatic histologically benign smooth muscle neoplasm." The physicians seem to agree with the histologic diagnosis, benign metastasizing leiomyoma (BML). The WHO classification and ICD-O-3 assign 8898/1 to "metastasizing leiomyoma." WHO states "This resembles a typical leiomyoma but it is found in the lungs of women with a history of typical uterine leiomyomas." A recent article states "Because of the hormone-sensitive characteristics of BML, treatments are based on hormonal manipulation along with either surgical or medical oophorectomy." Tamoxifen treatment is in keeping with the BML diagnosis. |
2016 |
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20160041 | First course treatment/Surgery of Primary Site--Skin: How are Surgery of Primary Site and Surgical Procedure of Other Site coded for an eyelid skin primary diagnosed by punch biopsy and treated with an orbital exenteration? See Discussion. |
Unlike most other sites, there is no specific code for a radical surgical procedure of a skin primary. In this case, the patient was diagnosed with a sebaceous cell carcinoma of the lower eyelid skin by punch biopsy. The tumor was large and an orbital exenteration was planned. Despite the extensive surgery performed, skin margins were less than 1 cm. Is an orbital exenteration a "major amputation" (code 60) in this case? Given that the margins were not greater than 1 cm, codes 45 - 47 (which includes a minor (local) amputation) don't seem to apply. However, if this procedure cannot be classified as "minor amputation" then doesn't it seem overkill to refer to the procedure as a "major amputation"?
An alternative would be to code Surgery of Primary Site to 32 for the skin resection (punch biopsy followed by a gross excision of the lesion, margins less than 1 cm) and code Surgical Procedure of Other Site to 2 (non-primary surgical procedure to other regional sites) to record the removal of the globe and orbit as part of the orbital exenteration. Which is correct? |
There is a similar question in the FORDS forum of the CoC CAnswer Forum. CoC is the curator for the surgery codes.
Surgical Procedure to Primary Site - Gross excision of the lesion, code in 30s series Surgical Procedure to Other Site (removal of eye) - code 4
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2016 |
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20160011 | Reportability--Stomach: Are microcarcinoid tumors reportable? See discussion. |
SINQ 20081076 states carcinoid tumorlets of the lung are not reportable and are defined as being less than 5 mm in diameter and benign. Per the WHO Classification of Digestive Tumours, microcarcinoid tumors are precursor lesions/nodules measuring greater than 0.5 mm, but less than 5 mm (0.5 cm). Is the term microcarcinoid tumor equivalent to carcinoid tumorlet, and therefore not reportable? Or is a microcarcinoid tumor a reportable type of neuroendocrine tumor (NET)? |
Microcarcinoid and carcinoid tumors are reportable. The ICD-O-3 histology code is 8240/3. Microcarcinoid is a designation for neuroendocrine tumors of the stomach when they are less than 0.5 cm. in size. Neuroendocrine tumors of the stomach are designated carcinoid when they are 0.5 cm or larger.
The term microcarcinoid tumor is not equivalent to carcinoid tumorlet. |
2016 |
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20160079 | First course treatment/Chemotherapy: Is metronomic chemotherapy coded as chemotherapy? |
Code metronomic chemotherapy as chemotherapy. Metronomic chemotherapy, also referred to as low-dose metronomic (LDM) chemotherapy, is an emerging cancer treatment approach which administers relatively low doses of traditional chemotherapy drugs over a long period of time and without ‘breaks’ in treatment. By using lower doses this method of treatment minimizes the side effects of traditional chemotherapy. |
2016 |
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