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Report Produced: 09/18/2025 07:14 AM

Report Question ID Question Discussion Answer Year
20160004

First course treatment/Other therapy: How is Sirolimus (Rapamycin) to be coded when given with known chemotherapy agents in a clinical trial? See discussion.

The SEER*Rx Database lists Sirolimus as an ancillary agent under the Category section, but as an mTOR inhibitor under the Subcategory. The Remarks section indicates Sirolimus (AKA Rapamycin) is an immunosuppressant, but is also a type of serine/threonine kinase inhibitor. Other types of kinase inhibitors (including Temsirolimus) are types of Chemotherapy. Although the Coding section states this drug should not be coded, Primary Sites (NSCLC and glioblastoma) are listed for this drug.

The SEER*Rx Database page for this drug is confusing. Please address the following.

1) Should Sirolimus not be coded when it is being given as a kinase inhibitor or an immunosuppressant?

2) If Sirolimus is ever treatment, should it be coded only for the primary sites listed?

3) If Sirolimus is given as part of a non-blind clinical trial for another site other than NSCLC or glioblastoma, should the Other Therapy field be coded to 2 [experimental - other treatment]?

Sirolimus is used to treat GVHD (graft versus host disease) and is not coded as treatment. Even though the sub-category is mTOR inhibitor it does not automatically mean it is a chemotherapeutic agent. Sirolimus affects cells differently than Temsirolimus.  The chemical compounds differ between these drugs. In order to code rapamycin, the drug given must be stated to be either the analog or ester compound.  The SEER*RX database has been corrected and NSCLC/glioblastoma are no longer listed for sirolimus.

 We researched clinical trials and found several that include sirolimus with other chemotherapy drugs for patients who either have received or will be receiving bone marrow transplants for hematologic diseases. In this case it is not coded. There are a few trials that are looking at sirolimus as a treatment for bladder, prostate, nerve sheath tumors, MDS, and AML. For these cases it would be coded in Other (code 2).

 2016
20160035

Reportability/Histology--Pituitary Gland: How are Rathke cleft cyst and Rathke pouch tumor distinguished and are they both reportable?

Rathke cleft cyst is not reportable. Cysts are not neoplastic. However, Rathke pouch tumor (C751, 9350/1) is a reportable neoplasm for cases diagnosed 2004 and later. The Rathke pouch is coded to the pituitary gland. Benign and borderline pituitary tumors have been reportable since 2004.

2016
20160046

MP/H Rules/Multiple primaries--Bladder: How many primaries should be reported for the case below? See discussion.

1993 Renal pelvis: Papillary urothelial carcinoma

1994 Bladder: Noninvasive bladder ca NOS

6/11/13 Bladder: Noninvasive papillary urothelial carcinoma

8/19/14 Bladder: urothelial carcinoma in situ

2/13/15 Bladder: Papillary urothelial carcinoma

Would this situation be 2 primaries - 1993 Renal pelvis and 1994 Bladder with the 2015 being the same primary as 1993 Renal pelvis? Or 3 primaries - 1993 Renal pelvis, 1994 Bladder, 2015 Bladder?

Abstract four primaries, 1993 renal pelvis, 1994 bladder, 2013 bladder, and 2015 bladder.

The 1993 renal pelvis diagnosis and the 1994 bladder diagnosis are separate primaries based on the rules in effect at that time (See pages 7-11, http://seer.cancer.gov/archive/manuals/historic/codeman_1992.pdf )

For the remaining diagnoses, the 2007 MP/H rules apply. The 2013 bladder diagnosis is a new primary per rule M7. The 2014 bladder diagnosis is not a new primary per rule M6. The 2015 bladder diagnosis is a new primary per rule M5.

2016
20160008

Reportability/Date of diagnosis--Liver: Is a statement of LI-RADS 5 or LI-RADS 4 diagnostic of HCC? See discussion.

We are seeing more use of LI-RAD categories on scans. The final impression on the scan will be LI-RADS Category 5 or LI-RADS Category 4, with no specific statement of HCC. The scans include a blanket statement with the definitions of the LI-RADS categories as below.

LIRADS (v2014) categories

M - Possible non-HCC malignancy

1 - Definitely Benign

2 - Probably Benign

3 - Intermediate Probability for HCC

4 - Probably HCC

5 - Definitely HCC (concordant with OPTN 5)

A previous SINQ, 20010094, indicates that we cannot use BI-RADS categories for breast cancer diagnosis, but those BI-RADS definitions are slightly different. Most often there will be a subsequent clinical statement of HCC, so the question is also in reference to Diagnosis Date. Can we use the date of the scan's impression, which states LI-RADS category 4 or 5, as the Diagnosis Date?

Report cases with an LI-RADS category LR-5 or LR-5V based on the 2014 American College of Radiology definitions, http://nrdr.acr.org/lirads/

Do not report cases based only on an LI-RADS category of LR-4.

Use the date of the LR-5 or LR-5V scan as the date of diagnosis when it is the earliest confirmation of the malignancy.

2016
20160037

Reportability/MP/H Rules/Histology--Ovary: What is the histology code for an ovarian tumor described as a mucinous borderline tumor, intestinal type?

Mucinous borderline tumor, intestinal type, of the ovary is not reportable. The behavior is /1. There is no applicable histology code for this histology when it ocurs in the ovary. 

2016
20160049

Grade/Sarcoma--Breast: Is the correct grade for high grade angiosarcoma of the breast a code 3 or 4? The breast usually uses a three grade system but sarcoma is not a typical histologic type of the breast.

Assign grade code 4 using the sarcoma table. Nottingham or Bloom-Richardson (BR) Score/Grade does not apply to angiosarcomas. This is a good question and points out needed clarification of the grade rules.

2016
20160056

MP/H Rules/Histology--Testis: How should histology be coded for a testicular primary with a combination of teratoma, yolk sac tumor and embryonal carcinoma? See discussion.

 

Patient had a radical orchiectomy with the final diagnosis of "Mixed germ cell tumor with the following features -- histologic type: Mixed germ cell tumor (teratoma 50%, yolk sac tumor 25%, and embryonal 25%)."

Assign 9085/3. Code this combination of teratoma, yolk sac tumor, and embryonal tumor in the testis to mixed germ cell tumor (9085/3) based on the WHO Classification of Tumors of the Male Genital Organs.                            

2016
20160028

MP/H/Histology--Sarcoma:  How should Ewing Sarcoma/primitive neuroectodermal tumor (PNET) be coded for a 2012 case?  See Discussion.

SEER SINQ 20031051 applies to cases diagnosed before 2007 and advises:  Code histology as 9260/3, Ewing sarcoma. Ewing sarcoma is a specific histology on the continuum of primitive neuroectodermal tumors. Code Ewing sarcoma as it is more specific than PNET, NOS.

For tumors diagnosed 2007 or later, refer to the MP/H rules.

Apply 2007 MP/H rule H6 and assign the numerically higher ICD-O-3 code that reflects PNET (9364/3).

According to the WHO Tumors of Soft Tissue and Bone, though Ewing sarcoma ICD-O-3 code is 9260/3, Ewing sarcoma with a higher degree of neuroectodermal differentiation present is classically termed peripheral neuroectodermal tumors (PNET).  WHO does not offer guidance how to classify tumors stated to be Ewing sarcoma PNET.

Histology code 9364/3 is assigned for a Ewing/PNET that arises outside of the brain/CNS. Peripheral neuroectodermal tumor (PNET) and peripheral primitive neuroectodermal tumor (PPNET) are Ewing family tumors.

Histology code 9473/3 (PNET, primitive neuroectodermal tumor, central primitive neuroectodermal tumor, or supratentorial PNET) is only used for tumors arising inside the brain/CNS.

2016
20160078

First course treatment/Radiation Therapy--Prostate: How do you code fiducial markers for prostate cases?

Do not code fiducial markers as a form of radiation treatment; rather, code the radiation therapy in the radiation treatment section.  Fiducial markers are small metal spheres, coils, or cylinders that are placed in or near a tumor to help guide the placement of radiation beams during treatment.

2016
20160062

Grade--Kidney: Should WHO/ISUP grade for renal cell carcinoma be coded for cases diagnosed 2016 and later? See discussion.

 

The 2016 WHO Classification of Tumours of the Urinary System appears to be moving away from using Fuhrman grading toward using WHO/ISUP grade. These seem like similar 4 grade staging systems; however, the SEER Manual specifically states to not use the Special Grade System table for WHO/ISUP. We are seeing the WHO/ISUP grade being used on 2016 pathology reports.

Examples of new grading for renal cell carcinomas

Histologic type: Clear cell renal cell carcinoma

Histologic grade (WHO/ISUP 2016): Grade 3 in a background of 2 (of 4).

And

Histologic type: Clear cell renal cell carcinoma

Histologic grade (ISUP): Grade 2.

Do not record WHO/ISUP grade in the grade/differentiation field.

Designated fields for this grade system are being proposed for future implementation.

2016