Summary Stage 2000--Lymphoma: How is SEER SS2000 coded for an ocular adnexal lymphoma when it extends from the primary site to adjacent sites that are still orbital structures? See Discussion.
In this case, the lymphoma arose in the posterior orbit and the primary site was coded as C696 (orbit, NOS). The mass directly extended to at least one "adjacent" site, the lacrimal gland. Should SS2000 be coded to 1 (localized) or 5 (regional, NOS) when an ocular adnexal lymphoma arises in the posterior orbit and extends to involve the lacrimal gland? Although both the posterior orbit and the lacrimal gland are parts of the orbit, they have separate ICD-O-3 topography codes. Should extension to multiple sites within the orbit be classified as localized disease?
The issue is what constitutes "adjacent" structures for a tumor that arises in the orbit. In an article published by the Indian Journal of Opthamology it states, "According to the Ann-Arbor staging system, lymphoma confined to the orbit is designated as Stage I, involvement of adjacent structures (sinuses, tonsil and nose) makes it Stage II." Does SEER agree with this definition of "adjacent" structures? Or are the lacrimal gland, ciliary body, retina, conjunctiva and/or choroid "adjacent" structures for a lymphoma stated to arise in the posterior orbit?
Assign SEER SS2000 code 5 (Regional, NOS) for a lymphoma of orbit extending to lacrimal gland. In SEER SS2000, this is Stage IIE: Direct extension to adjacent organs or tissues.
First course treatment/Immunotherapy--Prostate: Is XGEVA, given for bone mets from prostate cancer, abstracted as immunotherapy, or is it an ancillary drug and not recorded?
Do not record XGEVA when given for bone mets from prostate cancer. See SEER*Rx for more information.
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.
MP/H Rules/Histology: What is the correct histology code for a NUT midline carcinoma?
Code histology to 8010/3.
NUT carcinoma is identified by the NUTM1 gene rearrangement.
NUT midline carcinomas (NMC) are lethal and morphologically indistinguishable from other poorly diff carcinomas. They are epithelial tumors which can range from undifferentiated carcinomas to carcinomas with prominent squamous differentiation.
A new proposed ICD-O-3 code has been suggested for NUT tumors but it is not yet approved for implementation. Do not use the new code until it is approved for use in the United States.
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.
Birthplace/Place of birth, country: For patients originally born in a country that is currently listed as "historic only", where the original birth country now has a one-to-many relationship with the current country, how should the reported original birthplace be coded? (Example: Yugoslavia)
Assign code for Europe, NOS (ZZE) for Yugoslavia, NOS, without further information.
MP/H/Histology--Pituitary: Would you code Crooke cell adenoma as 8272/0 pituitary adenoma?
Yes, code Crooke cell adenoma to 8272/0 pituitary adenoma. According to the WHO classification, it is a variant of adrenocorticotropic hormone (ACTH) producing adenoma (8272/0).
Reportability--Bone: Is an "atypical cartilaginous tumor" reportable? See Discussion.
Patient had a core needle biopsy of the right acetabulum. Final diagnosis on the path report is: Atypical cartilaginous tumor (formerly chondrosarcoma, grade 1).
Is this cell type reportable? If so, is it reportable only because the pathologist recorded clarifying text in parentheses? If the text in the parentheses was not available, is the histology "atypical cartilaginous tumor" reportable?
Atypical cartilaginous tumor of bone is not reportable. The WHO terminology is "atypical cartilagenous tumor/chondrosarcoma grade I." WHO classifies this entity as low malignant potential (behavior code /1).
Chondrosarcoma grade II or grade III is reportable based on the WHO classification of malignant (behavior code /3).
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).
Radiation Therapy--Breast: Are iodine 125 (I-125) seed implants for breast cancer coded as brachytherapy or as a localization technique similar to wire localization? See Discussion.
We are seeing many I-125 seed implants for breast cancer. Many of my associates are coding them as brachytherapy. I think they are the newest of the localization technique like wire localization but with greater accuracy. Most are done the same day as the surgery so brachytherapy does not make sense. Which is correct?
I-125 seeds could be used for brachytherapy for breast cancer or as a localization technique for nonpalpable breast tumors. If the seeds were in place a short time and removed as part of a breast surgical procedure, they were likely used for tumor localization. Radioactive seed localization (RSL) is thought to be more precise than the wire implantation technique for localizing lesions.
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