SEER Inquiry System - Search

Patient has only a LUL tumor on imaging. The tumor board initially states, possibly a mixed tumor, likely IIIA SCC and/or IIIA or B small cell. Later, the physician refers to it as "Stage III lung cancer, mixed histology with small cell in the lymph node and squamous cell in the LUL mass." Patient has no further workup and has declined therapy.

Sarcomotoid (8318) is listed as a specific renal cell subtype in the MP/H manual, but it is not listed as a renal cell subtype in the most recent WHO blue book for Urinary Organs. We are wondering if sarcomatoid features, as listed in the CAP protocol format in the following example, should be ignored when coding histology?

Left kidney, radical nephrectomy:

Clear cell renal cell carcinoma, with the following features:

Tumor size: 8.5 X 6 cm.

Tumor focality: Unifocal.

Macroscopic extent of tumor: Tumor limited to kidney.

Sarcomatoid features: Present (<20% of tumor shows sarcomatoid features).

Histologic grade: G4.

Microscopic tumor extension: Tumor limited to kidney.

Margins: All margins negative for invasive carcinoma.

Lymph-vascular invasion: Not identified.

Patient was diagnosed with DCIS of the left breast in June 2014. The patient had a simple mastectomy with 2 axillary lymph nodes removed. The final diagnosis was intermediate to high grade ductal carcinoma in situ, predominantly micropapillary type, forming a 1.4 cm mass. No invasive carcinoma identified. Margins negative. In April 2017, the patient was found to have parietoccipital bone lesions, which were resected. The resulting diagnosis was metastatic carcinoma, morphologically consistent with breast primary " See Comment: The previous breast lesion is not available for review at the time of signout. However, the tumor is morphologically compatible with a breast primary.

SINQ 20110111 would not make this is new primary. However, it seems that rule M8 might apply. An invasive tumor following an in situ tumor more than 60 days after diagnosis is a multiple primary. See Note 2: Abstract as multiple primaries even if the medical record/physician states it is recurrence or progression of disease.

The Summary Cancer Data does not seem to describe a more specific histology, but it does describe the tumor histology with the worst outcome and the most extensive tumor. The anaplastic carcinoma grossly extended into skeletal muscle and gave rise to multiple regional lymph node metastases. The more appropriate histology seems to be 8021.

However, current MP/H Rules for a single tumor indicate the histology should be coded to the numerically higher histology code (8260). Coding the histology to 8260 does not account for the more aggressive tumor. Should this histology be 8260 or 8021?

5/27/02 Transurethral resection of bladder tumor (TURBT)--papillary transitional cell carcinoma, +lamina propria, no muscle invasion. All urine cytologies in 2011 and 2012 (only follow up received) show no malignancy. 3/11/15 Lung fine needle aspirate--poorly differentiated carcinoma consistent with urothelial carcinoma. 4/30/15 Renal pelvis biopsy--low grade papillary urothelial carcinoma, no lamina propria invasion, no muscularis propria invasion.

There is a discrepancy in regional lymph nodes for lung between SEER and AJCC. Supraclavicular lymph nodes/cervical lymph nodes are distant for SEER but regional for AJCC. For SEER states, when there is an FNA or biopsy of a supraclavicular lymph node performed and it is positive for a lung primary and no other lymph nodes are examined, do you code 95 in Regional Nodes Positive/Regional Nodes Examined and code "1" for Scope of Regional Lymph Node Surgery or do you not count the FNA/biopsy of the supraclavicular lymph node since it is distant?

Pathology states: Translocation renal cell carcinoma. Comment Tumor morphology and IHC profile consistent with MiT family translocation RCC with Xp11 translocation.

Pathology report 1/13/15, Histology - Transverse colon resection pathology = Invasive moderately differentiated adenocarcinoma. The invasive adenocarcinoma arises in a sessile serrated adenoma.

Bronchial washings were negative. Four lymph nodes were biopsied and found to have metastatic poorly differentiated neuroendocrine carcinoma. The treating oncologist calls it small cell carcinoma, extensive stage, and treats patient with carboplatin and VP-16 (etoposide) The MP/H rule says to take path/cyto from a metastatic site if no pathology/cytology available from the primary site. Is the physician's statement and treatment taken into consideration here?