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20170079 | Surgery of Primary Site--Corpus Uteri: Is surgery for a uterine corpus primary described as total abdominal hysterectomy-bilateral salpingo-oophorectomy (TAH-BSO) with specimens including uterine corpus, cervix, bilateral ovaries and fallopian tubes, and bilateral parametria coded as a modified radical hysterectomy? It would be very helpful if an explanation of the difference between a total hysterectomy, modified radical hysterectomy, and radical hysterectomy can be included. See Discussion. |
Surgery text indicates TAH-BSO with bilateral pelvic and paraaortic lymph node dissection. The pathology report indicates the specimen includes: Uterine corpus, cervix, bilateral ovaries and fallopian tubes, bilateral parametria. The Gross Description also indicates: Representative sections submitted in 16 cassettes as follows: A1: Anterior cervix A2: Posterior cervix A3: Full thickness anterior lower uterine segment A4: Full thickness posterior lower uterine segment A5: Tumor A6-A7: Full thickness anterior endomyometrium to include tumor A8-A10: Full thickness posterior endomyometrium with tumor A11: Representative sections of right fallopian tube and fimbria A12: Representative sections of right ovary A13: Representative sections of left fallopian tube and fimbria A14: Representative sections of left ovary A15: Right parametrial tissue A16: Left parametrial tissue A17-23: Remainder of cervix. |
Assign code 50: total hysterectomy with removal of tube(s) and/or ovary(ies). Removes both the corpus and cervix uteri. It may also include a portion of the vaginal cuff. Both the radical and modified radical hysterectomy (code 60) include removal of part of the vagina, not mentioned in the pathology or surgery text. The SEER Glossary for Registrars defines the procedures as follows. Total hysterectomy: Surgery to remove the entire uterus, including the cervix Radical hysterectomy: Surgery to remove the uterus, cervix and part of the vagina. The ovaries, fallopian tubes and nearby lymph nodes may also be removed. Modified radical hysterectomy: Surgery to remove the uterus, cervix, upper part of the vagina, and nearby ligaments and tissues. Nearby lymph nodes may also be removed. In this type of surgery, not as many tissues and/or organs are removed as in a radical hysterectomy. |
2017 |
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20170064 | Grade/Histology--Rectum: How should histology and grade be coded for high grade neuroendocrine tumor (NET) (WHO Grade 3) of the rectum? See Discussion. |
Rectal mass biopsy final diagnosis: High grade neuroendocrine tumor (WHO Grade 3). Neither SINQ 20170033 nor 20160023 address coding histology or grade for neuroendocrine tumors that are designated as high grade and/or WHO grade 3. |
Assign histology code 8246/3. Assign grade code 4 based on the description "high grade." A high-grade neuroendocrine "tumor" is actually a neuroendocrine "carcinoma" (NEC) according to WHO Classification of Tumors of the Digestive System. If possible, verify this interpretation with the diagnosing pathologist. Use text fields to document the details of this case. |
2017 |
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20170031 | MP/H Rules/Multiple primaries--Penis: How many primaries should be reported for a diagnosis of invasive squamous cell carcinoma (SCC) of the penis in 6/2011, treated with excision and fulguration followed by 10/2014 penile lesion found to be SCC with basaloid features focally highly suspicious for invasion? Clinically, the 2014 tumor is stated to be in situ and recurrent penile cancer and follow-up in 2/2015 indicates there was no evidence of tumor following treatment. Subsequently, in 3/2016 the patient has another penile lesion biopsy showing SCC in situ suspicious for invasion, clinically stated to be recurrent. See Discussion. |
At the central registry, we have accessioned this scenario as three primaries per Multiple Primaries/Histology (MP/H) Rule M10 (diagnosed more than 1 year apart), as the patient was stated to be disease free between each occurrence. However, the diagnosing/treating facility is not reporting these cases due to clinical statements of recurrent disease. This is an example of a case type identified on casefinding audits conducted by our central registry in which we have learned SEER's expectation of MP/H rule application does not match hospital reporting. Can the 2018 version of the MP/H rules more clearly address how this type of clinically recurrent (multiple times) case should be handled? |
Accession three tumors as the tumors were each diagnosed more than one year apart according to the MP/H Rule M10 for Other Sites. And, as you have noted, the patient was free of disease after each diagnosis. The MP/H rules have very clear instructions regarding the word "recurrence." See page 10, specifically A.7., https://seer.cancer.gov/tools/mphrules/2007_mphrules_manual_08242012.pdf SEER will evaluate the MP/H rules in the upcoming revision. |
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20170003 | Reportability/Histology--Brain and CNS: Is epidermoid tumor of the cerebellopontine angle (CPA) and trigeminal vesicle nerve reportable, and if so, what is the correct histology code? See discussion. |
Patient presented to hospital ED and had brain MRI that revealed 3.2 cm space occupying lesion in region of the left CPA and trigeminal vesicle nerve compatible with epidermoid tumor. |
Epidermoid tumor of the brain is not reportable. There is no ICD-O-3 code for epidermoid tumor or epidermoid cyst. This type of tumor is often referred to as a cyst because it has a thin wall that secretes a soft material into the center. |
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20170014 | Reportability/Histology--Heme & Lymphoid Neoplasms: Is a physician statement that a patient has a malignant histiocytic disorder best described as Erdheim-Chester disease reportable? If reportable, should histology be coded to 9751/3? See Discussion. |
The patient had a mediastinal mass biopsy showing fibrosclerotic tissue with patchy lymphohistiocytic foci and scattered plasma cells, followed by a retroperitoneal mass biopsy showing fibrohistiocytic infiltrate. Erdheim-Chester disease is not reportable per the Heme Database. However, the physician specifically states this is a malignant disorder. |
Erdheim-Chester disease is not reportable. Use the Hematopoietic and Lymphoid Neoplasm Database to determine reportability. The WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues states that Erdheim-Chester disease is a possible adult form of disseminated juvenile xanthogranuloma with bone and lung involvement; no histology code is provided. |
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20170033 | Grade--Appendix: What is the code and term to use for the grade/differentiation field for well differentiated, Grade 2 neuroendocrine tumor (NET)? See Discussion. |
Diagnosis: Fragmented appendix with: Goblet cell carcinoid tumor (typical goblet cell carcinoid): WELL DIFFERENTIATED neuroendocrine tumor; INTERMEDIATE GRADE (GRADE 2 NET). Size 3.5 cm according to surgical pathology report. Tumor infiltrates through appendiceal wall to subserosa. Tumor is present in what appears to be the wall of the appendix near the perforation site or in hemorrhagic tissue on the surface of the appendix. MAXIMUM MITOTIC RATE IS TWO (2) FIGURES PER 10 HIGH POWER fields (2/10hpf). (4/10 hpf according to report). WD indicates a 3- grade system (code 1 for WD) Intermediate grade indicates a 3- grade system (code grade 3 for intermediate grade), Grade 2 indicates a 2- grade system (code 2 for grade 2). Please advise. |
See SINQ 20160023 for NET grade coding instructions. Coding grade for NETs is slightly different from coding grade for other solid tumors. Since this diagnosis includes "Well differentiated" and "Grade 2," assign grade code 2, the higher grade. According to our expert pathologist consultant, "intermediate" fits best with grade 2. |
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20170010 | CS Site Specific Factor--Breast: What estrogen receptor/progesterone receptor (ER/PR) values should be coded in a case with two separate tumors (1 ductal, 1 lobular) diagnosed simultaneously in the same breast (single primary) with differing ER/PR values for each tumor? One is ER/PR positive; the other is ER/PR negative. |
In cases where ER (or PR) is reported on more than one tumor specimen, record the highest value. If any sample is positive, record as positive. Guidance on Collaborative Stage (CS) site-specific factors (SSFs) in the breast schema can be found in the SEER Registrar Staging Assistant (SEER*RSA): SSF1-Estrogen Receptor (ER) Assay and SSF2-Progesterone Receptor (PR) Assay. The SEER* RSA breast schema is found at: https://staging.seer.cancer.gov/cs/schema/02.05.50/breast/?breadcrumbs=(~schema_list~) |
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20170081 | Grade/Neuroblastoma: What grade is to be used when pathology states only differentiating retroperitoneal neuroblastoma? |
For cases diagnosed prior to 2018 Assign grade code 2 for "differentiating" retroperitoneal neuroblastoma. The rationale of our expert pathologist advisor is that "it leaves the grade 1 category open (since a "well differentiated neuroblastoma" is actually called ganglioneuroblastoma), and it also avoids putting "differentiating" into what is usually a well differentiated category." Additionally, assign grade code 3 to a poorly differentiated retroperitoneal neuroblastoma and grade code 4 to an undifferentiated retroperitoneal neuroblastoma. For cases diagnosed 2018 and later Follow the instructions for coding grade in SEER*RSA |
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20170068 | MP/H Rules/Histology--Lung: What is the histology of a lung tumor described as solid predominant with mucin production, 8230/3 (Multiple Primaries/Histology (MP/H) Rule 5) or 8255/3 (MP/H Rule 6)? See Discussion. |
Pathology report: Left lower lobe lung, Tumor Size: Greatest dimension: 3.0 cm Additional dimensions: 2.5 x 2.0 cm; Tumor Focality: Unifocal; Histologic Type: Invasive adenocarcinoma Solid predominant with mucin production; Histologic Grade: G3: Poorly differentiated. Is the correct histology for this case 8230/3 (rule H5) or 8255/3 (rule H6)? |
Code histology as 8230/3, solid adenocarcinoma with mucin formation, using MP/H Rule H3 as one histologic type is identified. All of the histologic terms (solid, mucin production) are covered by 8230/3. Therefore, rule H3 applies. Use the first rule that applies, and stop. |
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20170062 | Race, ethnicity: How do you code race for someone from New Zealand? |
I recently did a presentation on coding the data item Race. In my presentation I discussed understanding geography help code race in some circumstances. One of the slides demonstrates how large Polynesia is and what Pacific islands are found in Polynesia, such as, Tahiti, Samoa, and even Hawaii, all of which have their own codes. Someone in the audience asked "How do you code New Zealand? Upon some research, New Zealand is not listed in Appendix D of the SEER coding manual. We could code them 01-White. But research shows there is a very large indigenous population. Technically, New Zealand is located within the boundaries of Polynesia - Code 25 (Polynesian). |
If the only information you have on race is that the person is from New Zealand, code race as white. This is based on the instructions for Australia, the closest neighbor to New Zealand as no other guidance was found. |
2017 |
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