SEER Inquiry System - Search

Pathology--Final description: Uterus, cervix, bilateral fallopian tubes and ovaries, total hysterectomy and bilateral salpingo-oophorectomy: Endometrial adenocarcinoma, endometrioid type, well differentiated, FIGO 1/3. Myometrial invasion: focal myometrial invasion (30% of myometrium) Tumor size: 2 x2 cm Tumor site: Fundus, exophytic/polypoid lesion Gross description: The 3.0 cm in length by 2.5 cm in diameter triangular endometrium is tan-red and smooth with a 2.0 x 2.0 cm tan-pink, exophytic fundic mass which extends on to both anterior and posterior aspects, 4.1 cm from the os.

The pathologist noted this was a challenging brain neoplasm that did not easily fit into a specific WHO diagnostic classification. Multiple differential diagnoses were given including pilomyxoid astrocytoma, ganglioglioma and dysembryoplastic neuroepithelial tumor (DNET), but there were no definitive features characteristic of any of these tumors. In the Comment section following the Final Diagnosis, it further states: "In summary, the tumor appears to be a difficult to classify non-infiltrating glial/glioneuronal neoplasm without definitive high-grade features."

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

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?

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.

Patient had a biopsy in April 2014; pathology was reported as non-small cell carcinoma with neuroendocrine phenotype, possible large cell neuroendocrine carcinoma. The patient had five cycles of cisplatin/etoposide with no response. In May 2015, a re-biopsy at a referral institution reports poorly differentiated small cell carcinoma and states "feels that this could have been the histology all along and why patient has failed multi lines of chemo."

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.

The FORDS Manual (pg. 22) states: The first course of treatment includes all methods of treatment recorded in the treatment plan and administered to the patient before disease progression or recurrence. The instructions in the FORDS Manual and clarification from multiple CAnswer Forum posts indicates the planned first course treatment stops following disease progression, even when the first course treatment plan is not altered or changed.

SEER, on the other hand, instructs registrars to do the opposite. The SEER Manual instructs registrars to code all completed treatment given as part of the initial first course treatment plan, even after disease progression, provided the treatment plan is not changed or altered. (See 2016 SEER Manual, Section VII First Course of Therapy, Treatment Timing, Rule 1 and Example 1.)

For consistency in data collection, shouldnt the standard setters use the same guidelines to define first course treatment? Given that the majority of cases are reported to SEER by registrars in CoC facilities, who may not be abstracting treatment modalities that occur after progression, the SEER expectation is likely not able to be performed consistently. Wont this difference in standard setter data collection expectations negatively impact the treatment data reflected on our files?

Per Rule M8, this is a single primary as there are multiple urothelial tumors as outlined in Table 1 (papillary urothelial carcinoma [8130] and sarcomatoid urothelial carcinoma [8122]) simultaneously present in multiple urinary organs (bladder, ureter and renal pelvis). As Rule M8 indicates these are a single primary, despite the histologies differing at the third digit (8130 vs 8122), then Rule H14 (Code the histology of the most invasive tumor) seems to be the most applicable histology rule. Following Rule H14 (in the Text version of the MP/H Rules), the histology would be coded as 8122 (sarcomatoid urothelial carcinoma) since the renal pelvis tumor was the most invasive tumor present.

However, in both the Matrix and Flowchart versions of the MP/H Rules, Rule H14 contains a note (missing from the Text version) that states that this rule should only be used when the first three numbers of the histology codes are identical (This is a single primary). Rule M8 clearly tells us these are a single primary, despite the differences at the third digit of the histology. Further defaulting to Rule H15 (Code the numerically higher histology code) in this case would ignore the histology of the tumor with the worse prognosis (the most invasive tumor). Was this note included in the Matrix and Flowchart versions in error?