Report | Question ID | Question | Discussion | Answer | Year |
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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. |
2017 |
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20170022 | MP/H Rules/Histology--Brain and CNS: What is the code for an embryonal tumor with multilayered rosettes. WHO shows the code as 9478/3, but this code is not available for use in the United States. |
Assign ICD-O-3 code 9392/3 until code 9478/3 is implemented in 2018. Per our expert neuropathologist, embryonal tumor with multilayered rosettes was previously called ependymoblastoma. |
2017 | |
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20170066 | Primary Site/Corpus uteri: Is the primary site C541 (endometrium) or C543 (uterine fundus) when the histology states endometrial adenocarcinoma, endometrioid type, but tumor site states fundus? See Discussion. |
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. |
We recommend coding endometrium, C541, as the primary site for this case. While coding to fundus would not be incorrect, according to our expert pathologist consultant, "it is more appropriate in a setting in which the region of the uterus is of importance, e.g. with a myoma or a myosarcoma, or if the endometrioid carcinoma were NOT in the endometrium but arising in a focus of adenomyosis within the fundic myometrium " |
2017 |
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20170077 | First Course Treatment: Should the definition in the 2016 SEER Coding Manual be revised for first course of treatment following disease progression for patients who complete the initial first course treatment plan without alteration but had one or more treatment modalities given after disease progression was identified? See Discussion. |
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? |
The example cited above will not be included in the 2018 edition of the SEER manual. Removing this example will improve the consistency in recording first course of treatment for cases diagnosed 2018 and later. |
2017 |
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20170036 | Grade--Prostate: How are the prostate-related fields completed when documentation in pathology reports only includes one of the new grade groups? See Discussion. |
Our pathologists have starting to use a new prostate cancer grading system that was adopted by WHO in 2016. The new grading scheme correlates with the prior Gleason grading scheme as follows: Grade Group 1 = Gleason score 6 or less Grade Group 2 = Gleason score 3+4=7 Grade Group 3 = Gleason score 4+3 = 7 Grade Group 4 = Gleason score 8 Grade Group 5 = Gleason score 9-10 Our pathologists are no longer dictating the Gleason Primary and Secondary Pattern values nor the Gleason's Score. Reverse correlation from the new grade groups to the required patterns and score are difficult with Grade Groups 2 and 3 needing to be distinguished from one another and Grade Group 5 including two unique scores. The prostate-related fields include: Collaborative Site Specific Factor 7: Gleason's Primary Pattern and Secondary Pattern Values on Needle Core Biopsy/TURP Collaborative Site Specific Factor 8: Gleason's Score On Needle Core Biopsy/TURP Collaborative Site Specific Factor 9: Gleason's Primary Pattern and Secondary Pattern Values on Prostatectomy/Autopsy Collaborative Site Specific Factor 10: Gleason's Score on Prostatectomy/Autopsy |
When all you have is the grade group, you may use the following table to convert the Prostate Grade Groups to the appropriate code for the indicated fields. Grade Group Gleason Score Gleason Pattern SSF7 SSF8 SSF9 SSF10 Grade/diff Grade Group 1 6 or less <=3+3 099 999 099 999 1 Grade Group 2 7 3+4 034 007 034 007 2 Grade Group 3 7 4+3 043 007 043 007 2 Grade Group 4 8 4+4, 3+5, 5+3 999 999 999 999 3 Grade Group 5 9-10 4+5, 5+4, 5+5 099 999 099 999 3 |
2017 |
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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. |
2017 |
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20170041 | MP/H Rules/Histology--Thyroid: How should histology be coded for a thyroidectomy final diagnosis of papillary thyroid carcinoma, favor cribriform-morula variant? See Discussion. |
This specific histology (cribriform-morula variant of papillary thyroid carcinoma) is not found in the ICD-O and is not mentioned in the 2007 MP/H Manual. However, per a web search it appears that this is a distinct type of papillary thyroid carcinoma (http://erc.endocrinology-journals.org/content/24/4/R109.full). Example: Right lobectomy shows thyroid epithelial neoplasm, pending consultation. Consultation: Thyroid gland, right lobe: papillary thyroid carcinoma, favor cribriform-morula variant. Consultation Comment: IHC stains argue against medullary carcinoma. The histologic features of growth patterns and cytologic atypia (with rare grooves and pseudoinclusions) and the immunohistochemical profile support a diagnosis of papillary thyroid carcinoma, favoring the cribriform-morula variant. It is important to note that a significant number of patients with this variant of papillary thyroid carcinoma have been associated with familial adenomatous polyposis syndrome. |
Assign code 8260/3 for papillary carcinoma of thyroid. Cribriform-morula variant is not listed in ICD-O-3 for papillary carcinoma. Multiple Primaries/Histology Rule H14 states to code papillary carcinoma of the thyroid to papillary adenocarcinoma, NOS (8260). |
2017 |
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20170055 | First Course of Treatment/Surgery of Primary Site--Corpus uteri: Do you code total hysterectomy or radical hysterectomy when a specimen indicates the uterus, cervix, ovaries, fallopian tubes, and right and left parametrium were resected, but shows no portion of the vagina. See Discussion. |
AFS1-AFS2-frozen section control, endomyometrium; AFS3-frozen section control, subserosal intramural mass; A4-anterior cervix; A5-posterior cervix; A6-anterior cervical endometrial junction; A7-posterior cervical endometrial junction; A8-A10-anterior endomyometrium, including tumor; A11-A13-posterior endomyometrium, including tumor and adjacent mass; A14-random section subserosal mass; A15-left parametrium at margin of resection; A16-right parametrium at margin of resection; A17-A18-left ovary and fallopian tube; A19-A20-right ovary and fallopian tube. The final diagnosis includes Endometrial adenocarcinoma, favor serous carcinoma, with papillary and solid areas. Tumor involves: Cervix present, Right ovary, Left ovary, Right fallopian tube, Left fallopian tube, Right parametrium, Left parametrium. |
Assign code 50 for total hysterectomy. According to Appendix C Surgery Codes for Corpus Uteri of the 2016 SEER Coding and Staging Manual, total hysterectomy is surgery to remove the entire uterus, including the cervix; whereas, radical hysterectomy includes the vagina. |
2017 |
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20170018 | MPH Rules/Multiple primaries--Melanoma: Does MP/H Rule M7 (diagnosed more than 60 days apart) apply to invasive melanoma cases with margins positive for in situ melanoma, or are these further excision of the original diagnosis and the same primary, even when it appears treatment was complete after the initial excision? See Discussion. |
A dementia patient has been managed for a persistent right cheek skin lesion that has been slow growing for about 5 years. It was biopsied in 12/23/15 revealing a Breslow 0.12 mm lentigo maligna melanoma by an outside provider. A larger resection of the lesion on 2/3/16 demonstrated a Breslow 0.30 mm lentigo maligna melanoma with melanoma in situ present at the margins per the available pathology report. There was no statement in the record that any additional treatment was planned or necessary. Patient healed well from the 2/3/16 procedure but developed a recurrent lesion in May that was biopsied on 5/10/16 by the same outside provider which again reveal lentigo maligna melanoma. 7/5/16 Reexcision at the current facility revealed a Breslow 6.1 mm lentigo maligna melanoma, Clarks level V. This was a cutaneous tumor per the path report and not a subcutaneous nodule. Clinically, the MD called this a , but there was no slide comparison to the previous melanoma. In auditing files for expected (but not received) abstracts due from facilities, we've observed these types of cases not being consistently reported as multiple primaries. |
Rule M7 pertains to separate tumors. Rule M7 does not apply to invasive melanoma cases with margins positive for in situ melanoma. Based on the information provided, it is not clear whether or not the 5/10/16 diagnosis is a separate lesion or the same lesion that was diagnosed earlier. |
2017 |
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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~) |
2017 |