Report | Question ID | Question | Discussion | Answer | Year |
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20170071 | Reportability/Brain and CNS: Is incidentaloma reportable from brain and central nervous system (CNS) imaging? See Discussion. |
We are seeing the term "incidentaloma" on magnetic resonance imaging (MR) reports of head and also with physician statements. For example, this MR of the head: Impression--Suboptimal study due to motion degradation. Heterogeneously enhancing pituitary gland without evidence of acute abnormality. A 3 mm focus of relative hypoenhancement in the left gland is favored to represent an incidentaloma. Advise correlation with clinical findings. Also, there are cases where the scans show meningioma and then at a later date it is stated to be an incidentaloma in physician notes. Is the term "incidentaloma" alone reportable, if the term "tumor" for CNS cases is never stated? When I googled the term, it is stated to mean "tumor." |
The term "incidentaloma" alone is not reportable. Look for a reportable term elsewhere or in later information. When the term "incidentaloma" is used on a magnetic resonance imaging (MR) report, it refers to "a disease or physical condition found as a secondary by-product of capturing the necessary volume of tissue within the field of view of the MR examination" (http://radsource.us/incidentaloma). It is not necessarily neoplastic. |
2017 |
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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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20170001 | MP/H Rules/Histology--Kidney: How is the histology coded and what rule(s) apply to the classification of succinate dehydrogenase-deficient renal cell carcinoma? See Discussion. |
Partial nephrectomy showed carcinoma, histologic type: succinate dehydrogenase-deficient renal cell carcinoma. This is not a term in the ICD-O, and is not a histology covered in the Kidney MPH rules. However, a recent web search indicates this is a specific type of RCC that was added to the 2016 WHO classification of RCC (per abstract: https://www.ncbi.nlm.nih.gov/pubmed/27179267) and makes up 0.05-0.2% of RCC cases (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229399/). |
Code the histology to renal cell carcinoma, NOS (8312/3). While WHO lists succinate dehydrogenase-deficient renal cell carcinoma in the latest edition, no specific histology code is provided. MP/H Rule H10 applies since only one histology type is provided, though no code is listed. |
2017 |
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20170005 | Reportability/Histology--Testis: Is neoplasm consistent with carcinoid type of monodermal teratoma reportable as a teratoma, NOS, and if yes, what is the histology code? |
Carcinoid type of monodermal teratoma or well differentiated neuroendocrine tumor (carcinoid), monodermal teratoma of the testis is reportable. Assign 8240/3 according to the WHO classification for this neoplasm. |
2017 | |
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20170006 | Diagnostic confirmation--Heme & Lymphoid Neoplasms (Lymphoma): To code "3" in Diagnostic Confirmation, does the genetic testing need to confirm a specific histology or is it enough that is simply rules out others? See Discussion. |
For example, pathology states: Right axillary lymph node, excision: Diffuse large B-cell lymphoma (DLBCL) (see note). COMMENT: FISH studies were performed that were negative for BCL-6, c-Myc/IgH, CCND1/IgH and IgH/BCl-2 gene rearrangement, ruling out the most common forms of double-hit lymphoma. Flow cytometry studies demonstrated positivity for CD45, CD20, HLA-Dr, CD19, CD11c, CD22, CD30, CD38, CD79b, and FMC7. Low positivity was seen for CD5. No reactivity was seen for CD10, CD23, CD25, CD103 or CD123. |
Both histologic plus immunophenotyping or genetic testing should be positive to assign code 3 for Diagnostic Confirmation. The Hematopoietic and Lymphoid Neoplasm Coding Manual Diagnostic Confirmation instructions state, assign 3 for Cases positive for neoplasm being abstracted (including acceptable ambiguous terminology and provisional diagnosis) AND Immunophenotyping, genetic testing, or JAK2 is listed in the Definitive Diagnosis in the Heme DB AND a.) Confirms the neoplasm OR b.) Identifies a more specific histology (not preceded by ambiguous terminology). Because the patient was diagnosed with DLBCL by histology, and flow cytometry was positive for CD antigens (immunophenotyping) 20, 22, and 30 for DLBCL, code 3 is appropriate. |
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 | |
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20170065 | MP/H Rules/Histology--Thyroid: How should histology be coded for a single tumor with final diagnosis undifferentiated (anaplastic) carcinoma arising in association with papillary thyroid carcinoma and the Summary Cancer Data states Histologic type: Undifferentiated (anaplastic) carcinoma only? See Discussion. |
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? |
Code the most specific histologic term, 8260, for papillary carcinoma of the thyroid using Multiple Primary/Histology Rule H13 for Other Sites (single tumor, invasive section). Use text fields to describe the complete histology. |
2017 |
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20170042 | Reportability--Heme & Lymphoid Neoplasms: Is a diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) with large cell transformation equivalent to a diagnosis of diffuse large B-cell lymphoma (DLBCL) without mention of Richter transformation or Richter Syndrome? See Discussion. |
The patient has a history of CLL/SLL dating back to 2007, but has had progressive disease with development of a new left frontal brain tumor. The brain tumor resection proved CLL/SLL with large cell transformation, but neither the pathologist nor the managing physician called this a Richter transformation, Richter syndrome or provided a diagnosis of DLBCL. However, a large cell transformation of CLL/SLL is a Richter transformation. Can this be accessioned as a new acute neoplasm per Rule M10? |
Accession as multiple primaries according to Hematopoietic and Lymphoid Neoplasm Coding Manual Rule M10. Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) followed by CLL/SLL with large cell transformation is multiple primaries because it is a chronic neoplasm followed by an acute neoplasm, more than 21 days in this case. |
2017 |
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20170020 | Size of tumor--Breast: Please clarify guideline #7 if the only size you have is from a CORE biopsy specimen and imaging only states nonspecific sizes, like "architectural distortion" or "calcifications" and a core biopsy pathology reports invasive tumor spans 5mm. Do you use the core biopsy size, or use 999 for clinical tumor size? See discussion. |
SEER Program Coding and Staging Manual 2016 states: Record size in specified order using a. The largest measurement of the primary tumor from physical exam, imaging, or other diagnostic procedures before any form of treatment. See Coding Instructions 7-9 below. b. The largest size from all information available within four months of the date of diagnosis, in the absence of disease progression when no treatment is administered. #7 Priority of imaging/radiographic techniques: Information on size from imaging/radiographic techniques can be used to code clinical size when there is no more specific size information from a biopsy or operative (surgical exploration) report. It should be taken as a lower priority, but over a physical exam. |
Do not code size of tumor based on the size of the core biopsy. If the statement "invasive tumor spans 5mm" from the core biopsy report represents the surgeon's assessment of tumor size, use this information to code tumor size when no other information is available. |
2017 |
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20170056 | Reportability/Histology--Skin: Is 'skin, left temporal scalp, low grade adnexal carcinoma, probable sweat gland origin' reportable as 8400/3, skin of temple? |
Assign 8390/3 for adnexal carcinoma of skin. 8390/3 is reportable, including 8390/3 of skin. |
2017 |