Report | Question ID | Question | Discussion | Answer | Year |
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20180094 | Reportability--Prostate: According to the 2018 SEER Program Manual, a prostatic intraepithelial neoplasia (PIN) III is not reportable, but is an atypical small acinar proliferation (ASAP) PIN 4 reportable? |
ASAP is not reportable. Patients with ASAP found on needle biopsy will likely undergo another biopsy. |
2018 | |
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20180108 | Solid Tumor Rules (2018)/Histology--Lung: What is the correct histology of a lung mass with a CT-directed fine needle aspirate "positive for malignancy, favor squamous cell carcinoma. See Discussion. |
Immunostain results of the malignant cells show strong staining with p63 and negative staining with TTF-1 and Napsin. Rare cells stain with CK7. Findings are most compatible with squamous cell carcinoma. The patient is treated as if he has squamous cell carcinoma. The new histology coding rules say you cannot use ambiguous terms which modify the histology to code the histology. So is this 8010/3? |
Code histology to SCC. The lung rules were updated 10/12/2018 to include clarification on using ambiguous terminology to code histology. See page 32. Note 2: Histology described by ambiguous terminology is coded when a case is * Clinically confirmed by a physician (attending, pathologist, oncologist, pulmonologist, etc.) * Patient is treated for the histology described by an ambiguous term Your case meets both of these criteria so code histology to SCC. |
2018 |
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20180013 | Reportability--Brain and CNS: Are tuberous sclerosis cancers found in the brain reportable? See Discussion. |
I have searched ICD-O-3 for a histology listing but could not locate. I also searched the SEER Inquiry database for possible answers, but none were found. The patient underwent a pediatric MRI of the brain of which final impression was: 1) Subependymoma nodules, cortical tubers, and SEGAs are seen bilaterally consistent with tuberous sclerosis. |
SEGA (Subependymal giant cell astrocytoma) is reportable if diagnosed in 2004 or later. Tuberous sclerosis complex (TSC) is not a neoplasm and is not reportable. SEGA is a neoplasm that commonly occurs in TSC patients. Refer to the reportability instructions on pages 5-7 in the SEER manual, https://seer.cancer.gov/manuals/2016/SPCSM_2016_maindoc.pdf |
2018 |
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20180029 | Reportability--Skin: Is early/evolving lentigo maligna reportable? |
As of 01/01/2021, early or evolving melanoma in situ, or any other early or evolving melanoma, is reportable. |
2018 | |
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20180077 | Solid Tumor Rules (2018)/Histology--Head & Neck: How is histology coded for a p16-positive squamous cell carcinoma of the base of tongue? Is p16-positive squamous cell carcinoma equivalent to a diagnosis of squamous cell carcinoma human papilloma virus (HPV)-positive (8085)? See Discussion. |
Table 6 (Tumors of the Oropharynx, Base of Tongue, Tonsils, Adenoids) in the Head and Neck Equivalent Terms and Definitions lists both squamous cell carcinoma HPV-positive and squamous cell carcinoma HPV-negative as subtypes/variants of squamous cell carcinoma (the NOS histology, 8070). Squamous cell carcinoma HPV-positive and squamous cell carcinoma HPV-negative are also listed in the 2018 ICD-O-3 update table. Previous clarification from the standard setters regarding the 2018 ICD-O-3 Update table indicated that histology codes 8085 and 8086 (HPV-positive and HPV-negative squamous cell carcinoma, respectively) included p16+ and p16- squamous cell carcinoma, respectively. Presumably, this clarification was made because p16 is a surrogate marker for HPV, and capturing whether a tumor is HPV-related or not has implications for staging for 2018 and later diagnoses. However, this clarification was not added to the 2018 ICD-O-3 Update table via errata, nor do the Head and Neck Equivalent Terms and Definitions or Histology Coding Rules address this. Is a diagnosis of p16-positive squamous cell carcinoma equivalent to a diagnosis of squamous cell carcinoma HPV-positive (8085)? If so, will this clarification be added to the Head and Neck Solid Tumor Rules? |
HPV-positive is not equivalent to HPV-mediated (p16+). According to the 2018 SEER Manual, HPV-type 16 refers to virus type and is different from p16 overexpression (p16+). HPV status is determined by tests designed to detect viral DNA or RNA. Tests based on ISH, PCR, RT-PCR technologies detect the viral DNA or RNA; whereas, the test for p16 expression, a surrogate marker for HPV, is IHC. HPV testing must be positive by viral detection tests in order to code histology as 8085. |
2018 |
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20180049 | Solid Tumor Rules (2018)/Histology--Lung: What is the difference between Lung Rules H7 and H8 (Single Tumor Module)? When would one use H8 rather than H7? See Discussion. |
Is Rule H8 a duplicate of Rule H7? Rule H7 instructs one to use Table 2 when there are multiple histologies and the combination is listed in Table 2 (or a combination code was received from Ask a SEER Registrar). Rule H8 states to code adenocarcinoma with mixed subtypes (8255) when there are multiple adenocarcinoma subtypes OR any combination of histologies which are not listed in Table 2. However, both conditions for Rule H8 are already included in Table 2 (the last row). How would one ever move past Rule H7 if all the conditions for both Rules H7 and H8 are covered first under Rule H7? Example: A resection pathology report proves invasive adenocarcinoma, acinar, solid and papillary types. Rule H7 seems to be the first H Rule that applies as there are multiple histologies (identified using a reportable term: type) AND the combination is listed in Table 2. The last row of Table 2 instructs one to code Adenocarcinoma with mixed subtypes (8255) when there are at least two of the subtypes/variants of adenocarcinoma listed in Column 1 (Required Terms). In this case, there were three subtypes/variants that are listed in Column 1 (acinar, solid and papillary). However, Rule H8 also instructs one to, Which rule applies here, Rule H7 or Rule H8? |
January 2019 update: The differences between H7 and H8 are H8 applies to tumors with multiple subtypes of adenocarcinoma while H7 applies to histology combinations other than adenocarcinoma such as adeno and squamous. |
2018 |
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20180089 | Reportability--Appendix: Is disseminated peritoneal adenomucinosis (DPAM) reportable when it is being referred to as if the primary tumor is a low-grade appendiceal mucinous neoplasm (LAMN)? See Discussion. |
Example 1: 8/23/2017 debulking path diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) with involvement of intrapelvic mucin, left ovarian mass, uterine serosa and pelvic tumor, consistent with disseminated peritoneal adenomucinosis, that may also be called low-grade mucinous carcinoma peritonei. 8/8/2018 resection of sigmoid and rectum, path diagnosis of peri-colorectal fibroadipose issue with low-grade mucinous carcinoma compatible with the prior diagnosis of pseumomyxoma peritonei with low-grade mucinous carcinoma histology. Example 2: Path diagnosis of low-grade appendiceal mucinous neoplasm in association with low grade mucinous carcinoma peritonei involving the serosa of the small intestine and mesentery. Also, there is involvement of serosal lined soft tissue of peritoneum, omentum, stomach, falciform ligament, gallbladder, diaphragm and spleen. Some pathologists in our area are referring to DPAM as mucinous carcinoma peritonei, which is causing confusion because the term carcinoma is being used. One would assume that because the pseudomyxoma peritonei/underlying tumor itself is low-grade (LAMN), then the case is not reportable, but we would like clarification. |
For cases diagnosed prior to 1/1/2022 Disseminated peritoneal adenomucinosis (DPAM) is not reportable when the primary tumor is a low-grade appendiceal mucinous neoplasm (LAMN). The term disseminated peritoneal adenomucinosis (DPAM) is discouraged by the WHO Digestive System monograph (page 123, section on pseudomyxoma peritonei (mucinous carcinoma peritonei)), since it does not clarify whether the process is low grade or high grade carcinoma. When used, the term should be referring back to the histology of the defining process and in both of these examples this appears to be LAMN, and therefore not reportable. The only exception to this might be if the peritoneal implants were invasive; that is, they contained adenocarcinoma invading into the underlying peritoneum, bowel serosa, etc., rather than simply being present within the surface mucinous material. The pathologist would make this clear if this was, in fact, believed to be invasive carcinoma. |
2018 |
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20180096 | Reportability/Histology--Small intestine: Is a neuroendocrine microtumor of the duodenum a reportable tumor? See Discussion. |
This comment was added to the pathology report by the pathologist: A focus of neuroendocrine microtumor measured 350 micrometers, qualifying as a neuroendocrine microtumor. Focus was immunohistochemically positive for chromogranin and synaptophysin and negative for gastrin. The Ki-67/CD45 immunostain showed <1% positivity in microtumor. |
Neuroendocrine microtumor of the duodenum is reportable as 8240/3. "Microtumor" pertains to the size/amount of NET and not to a histologic type. |
2018 |
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20180016 | Primary site--Pancreas: Is the uncinate process of the pancreas coded to C259, C250, or C257? |
Assign C250 to the uncinate process of the pancreas. The uncinate process is part of the head of the pancreas. |
2018 | |
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20180031 | First Course of Treatment/Other Therapy: Where do you code Optune TTF therapy? What needs to be included in the text portion to document this treatment? |
Code OPTUNE in the Other Treatment field. See NovaTTF in SEER*Rx (http://seer.cancer.gov/seertools/seerrx/). NovaTTF is the pre-FDA approval name for OPTUNE. If OPTUNE was administered for recurrence, be sure NOT to record it in the first course of treatment fields. Check with CoC if you have questions about coding treatment for recurrence. |
2018 |