Report | Question ID | Question | Discussion | Answer | Year |
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20180056 | Primary Site--Ovary: How should primary site be coded for a previously diagnosed ovarian cancer which is now being reclassified as fallopian tube? See Discussion. |
There is a group of patients diagnosed within the past few years with ovarian cancers who are now enrolled in a clinical trial and are being screened as potential patients for a particular protocol. The screening for these particular cases is being done by a pathologist who has a particular interest in GYN pathology. As the pathologist is screening the cases, there are some which the pathologist is reclassifying as being fallopian tube primaries rather than ovarian primaries. This is apparently due to newly emerging findings and literature. The problem for me is that these cases have been entered into the registry as ovarian primaries, which was correct as of the time of the initial diagnosis. Should the abstracts remain as they were initially coded, since the diagnosis was ovarian cancer at the time they were diagnosed, or should these cases be updated to reflect the current pathologist's interpretation that these are fallopian tube primaries? |
Do not change the primary site in this situation. Since the review was done for a clinical trial and the change was not officially made in the patient's medical record, the primary site remains ovary for the cancer registry. Add an explanatory note in a text field for future reference. |
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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20180104 | Reportability--Ambiguous terminology: Are the following terms reportable: almost certainly and until proven otherwise? See Discussion. |
Example 1: Physician states patient has an almost certain melanoma. Due to the patient's age, there is no plan to for any treatment or further workup. Almost certain is not listed as a reportable phrase, so typically we would not accession this case. Example 2: Imaging states a diagnosis of renal cell carcinoma until proven otherwise. No additional workup is available at this facility. This terminology is also not seen on the ambiguous reportable terminology list but we are seeing it more often and wanted confirmation. |
Use the ambiguous terminology list as a last resort. Consult with the physician and search for further information to assist with the decision. If no further information can be obtained, use the ambiguous terms list to decide; in this case, the terms are not on the list and these examples would not be reportable. |
2018 |
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20180023 | Reportability/Behavior: Is myxoinflammatory fibroblastic sarcoma (MIFS) reportable for 2018? This histology is on the 2018 ICD-O-3 histology update list with a behavior code of /1. See discussion. |
This will be a tough one for registrars to recognize as non-reportable since the terminology contains sarcoma, so we just want to double check. |
Myxoinflammatory fibroblastic sarcoma (MIFS) (C49._), 8811/1, is not reportable for 2018 based on the 2018 ICD-O-3 New Codes, Behaviors, and Terms list. This is a new histology/behavior not previously listed in ICD-O-3. According to the WHO 4th Ed Tumors of Soft Tissue & Bone, this histology has been given a benign (/1) behavior; however, if the pathologist and/or physician state the tumor is malignant or metastatic, report the case and assign behavior code /3. |
2018 |
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20180012 | First course of treatment: What is the correct code to use for allogenic stem cell transplant? |
Code an allogenic stem cell transplant as 20 (Stem cell harvest (stem cell transplant) and infusion) in Hematologic Transplant and Endocrine Procedures in the 2016 SEER Manual. |
2018 | |
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20180010 | Diagnostic confirmation--Heme & Lymphoid Neoplasms: Is Diagnostic Confirmation coded as 5 (positive laboratory test/ marker study) or code 8 (clinical diagnosis only) for a case that has a positive JAK2 mutation, and based on the results of the JAK2, the physician diagnosed the patient with polycythemia vera? There were no blood smears or bone marrow biopsies done. |
Assign diagnostic confirmation code 5 for a positive laboratory test/marker study. A note was added to the Hematopoietic manual to state that code 5 now includes cases with no histological confirmation but there is positive immunophenotyping or genetic studies. |
2018 | |
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20180002 | MP/H Rules/Multiple primaries--Urinary: Is a renal pelvis diagnosed 5/2016 a separate primary when the first invasive bladder was 12/2011? Per rule M7, the 5/2016 renal pelvis is more than 3 years later. Does Multiple Primary/Histology (MP/H) rule M7 refer back to the original diagnosis date or to the last occurrence? See Discussion. |
12/30/11 Bladder Biopsy: Diffuse carcinoma in situ of bladder, urothelial cancer at trigone (Stage T1) 1/30/2012 Transurethral resection of the bladder was non-papillary, urothelial carcinoma, focal invasion of lamina propria, staged T1 11/10/14, 9/28/15, 9/26/16, 10/19/17 all had positive bladder cytology of urothelial carcinoma 5/16/16 Left renal pelvis aspirate: positive for malignant cells, urothelial carcinoma 9/26/16 Left renal pelvis aspirate: positive for malignant cells, urothelial carcinoma 10/18/16-11/7/16 Bacillus Calmette-Guerin (BCG) x3 administered into the renal collecting system via ureteral catheter |
For cases diagnosed prior to 2018 This case is a single primary. This patient has not had a disease-free interval as demonstrated by the positive cytologies from 2014 through 2017. The MP/H rules cannot be applied in this case. To answer your question about the timing of rule M7, please see slide 6 in the Beyond the Basics MP/H advanced training, General Instructions, https://seer.cancer.gov/tools/mphrules/training_adv/SEER_MPH_Gen_Instruc_06152007.pdf |
2018 |
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20180106 | First Course Treatment--Other Therapy: Please explain how to code this new therapy, peptide receptor radionuclide therapy (PRRT) for rare neuroendocrine tumors. See Discussion. |
According to this article, PRRT treatment lutetium Lu 177 dotatate was approved earlier this year by the United States Food and Drug Administration for adult use. PRRT is a nuclear medicine therapy that travels throughout the body looking for a certain receptor within neuroendocrine tumors. These include pancreatic and small neuroendocrine tumors in the gastrointestinal tract. Once absorbed into the tumor, the radioactive material starts to break down tumor cells, killing them. It is the first radioactive drug approved for the targeted treatment of gastroenteropancreatic neuroendocrine tumors. |
For cases diagnosed prior to 2023: Code Peptide Receptor Radionuclide Therapy (PRRT) in the data item Other Therapy, code 1, Other. See SINQ 20220042 and 20230005 for information pertaining to cases diagnosed in 2023 or later. |
2018 |
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20180033 | Reportability--Corpus uteri: Is smooth muscle tumor with uncertain malignant potential (STUMP) reportable? See Discussion. |
Spindled cell lesion of smooth muscle origin (desmin and SMA are positive, CD34, S100, pancytokeratin, Pax8, MDM2 and CDK4 are negative). Many of the cells have hyperchromatic, bizarre-shaped nuclei. Mitotic activity is inconspicuous. There are no areas of necrosis. The overall findings in this biopsy is best classified as a "STUMP"; however, a leiomyosarcoma cannot be excluded. |
STUMP (smooth muscle tumor of uncertain malignant potential) is not reportable. According to the WHO classification of uterine corpus tumors, the behavior code for STUMP is /1. |
2018 |
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20180065 | Immunotherapy: Is immunotherapy ever palliative treatment according to any oncologists or SEER? |
Any treatment that destroys or modifies cancer tissue should be recorded as the appropriate type of treatment -- chemo, immuno, etc. Even if immunotherapy is given for symptoms/palliative treatment, it is likely to kill off tumor cells. |
2018 |