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20180102 | Solid Tumor Rules 2018/Histology--Brain and CNS: What code should be used for high grade neuroepithelial tumor with BCOR Alteration? See Discussion |
A recent molecular study of PNET tumors at NCI (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139621) seems to indicate the discovery of four new CNS tumor entities, of which HGNET-BCOR is one. The article suggests that these are not primitive neuroectodermal tumors tumors (PNET), but something different. |
This question was reviewed by an expert neuropathologist. He recommends coding these tumors to malignant tumor, clear cell type 8005/3. He states: these tumors are extremely rare. In summary, CNS HGNET-BCOR represents a rare tumor occurring in young patients with dismal prognosis. Whether CNS HGNET-BCOR should be classified among the category of "embryonal tumors" or within the category of "mesenchymal, nonmeningothelial tumors" remains to be clarified. Because CNS HGNET-BCOR share pathologic features and characteristic BCOR-ITD with clear cell sarcoma of the kidney, these tumors may represent local variants of the same entity. |
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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20180021 | Solid Tumor Rules (2018)/Histology--Corpus uteri: What is the correct histology code for "Mesophrenic-like adenocarcinoma" of the corpus uteri?" See Discussion. |
The article I read (https://www.ncbi.nlm.nih.gov/pubmed/?term=28984674) makes the distinction between mesophrenic adenocarcinoma and mesophrenic-like adenocarcinoma. The authors propose the term mesonephric-like Mullerian adenocarcinoma. So would this be coded as Mullerian adenocarcinoma? |
Assign code 9110/3, mesonephric adenocarcinoma. These tumors commonly arise in the cervical wall and more commonly involve the lower uterine segment than do other cervical adenocarcinomas. |
2018 |
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20180019 | Marital Status: Is Marital Status always a self-reported status? See Discussion. |
The SEER Manual states that Marriage is self-reported for the instruction in code 2, but it does not indicate if all other marital statuses are self-reported. Examples: How is Marital Status reported for the following situations? 1. Patient with multiple tumors in the database, for the first tumor marital status is reported as married (code 2), for the subsequent tumor, marital status is reported as single (code 1). 2. Patient self- reports as single, but also has children. 3. Patient states they are in common law marriage, but our state is not a common law marriage state. |
Marital Status is self-reported because the information is recorded in the medical record based on information obtained from the patient. Use text fields to document relevant information. Examples 1. Assign code 2 for the first tumor and assign code 1 for the subsequent tumor unless the available information indicates the patient is divorced at the time of the subsequent tumor diagnosis. Patient may self-report single after a divorce. Assign code 4 in that situation. The code assigned for marital status reflects the patient's marital status at the time of diagnosis for the tumor being abstracted. It is possible that marital status may be different for each tumor if the patient has multiple tumors. 2. If marital status is stated to be single, assign code 1. 3. If marital status is stated to be common law marriage, assign code 2. Common Law Marriage is defined as a couple living together for a period of time and declaring themselves as married to friends, family, and the community, having never gone through a formal ceremony or obtained a marriage license. |
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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20180113 | Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of a 2018 lung cancer case with invasive non-mucinous adenocarcinoma? For non-mucinous carcinoma/adenocarcinoma, the Solid Tumor Rules have codes for microinvasive, minimally invasive, preinvasive, and in situ. Do we default to the microinvasive/minimally invasive code? |
Code histology to adenocarcinoma, NOS (8140/3). The World Health Organization and the College of American Pathologists no longer recognize non-mucinous carcinoma/adenocarcinoma, NOS. Pathologists are discouraged from using this term. Microinvasive/minimally invasive lung tumors have very specific criteria and these criteria do not apply to non-mucinous carcinoma, NOS. |
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20180024 | Primary site--Colon: What is the correct topography code for appendiceal orifice? See Discussion. |
From a number of definitions reviewed, it seems unclear if it's part of the appendix or the cecum of the colon. For example: The cecum is usually located in the right iliac fossa. In the pole of the cecum, there is often the appearance of fusion of the three teniae coli around the appendix, giving rise to the tri-radiate fold (Mercedes Benz sign), but the anatomy can be variable. The most reliable landmarks of the cecum are the appendiceal orifice and ileocecal valve. The appendiceal orifice is usually an unimpressive slit, often crescentic in shape. The ileocecal valve is made up of the superior and inferior lips (usually not seen en face) and is the gateway leading into the terminal ileum. It is located on the prominent ileocecal fold encircling the cecum, between 3 and 5 cm distal to the cecal pole. (https://www.sciencedirect.com/science/article/pii/S2212097113701730) |
Assign C180, Cecum, when the neoplasm originates in the appendiceal orifice. The appendiceal orifice is a landmark in the cecum. During colonoscopy, visualization of the appendiceal orifice indicates that the entire colon was examined, from the anus to the cecum. |
2018 |
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20180001 | Reportability/Date of diagnosis--Small intestine: Is this case reportable? Widely metastatic gastrointestinal stomal tumor (GIST) was diagnosed at an out-of-state facility in 2017 and referred back to a hospital in our state for chemotherapy where there is a history of a small bowel resection of GIST of uncertain malignant potential (8936/1) doneat the hospital in 2003. If so, is the diagnosis date 2003 or 2017? See Discussion. |
The hospital registrar reports that the case was identified at the hospital because of the referral for chemotherapy for the metastatic GIST. The records from the out-of-state hospital mentioned a history of a small bowel resection in 2003 for a borderline tumor. The registrar went back through the hospital's old records and found the surgery was done for GIST of low malignant potential at her facility. The question is whether to report the case or not, and if reported, is 2003 the diagnosis date. The rules say to change the behavior and backdate the diagnosiswhen a tumor is presumed benign and islater diagnosed as malignant. Another problem for this case is that the out-of-state hospital did not review the slides from the 2003 surgery. |
Report the case with a diagnosis date of 2017. The 2003 diagnosis was not reviewed, and there are no physician statements that cancer was present in 2003, or that the metastases are attributable to the 2003 diagnosis. Document the details of the case in text fields. |
2018 |
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20180007 | Multiple primaries/Primary site--Heme & Lymphoid Neoplasms: Are plasmacytomas in thyroid and laryngeal masses one primary based on rule M2, abstract a single primary when there is a single histology? If so, what is the primary site? See Discussion. |
Patient presented with hoarseness and palpable neck mass. No palpable adenopathy (per hospital abstract). 02/19/16 Thyroid Ultrasound: Right thyroid lobe with mass, 63X35X44XMM (per hospital abstract). 06/01/16 Right thyroid lobectomy, radical resection right laryngeal tumor (per hospital abstract). 06/01/16 Operative Procedure: Tumor was invading laryngeal soft tissue and cartilage anteriorly and to the right. There may be a small amount of residual tumor invading cartilage although this was not clear (per hospital abstract). GROSS DESCRIPTION: 1. The specimen is received fresh for intraoperative consultation, labeled with the patient's name and "right thyroid mass." It consists of a 3.0 x 2.2 x 2.0 cm irregular, ragged fragment of tan-red, firm, rubbery soft tissue. The specimen is serially sectioned to reveal a tan-red, gritty cut surface with focal fleshy areas. A touch prep is performed. A representative section is submitted for frozen section analysis in 1FSA. A portion of tissue is submitted for flow cytometry with the accession number MSO-16-1786. The remaining specimen is entirely submitted in 4 additional cassettes (1B-1E). 2. The specimen is received in formalin and is labeled "right thyroid lobe." It consists of a thyroid lobe measuring 4.3 x 4.0 x 1.3 cm and weighing 10.0 g. The external surface is covered by a thin fibrous capsule with a focal area of roughening on the posterior surface. The lobe is inked black posterior, blue anterior and orange isthmus margin. Serial sectioning reveals a red-brown and beefy parenchyma. A definitive nodule is not grossly identified. The entire specimen is serially submitted from superior to inferior in 9 cassettes. 3. The specimen is received in formalin, labeled with the patient's name and "right neck/laryngeal mass." It consists of an irregular, focally nodular red-tan mass measuring 7.0 x 5.5 x 4.0 cm and weighing 54 g. The convex portion of the specimen is mostly encapsulated with focal adherent red-brown striated skeletal muscle. The concave portion of the specimen is focally ragged and disrupted. The convex portion of the specimen is inked black and the concave portion is inked blue. The specimen is serially sectioned to reveal a white-grey to red, granular, gritty cut surface with focal fleshy areas. Representative sections are submitted in 12 cassettes. Final DX DIAGNOSIS: 1. Right thyroid mass excision Plasma cell tumor /plasmacytoma 3 cm. Tumor cells are positive for kappa and negative for lambda immunostains. Recommend correlation with flow cytometry MSO-16-1786, monoclonal plasma cell population with cytoplasmic kappa positivity. Ki-67 stains 7 percent of cells. Focal stromal hyalinization. Congo red stain for amyloid negative. No thyroidal tissue identified. 2. Right thyroid lobe excision Benign thyroid tissue with focal solid cell nest negative for malignancy. One out of two 1/2 perithyroidal lymph nodes positive for plasma cell tumor. 3. Laryngeal mass excision Plasma cell tumor /plasmacytoma 7 cm involving soft tissue and skeletal muscle. Tumor cells are positive for kappa and negative for lambda immunostains. Ki-67 stains 7 percent of cells. Focal stromal hyalinization and calcification. Congo red stain for amyloid negative |
Abstract this case as a single primary. Hematopoietic Multiple Primary Rule M2 applies. Code to unknown primary, C809, based on rule PH27. There is no indication in the information provided of the site of origin; therefore, PH2 cannot be used. We recommend a thorough review of the case to determine if the site of origin is identified in the medical record. |
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 |
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