Report | Question ID | Question | Discussion | Answer | Year |
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20180039 | Solid Tumor Rules 2018/Histology--Testis: What is the histology code for a 2018 diagnosis of left testis tumor diagnosed as mixed germ cell tumor with secondary malignant components: primitive neuroectodermal tumor (PNET) and rhabdomyosarcoma? See Discussion. |
The patient has testicular cancer with bilateral lung metastases and possible liver metastasis. The left orchiectomy final diagnosis was The Summary describes a single tumor that is, Germ cell neoplasia in situ (GCNIS) is also present. Although there is mixed germ cell tumor present, the PNET component of the tumor is locally invasive extending into the epididymis, hilar soft tissues, spermatic cord, and tunica vaginalis. The mixed germ cell tumor is limited to the testis only. We are instructed not to use to the term to code histology in the MP/H Rules General Instructions (Other Site Rules not updated for 2018), however the PNET comprises the majority of this tumor and represents the most extensive disease. Should the PNET histology be ignored in this case as its a ? |
Assign code 9084/3. According to our expert pathologist consultant, this is a teratoma with a somatic-type malignancy. This code is the best choice even though it does not capture the mixed germ cell elements of the tumor, or the character of the somatic component (rhadomyosarcoma, PNET).There aren't enough histology code numbers to cover all of the possibilities. Use text fields to describe the specifics of this case. |
2018 |
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20180066 | Solid Tumor Rules (2018)/Laterality--Brain and CNS: How is laterality coded for bilateral non-malignant central nervous system (CNS) or malignant CNS tumors now that laterality is no longer used to identify these tumors as multiple primaries? See Discussion. |
The Equivalent Terms and Definitions sections in the Solid Tumor Rules for these schemas identify which sites must have laterality coded, but there is no instruction for coding laterality when bilateral tumors are a single primary. The SEER Manual currently only indicates code 4 (bilateral) is seldom used (e.g., bilateral ovarian tumors, Wilms tumors, etc.) but does not indicate laterality code 4 should be used for CNS tumors. Is this note going to be updated or should a non-bilateral code be applied? Example: MRI demonstrates multiple left-sided dural-based meningiomas including a 4.4 cm left posterior fossa meningioma, a 0.8 cm left frontal-parietal meningioma and a right posterior frontal meningioma. The large left posterior fossa meningioma was resected and proved atypical meningioma. Should the laterality be 4 (bilateral) as the patient had both left and right-sided meningiomas confirmed to be a single primary? Or should the laterality be coded as 2 (left) since only the large left-sided meningioma was proven to be a borderline tumor (atypical meningioma, 9539/1) and the others were benign? |
Determine whether the CNS tumors are single or multiple primaries. Multiple cerebral meningiomas are a single primary according to the non-malignant CNS Solid Tumor Rules. Assign laterality using the 2018 SEER Manual for select invasive, benign, and borderline primary intracranial and CNS tumors using codes 1-9 for all sites listed in the Sites for Which Laterality Codes Must Be Recorded table. In the example, assign code 4, bilateral involvement at time of diagnosis, lateral origin unknown for a single primary. The solid tumor rules are not a one-stop-shop for all coding. Refer to the appropriate coding manual for laterality. We removed laterality for determining multiple primaries in meningiomas as they were being over-reported according to CBTRUS. |
2018 |
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20180103 | Histology/Grade--Small intestine: For a 2017 diagnosis, is the grade/differentiation field coded 1 or 9 when the diagnosis is well-differentiated neuroendocrine tumor (NET) (carcinoid)? It seems as though the term well-differentiated defines type of neuroendocrine tumor so they can diagnosis the carcinoid. See Discussion. |
5/15/17 Duodenal bulb, biopsy: Fragments of duodenal mucosa with well differentiated neuroendocrine tumor (carcinoid), extending to the edge of specimen and peptic duodenitis in the submitted tissue. No significant intraepithelial lymphocytosis. |
Assign grade code 1 for well-differentiated NET (8240/3). Well-differentiated is synonymous with NET, grade 1, according to WHO Classification of Tumors of the Digestive System. |
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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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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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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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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20180092 | Reportability/Histology--Brain and CNS: Is diffuse intrinsic pontine glioma is reportable? If yes, what is the correct histology code? |
Diffuse intrinsic pontine glioma is reportable. For cases diagnosed in 2018, assign 9385/3. |
2018 | |
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20180083 | Solid Tumor Rules (2018)/Multiple primaries--Bladder: How many primaries are abstracted and which M Rule applies when a patient is diagnosed with an invasive urothelial carcinoma tumor of the bladder, followed less than three years later by an invasive urothelial carcinoma and small cell neuroendocrine carcinoma tumor of the bladder? See Discussion. |
The Solid Tumor Rules indicate bladder tumors that are urothelial carcinoma (8120) and small cell carcinoma (8041) are separate primaries per Rule M13 (Abstract multiple primaries when separate/non-contiguous tumors are on different rows in Table 2). These are distinctly different histologies and, presumably, one would want to capture the small cell carcinoma (or small cell carcinoma component) as this has a worse prognosis. However, if a subsequent bladder tumor is composed of invasive urothelial carcinoma and small cell neuroendocrine carcinoma, the histology is coded as 8045/3 per Rule H4, but this is not abstracted as a multiple primary. The only M Rule that applies is Rule M18 (Abstract a single primary when tumors do not meet any of the above criteria). The mixed histology code 8045 is not included in Table 2, so none of the histology-based M Rules apply. Is the subsequent mixed invasive urothelial and small cell carcinoma tumor (8045/3) the same primary as a previously diagnosed invasive urothelial carcinoma (8120/3) when these tumors are diagnosed within three years? |
Abstract two separate primaries using Solid Tumor Rules Urinary Sites Rule M13. While not stated in the urinary sites rules, these are separate histology codes in two different rows in Table 2 of the Rules. The initial histology is 8120 and the subsequent tumor is 8045 using Rule H4. Adding 8045 to Table 2 will cause issues. Small cell neuroendocrine in the bladder is very rare, extremely aggressive, and usually has a component of urothelial carcinoma. |
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 |