| Report | Question ID | Question | Discussion | Answer | Year |
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20180034 | Reportability--Vulva: Is a biopsy showing high grade squamous intraepithelial lesion (VIN II) in the vulva reportable for cases diagnosed in 2018? See Discussion. |
In comparison to SINQ 20180022, this case does not mention VIN III anywhere in the final diagnosis. Is any mention of HGSIL in the final diagnosis reportable, even if it is qualified with a non-reportable term in parenthesis or CAP protocol? |
Since this HSIL diagnosis is specified as VIN II, do not report it. WHO includes both VIN II and VIN III as synonyms for HSIL of the vulva. HSIL is reportable and VIN III is reportable. VIN II is not reportable. |
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 | |
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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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20180008 | MP/H Rules/Multiple primaries--Thyroid: Is medullary carcinoma of the right lobe of the thyroid, with foci of papillary microcarcinoma in both lobes, one primary with mixed histology (8347/3) or two separate primaries? |
For cases diagnosed prior to 2018 Abstract two primaries, Medullary (8510/3) and papillary microcarcinoma (8260/3). Other sites rule M17 applies. |
2018 | |
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20180047 | Reportability--Kidney: Is a hybrid oncocytic tumor reportable? See Discussion. |
10/27/2017 partial nephrectomy final path diagnosis: renal oncocytic neoplasm, favor hybrid oncocytic tumor. Comment: |
Do not report renal HTOC. According to our expert pathologist consultant, "the genetic studies seem to indicate that the chromosomal changes of chromophobe renal carcinoma are not found in the hybrid tumors." |
2018 |
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20180098 | Solid Tumor Rules (2018)/Histology: Please provide further explanation for prioritizing biomarkers in the histology coding rules. See Discussion. |
The 2018 Solid Tumor (ST) Rules General Rules state: For those sites/histologies which have recognized biomarkers, the biomarkers frequently identify the histologic type. Currently there are clinical trials being conducted to determine whether these biomarkers can be used to identify multiple primaries. Follow the Multiple Primary Rules; do not code multiple primaries based on biomarkers. Additionally, Biomarkers is at the top of the priority order to identify histology in several sections (it appears to be excluded from only Colon, Melanoma and Other sections). In the sections that include this rule, there is not much additional information on using biomarkers. Can you please provide further explanation for prioritizing biomarkers in the histology coding rules? For example, will the ST manual be updated when we need to look for specific biomarkers in a diagnosis? |
Instructions for biomarkers will be added to other site rules when applicable. The use of biomarkers to determine a specific histologic type is not yet a standard of care in the majority of cases. |
2018 |
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20180056 | 2018 SEER Manual/Primary Site--Ovary, Fallopian Tube: 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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20180062 | Histology--Heme & Lymphoid Neoplasms: How is histology coded when a lymph node excisional biopsy shows Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL), predominantly in diffuse T-cell histiocyte rich large B-cell lymphoma-like (THRLBCL) pattern. Comment states: The findings are that of nodular lymphocyte predominant Hodgkin lymphoma with diffuse T-cell rich pattern (T-cell/histiocyte-rich large B-cell lymphoma-like). This variant is regarded as clinically more advanced. See Discussion. |
It appears an argument could be made for both NLPHL (9659/3) and THRLBCL (9688/3). We favor coding NLPHL (9659/3) because the pathologist did specifically call this a Hodgkin lymphoma, and also specified that it only has a T-cell/histiocyte-rich large B-cell lymphoma-like pattern. |
Assign histology code 9659/3. According to the Hematopoietic database, this histology frequently has T-cells. The other description was not an actual histology, but noting that the appearance of the cells was similar to that histology. |
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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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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