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20190077 | Summary Stage 2018/EOD 2018: How should SEER Summary Stage 2018 be coded for a 2018 thymus primary which has mediastinal fat invasion without mediastinal pleural involvement? See Discussion. |
The Extent of Disease (EOD) manual states that "Confined to thymus WITH mediastinal or pleural involvement" should be coded as regional by direct extension. I have EOD primary tumor coded as 200 and based on SEER*RSA, this is localized. |
Code 200 derives Regional Extension (RE) for Summary Stage; however, based on the information you provided, thymus primary with mediastinal fat invasion without mediastinal pleural involvement, EOD Primary Tumor would be coded to 100: Confined to thymus (encapsulated tumor), which includes extension into the mediastinal fat; No mediastinal or pleura involvement. This derives "Localized" for Summary Stage. Per AJCC T1, extension into the mediastinal fat is separate from involvement of the mediastinal pleura. For Summary Stage 2018, this would be code 1, Localized only (localized, NOS): Confined to thymus, NOS; No mediastinal or pleura involvement or UNKNOWN if involved. We will note that "extension into the mediastinal fat" is included in code 100 for the next release (September 2020). |
2019 |
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20190015 | Update to current manual/EOD 2018--EOD Primary Tumor: Should Note 6 in Extent of Disease (EOD) Primary Tumor for the schemas Fallopian Tube, Ovary, and Primary Peritoneal Carcinoma be revised to exclude pelvic sites? See Discussion. |
There is a discrepancy between Notes 3 and 6 in the schemas Fallopian Tube, Ovary, and Primary Peritoneal Carcinoma for EOD Primary Tumor. Note 3 describes extension/discontinuous metastasis to the pelvic sites (code 450) and includes the sigmoid colon, rectosigmoid and rectum since these are all pelvic sites. However, Note 6 also includes rectosigmoid and sigmoid colon. Note 6 is describing extension/discontinuous metastasis to the abdominal sites (600-750), so it should include rectosigmoid or sigmoid colon (since those are pelvic sites). Note 6 indicates, Intestine, large (except rectum). In the previous Collaborative Stage, the corresponding note used to also include: except sigmoid colon, rectosigmoid and rectum. Did sigmoid colon and rectosigmoid get removed from the list here? That is, should Note 6 read, Intestine, large (except sigmoid colon, rectosigmoid, rectum)? Involvement of the sigmoid, rectosigmoid, or rectum via peritoneal seeding/metastasis is consistent with T2b disease and would correlate with code 450 (pelvic sites), not codes 600-750 (abdominal sites). Those codes only correlate with T3 and greater disease (i.e., peritoneal seeding/metastasis of the abdomen). |
Thank you for bringing this issue to our attention. Rectosigmoid and Sigmoid Colon belong in Note 3 and not Note 6 for the following EOD schemas: Fallopian Tube, Ovary, and Primary Peritoneal Carcinoma. Rectosigmoid and sigmoid colon will be removed as separate listings from Note 6. The only mention in Note 6 will be: Intestine, large (except rectum, rectosigmoid, and sigmoid colon) This change will be made for the next update. |
2019 |
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20190105 | Histology--Brain and CNS: What morphology code should be assigned to a low-grade glial/glioneuronal neoplasm? See Discussion. |
Pathology Diagnosis: Left temporal lesion - Low grade glial/glioneuronal neoplasm BRAF mutant. Pathologist Comment: The histopathological appearance of this lesion does not allow for a definitive diagnosis. However, the low-grade appearance, fibrillary nature, immunohistochemical profile, and the presence of a BRAF V600E mutation allow this to be categorized as a low-grade glial or possibly glioneuronal tumor. Despite the lack of exact classification this neoplasm can be expected to behave in a very indolent manner consistent with a WHO grade I classification. |
Assign 9413/0 for glioneuronal neoplasm. We consulted with our expert neuropathologist about the histology "glioneuronal neoplasm." This term is relatively new and has not yet been recognized by WHO or assigned an ICD-O code. Until such time that WHO determines a code for this neoplasm, our expert instructed us to use 9413/0. Since this is not a recognized neoplasm it is not included in the solid tumor rules. |
2019 |
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20190053 | Solid Tumor Rules (2018)/Histology--Brain and CNS: What is the histology code for a central nervous system (CNS) Ewing sarcoma family tumor with CIC alteration of the right parietal lobe? See Discussion. |
Table 3 (Specific Histologies, NOS, and Subtypes/Variants) lists Ewing sarcoma as a synonym for Peripheral primitive neuroectodermal tumor 9364. Presumably, this is to be used for the reportable malignant peripheral nerve tumors when diagnosed as pPNET or Ewing sarcoma. However, this patient has a type of central (or CNS) primitive neuroectodermal tumor (histology 9473). Table 3 does not list central primitive neuroectodermal tumor (PNET or CPNET) as a valid histology for CNS tumors. While Table 3 does not list all the possible histologies for the CNS, it currently is not clear how one would arrive at the histology code for a CNS Ewing sarcoma family tumor with CIC alteration, as this is recognized as a new entity for primitive neuroectodermal tumors of the CNS (i.e., PNET, histology 9473) per multiple journal articles. Ewing sarcoma family tumors include both peripheral PNET and central PNET tumors, but to code this histology as a peripheral PNET (9364) in this case seems incorrect when the primary tumor is stated to be of central nervous system origin, not peripheral nervous system origin. |
Code as 9364/3. WHO Classification of Tumors of the CNS, 4th edition, refers to Ewing sarcoma/peripheral primitive neuroectodermal tumor as a tumor of neuroectodermal origin involving the CNS either as a primary dural neoplasm or by direct extension from contiguous bone or soft tissues (such as skull, vertebra, or paraspinal soft tissue). |
2019 |
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20190011 | Reportability--Skin: Is an atypical smooth muscle cell proliferation of the skin reportable? See Discussion. |
Example: Patient has left thigh skin excision with final diagnosis of atypical smooth muscle cell proliferation, inked peripheral margin is involved and inked deep margin is free of disease in the sections examined. See Comment. Diagnosis comment states: The terminology regarding this lesion is controversial. Lesions with identical features are designated as leiomyosarcoma in the dermatopathology literature, whereas, the preferred classification in the soft tissue pathology is atypical intradermal smooth muscle neoplasm. Although the lesion appears predominantly dermal based, since the margin is involved, the lesion cannot be entirely evaluated, and therefore the final designation is deferred to the findings in the excisional specimen. (This slide was read by bone and soft tissue pathologist.) There has been no excision of this tumor and, as a central registry, we have no access to the pathologist for clarification. Is this skin case reportable based on the dermatopathology interpretation when further documentation is not available? |
Since you do not have the option of checking with the pathologist and no further information is available, do not report this case. The diagnosis is atypical smooth muscle cell proliferation of the skin, which is not reportable. Registrars with access to the pathologist should querry the pathologist for clarification in this situation. |
2019 |
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20190095 | Reportability/Histology--Thymus: Is a thymoma a malignancy if described as having separate tumor nodules within peri-thymic adipose tissue? See Discussion. |
Patient had a thymectomy including pericardial fat for a mediastinal mass found incidentally during lung screening. Final diagnosis is WHO B3 thymoma. Staging Summary lists transcapsular invasion: "Present, as separate tumor nodules within peri-thymic adipose tissue." Tumor extension is stated to be "Confined to thymus, including peri-thymic adipose tissue." The pathologist staged this resection as pT1a pNX with no mention of mets. Clinically, there are no noted metastatic sites and no further treatment is planned. |
Report this case as a malignant thymoma. Our expert pathologist consultant reviewed this case and in his opinion, the "separate tumor nodules within peri-thymic adipose tissue" fit registry reporting criteria for separate tumor nodules making this a malignant thymoma. |
2019 |
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20190089 | Solid Tumor Rules (2018)/Histology--Lung: Rule H3 of the Solid Tumor Rules was added to capture non-small cell carcinoma modified by ambiguous terminology when the physician confirms the ambiguous term as the histologic diagnosis, also included in Coding Histology instruction 3.B. If differentiation and features are not included in the histology term, does instruction 2 takes precedence? See Discussion. |
For example, pathologic diagnosis is non-small cell carcinoma with squamous features. The medical oncologist describes this as squamous cell carcinoma and begins treatment regimen. As I interpret the rules, we would use code 8046, non-small cell carcinoma, because of instruction 2 and the fact that features is not included in the list of ambiguous terminology. |
Code 8046 using Coding Instruction 2 that says to: Code the histology described as differentiation or features/features of ONLY when there is a specific ICD-O code for the "NOS with ____ features" or "NOS with ____ differentiation." Note: Do not code differentiation or features when there is no specific ICD-O code. In the example, no ambiguous terminology is used. If ambiguous terminology is used indicating a more specific term, you would code to the specific histology. |
2019 |
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20190106 | Tumor Size--Esophagus: Can information from the endoscopy procedure that implies a size of 3 cm for Tumor Size--Clinical be used for Esophagus? See Discussion. |
1-28-2018 CT Scan: 2.4 cm mass 2-15-2018 Endoscopy: Mass was present 22 to 25 cm. Biopsies were taken with cold forceps for histology; biopsy positive. |
For the case you describe, we would record the clinical tumor size stated on the CT report. The priority order for clinical tumor size is as follows. 1. Biopsy or operative (surgical exploration) report 2. Imaging 3. Physical exam We do not recommend coding tumor size based on an inferred tumor size from a description such as "Mass was present 22 to 25 cm." Look for an actual measurement of the mass, or a stated tumor size. Use text fields to record details. |
2019 |
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20190003 | Solid Tumor Rules (2018/2021)/Multiple Primaries--Brain and CNS: How many primaries should be accessioned and what multiple primaries/histology rules apply to a meningioma of the spinal meninges and a meningioma of the cerebral meninges? See Discussion. |
Example: Brain MRI shows a mass along underside of right tentorium extending to posterior incisura consistent with meningioma. Spinal MRI shows mass at C4-5 level consistent with meningioma. Resection of spinal meningioma shows final diagnosis of meningioma and College of American Pathologists (CAP) protocol summary indicates Histologic Type (WHO classification of tumors of the central nervous system): Meningioma, meningothelial. There is no resection of the cerebral meningioma planned. Is the CAP protocol used if it provides a further subtype for meningiomas? Per Solid Tumor Rules, the final diagnosis has priority over the CAP summary. The answer to this question does affect the number of primaries accessioned in this case. |
Accession as multiple primaries using Rule M7 of the Solid Tumor Rules for Non-Malignant Central Nervous System that says to assign multiple primaries for cerebral meninges C700 AND spinal meninges C701. The Non-malignant CNS H coding section, Priority Order for using Documentation to Identify Histology" lists final DX and synoptic report as requried by CAP as being equal in priority. Use whichever report provides more specific information. See the General Instructions, page 13. |
2019 |
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20190020 | Solid Tumor Rules (2018)/Histology--Head & Neck: What table in the Head and Neck Solid Tumor Rules applies to tumors of the lip (C000-C009)? The rules apply to all tumors in sites C000-C148, C300-C339, C410, C411, C442 and C479, but none of the histology tables include the lip. See Discussion. |
Example: Patient has a secretory carcinoma of minor salivary gland tissue (mammary analogue secretory carcinoma [MASC]) of the mucosal lower lip; it is unclear which table to use and how to arrive at the correct histology using the H Rules. Rule H1 (code the histology when only one histology is present) states, Note 1: Use Tables 1-9 to code histology. There is no table that includes the lip. The correct histology should be 8502 which is listed in Table 6 (Tumors of Salivary Glands) however this does not correspond to minor salivary glands of the mucosal lip (site C003 per ICD-O-3 coding instruction). The 2018 ICD-O-3 Update table does not include this histology, however Table 6 indicates code 8502 (secretory carcinoma) is a new code that was approved by IARC/WHO. The ICD-O-3 only includes this histology as secretory carcinoma of breast. Therefore, in order to arrive at the correct histology, one must be aware of previous SINQ entries 20160036 and 20130003 that indicate secretory carcinoma (or MASC) is histology 8502. However, these are related to MP/H Rules, so registrars may be hesitant to apply this guideline to cases coded using Solid Tumor Rules. |
Assign 8502/3 using Table 6 of 2018 Solid Tumor Rules for Head and Neck. Table 4 notes that there is no ICD-O site code for minor salivary glands. Many minor salivary glands are located in the lips, inner cheek (buccal mucosa), and there are extensive minor salivary glands in the linings of the mouth and throat. Code to the site in which the salivary gland is located. Mammary analog secretory carcinoma (MASC), also called secretory carcinoma, is a rare, generally low-grade salivary gland carcinoma characterized by morphological resemblance to mammary secretory carcinoma and ETV6-NTRK3 gene fusion. Common sites are of the parotid gland, oral cavity, submandibular gland, and the axilla with rare sites being the face including the lips, trunk, and limbs according to WHO Classification of Head and Neck Tumors, 4th edition and WHO Classification of Skin Tumors, 4th edition. This histology is usually associated with primary site of breast and you may get an edit that you can override. |
2019 |