Report | Question ID | Question | Discussion | Answer | Year |
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20190044 | Solid Tumor Rules (2018)/Histology--Colon: Is the term phenotype equivalent to type, subtype, variant for the purpose of coding histology? See Discussion. |
In our region, pathologists often describe histology using the term phenotype. However, the use of the term phenotype is not discussed in the Solid Tumor Manual. Example: Final Diagnosis of a colon tumor is invasive adenocarcinoma with a mixed phenotype, and the Diagnosis Comment states: The majority of the disease is poorly differentiated/signet ring cell phenotype. Would the histology be coded to 8490 (signet ring cell carcinoma), if the majority of the tumor is a more specific histology described by the term phenotype? |
While variant, type, and subtype can be used interchangeably according to the Solid Tumor Rules, SINQ 20170058 states that the Multiple Primaries/Histology (now Solid Tumor) Rules do not include coding phenotype. Code as invasive adenocarcinoma NOS (8140). |
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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20190016 | Update to current manual/SS2018--Breast: Should Code 3 of the Summary Stage 2018 (SS2018) for Breast designate the intramammary and infraclavicular lymph nodes as being ipsilateral? Similarly, should Code 7 designate infraclavicular lymph nodes as contralateral/bilateral? Laterality (ipsilateral, contralateral/bilateral) is included for axillary and internal mammary nodes in the respective codes. |
Based on your question, a review of the AJCC manual was done to clarify how these nodes would be coded. A review of Extent of Disease (EOD) Regional Nodes and EOD Mets was also done. That information is correct and in line with AJCC 8th edition. We apologize that SS2018 was not updated accordingly and thank you for bringing this issue to our attention. Per AJCC, infraclavicular and intramammary nodes are ipsilateral for the N category. Contralateral or bilateral involvement are included in the M category. The following will be applied to the planned 2020 update of the SS2018 manual. Code 3 Ipsilateral will be added to Infraclavicular and Intramammary Infraclavicular (subclavicular) (ipsilateral) Intramammary (ipsilateral) Code 7 The following will be added under Distant lymph nodes Infraclavicular (subclavicular) (contralateral or bilateral) Intramammary (contralateral or bilateral) |
2019 | |
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20190079 | Reportability/Histology--Pancreas: Is mucinous cystic neoplasm of pancreas reportable? |
Non-invasive mucinous cystic neoplasm (MCN) of the pancreas with low or intermediate grade dysplasia is NOT reportable. Non-invasive mucinous cystic neoplasm (MCN) of the pancreas with high grade dysplasia is reportable. For neoplasms of the pancreas, the term MCN with high grade dysplasia replaces the term mucinous cystadenocarcinoma, non-invasive. |
2019 | |
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20190070 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded for a when the pathologist notes the low grade B-cell lymphoma raises the possibilities of extranodal marginal zone lymphoma of mucosa associated tissue (MALT lymphoma) and lymphoplasmacytic lymphoma (LPL)? See Discussion. |
Rule PH28 confirms the more specific histologies are ignored if this is truly a low grade B-cell lymphoma (i.e., non-Hodgkin lymphoma, NOS) since both MALT lymphoma and LPL are more specific types of low grade B-cell lymphomas. This leaves only a diagnosis of low grade B-cell lymphoma with plasmacytic differentiation to consider. SINQ 20130033 states a low grade B-cell lymphoma with plasmacytic differentiation should be coded as 9680/3 (diffuse large B-cell lymphoma (DLBCL)). However, DLBCL is a high grade B-cell lymphoma, not a low grade B-cell lymphoma. If the pathologist classifies this as a non-specific low grade B-cell lymphoma, and clarifies that this may represent a more specific type of low grade B-cell lymphoma (MALT lymphoma or LPL), should the histology be coded to a high-grade lymphoma (DLBCL) or non-Hodgkin lymphoma, NOS? |
Code low grade B-cell lymphoma with plasmacytic differentiation as 9591/3 (Non-Hodgkin lymphoma, NOS). Plasmacytic differentiation is commonly seen with B-cell neoplasms. If further information identifies a more specific histology, the abstract can be updated to reflect the more specific histology. In the latest WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues, 4th ed., there is confirmation that DLBCL is a high grade B-cell neoplasm. We will update the SINQ question. |
2019 |
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20190023 | First course of treatment/Radiation therapy--Kidney: Patient has a CT-guided biopsy of a right renal mass with procedure details under the Interventional Radiology Procedure Note stating "Gelfoam tract embolization." Is this particular embolization treatment? |
Gelfoam tract embolization for a CT-guided renal biopsy is not treatment. It is a method to plug the biopsy track to reduce the risk of hemorrhage. |
2019 | |
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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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20190004 | Systemic/Surgery Sequence: Does the Systemic/Surgery Sequence field apply to only the first surgery performed (Date of First Surgical Procedure) or does it apply to the most definitive surgery (Date Most Definitive Surgery) as well? See Discussion. |
Example: Bladder primary with transurethral resection of the bladder tumor (TURBT) on 2/17/2017 (Date of First Surgical Proc) followed by a second TURBT on 3/24/2017 (Date Most Definitive Surgery) with mitomycin C instilled on the second, most definitive TURB procedure. There is an edit failure (IFX166) when Systemic/Surgery Sequence is coded 5 (intra-operative systemic) and Systemic Date does not match Date of First Surgical Procedure. How should we capture the intra-operative systemic treatment during the second, most definitive TURB? Is the correct Surgery/Systemic Sequence code 3 (systemic after surgery) for this case because (intra-operative) chemo was technically given after the first surgery? |
Assign code 3 to Systemic/Surgery Sequence and document the intraoperative treatment in the text field. Surgery is defined as a Surgical Procedure to the Primary Site (codes 10-90), Scope of RLN Surgery (codes 1-7), or Surgical Procedure of Other Site (codes 1-5) in the 2018 SEER Manual. In this case, the treatment was after the first surgical procedure. |
2019 |
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20190052 | Solid Tumor Rules (2018)/Multiple Primaries--Head & Neck: How many primaries are accessioned when a patient is diagnosed with right nasal cavity (C300) invasive nonkeratinizing squamous cell carcinoma (8072/3) in 2015 treated with radiation and excision, followed by a 2019 right nasal cavity (C300) invasive squamous cell carcinoma (NOS, 8070/3)? See Discussion. |
Head and Neck Multiple Primary Rule M8 appears to be the first rule that applies to this case and instructs the user to abstract multiple primaries when separate/non-contiguous tumors are on different rows in the appropriate site table (Tables 1-9) in the Equivalent Terms and Definitions. Table 1 (tumors of the nasal cavity) shows Non-keratinizing squamous cell carcinoma and squamous cell carcinoma on different rows making the 2019 case a new primary. Is this correct? |
Abstract two primaries using Head and Neck Solid Tumor Rule M8 when separate/non-contiguous tumors are on different rows in the appropriate site table, in this case, Table 1 Nasal Cavity and Paranasal Sinuses. |
2019 |
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20190065 | Update to current manual/EOD 2018/Summary Stage 2018--CLL/SLL: Can chronic lymphocytic leukemia (CLL) be staged when diagnosed by peripheral blood and no bone marrow biopsy, and observation is employed? See Discussion. |
The physicians do not use the Lugano system as we are instructed to stage chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) as lymphomas. I had always been instructed that this qualifies as "bone marrow involvement," or "diffuse disease," and therefore is a Stage IV. Our experts advise that there is not enough information to code it to bone marrow, but do not elaborate as to whether you can actually code Extent of Disease (EOD), SEER Summary Stage, and AJCC Staging? |
For EOD and Summary Stage: Peripheral blood involvement for CLL (or any lymphoma-but most commonly for CLL) can be coded. This is code 800 for 2018 EOD Primary Tumor, and code 7 for Summary Stage 2018. We have recently received confirmation that peripheral blood involvement only is not enough information to assign AJCC stage; assign code 99 for AJCC Stage Group. We will correct in the 2021 release of EOD so that peripheral blood involvement only will have its own code to derive the appropriate AJCC TNM Stage Group (99). |
2019 |