Report | Question ID | Question | Discussion | Answer | Year |
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20200086 | Solid Tumor Rules (2018)/Histology--Head & Neck: Paraganglioma, NOS is reportable and malignant for cases diagnosed 1/1/2021 and later. Paraganglioma, NOS is listed in the ICD-O-3.2 Coding Table as 8680/3 without synonyms or related terms. Table 4 (ICD-O-3.2 Implementation Guidelines) lists 8693/3 Paraganglioma as a new preferred term. Is this correct? See Discussion. |
Table 4 (Changes in reportable terminology), 2021 ICD-O-3.2 Update, does confirm that the term malignant no longer needs to be used to describe a paraganglioma, but Table 4 includes the histology for extra-adrenal paraganglioma, NOS (8693/3) as the new preferred term for paraganglioma. Paraganglioma, NOS is histology code 8680/3. Which code is correct? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The correct code for extra-adrenal paraganglioma is 8693/3. The preferred term for 8380/3 is Paraganglioma, NOS. Table 4 of the 2021 ICD-O update was based on information from WHO. Table 9 in the Head and Neck ST rules is being revised and formatted differently for ease of coding based on diagnosis year (prior to 2021 and 2021 forward). Not ALL paragangliomas will be included in Table 9. If a term and code are not provided in the rules, refer to ICD-O and updates. |
2020 |
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20200014 | Solid Tumor Rules (2018)/Histology--Brain and CNS: How are histology and primary site coded when a resection of a spine, designated intramedullary lesion, shows primary intramedullary melanocytoma? See Discussion. |
Patient has a resection labeled as: Spine, designated intramedullary lesion. The Final Diagnosis is: Melanocytic neoplasm with features most consistent with primary intramedullary melanocytoma. The Diagnosis Comment states: The overall immunophenotypic and morphologic impression is a primary central nervous system melanocytoma. The ICD-O-3 lists melanocytoma, NOS histology code as 8726/0, but does not provide a site-associated code. If the ICD-O-3 is used, the histology would be 8726/0 and the primary site presumably would be C720 since the tumor was specifically described as being intramedullary (i.e., within the spinal cord medulla). Table 6 (Solid Tumor Rules, Non-Malignant CNS Equivalent Terms and Definitions) does not list either an intramedullary melanocytoma or melanocytoma (NOS). However, Table 6 does include meningeal melanocytosis 8728/0 and meningeal melanocytoma 8728/1. If Table 6 is used and the histology is coded 8728/1, then the primary site would presumably be C701 per the ICD-O-3 site-associated listing for this histology (C709). |
Code primary site to spinal meninges (C701) and histology to meningeal melanocytoma (8728/1). According to the WHO Classification of Tumors of the Central Nervous System, 4th ed., primary melanocytic neoplasms of the central nervous system are diffuse or localized tumors that presumably arise from leptomeningeal melanocytes. Benign or intermediate grade lesions are termed melanocytomas. Meningeal melanocytoma is defined as a well-differentiated, solid, and non-infiltrative melanocytic neoplasm that arises from leptomeningeal melanocytes. Most arise in the extramedullary, intradural compartment at the cervical and thoracic spine though they can be dural-based or associated with nerve roots or spinal foramina. |
2020 |
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20200070 | Solid Tumor Rules (2018)/Multiple Primaries--Breast: The December 2020 revision to 2018 Breast Solid Tumor Rules, Rule M10, using behavior rather than timing to determine the number of primaries, has caused synchronous separate/non-contiguous tumors reported as invasive carcinoma, NST (8500/3) and lobular carcinoma in situ (8520/2) (or vice versa) to be reported as separate primaries per Rule M14. Should an invasive carcinoma NST and a synchronous, separate lobular carcinoma in situ be separate primaries per M14? See Discussion. |
Recognizing the addition of the behavior requirement into this rule is an attempt to stop non-synchronous ductal carcinoma and lobular carcinomas from being accessioned as a single primary (SINQ 20200022), the issue with using behavior rather than timing is that now, synchronous separate/non-contiguous tumors that are invasive carcinoma NST (8500/3) and lobular carcinoma in situ (8520/2) (or vice versa) are separate primaries per M14. Lobular and carcinoma, NST are separate rows in Table 3, so we cannot stop at M10 and code the mixed histology because there are two separate histologies with different behaviors. There is no rule that states we can just ignore the in situ tumors for the purpose of applying the M Rules. (We are instructed to ignore the in situ when coding histology only in certain circumstances.) The problem with Rule M10 appears to be related to timing. This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The original issue with M10 was with registrars being instructed that multiple in situ and invasive tumors were a single primary and then coding 8522/3 when one tumor was in situ and one was invasive. This incorrectly identified both components as being malignant (/3). Our effort to correct this misconception apparently did not work. M10 has been revised to state that yes, an in situ lobular or duct plus an invasive lobular or duct is a single primary with a new note that states: When a mixture of behaviors is present in carcinoma, NST, and lobular carcinoma, follow the H rules to determine the correct histology code. They will stop at H8 which instructs them to code the invasive histology. 8522/3 should only be used when both components are invasive. |
2020 |
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20200081 | Solid Tumor Rules (2018)/Histology--Pancreas: How is the histology coded, and what H Rule applies, for a 2021 diagnosis when the pathological diagnosis is neuroendocrine tumor (NET) G1 or NET G2, but clinically, the tumor is stated to be insulinoma? See Discussion. |
Insulinoma, NOS is reportable for cases diagnosed 2021 and later. However, the diagnosis of insulinoma is most frequently made with clinical correlation of the patient's clinical syndrome and serum hormone levels. Despite a pathological diagnosis of NET, this will clinically be stated as insulinoma based on the functional type of tumor. At the largest facility in our area, all pathology reports with a diagnosis of insulinoma over the last year only provide a pathological Final Diagnosis of NET (either G1 or G2), but elsewhere specify, Functional Type: Pancreatic neuroendocrine tumor, functional. Correlation with Clinical Syndrome and Elevated Serum Levels of Hormone Product: Insulin-producing (Insulinoma). For 2021 and later, it seems this should be accessioned as insulinoma (8151/3), but one cannot arrive at that histology using the current Other Sites (MP/H) H Rules. Following the existing rules, one would code the histology to NET, G1 or NET, G2 (8240 or 8249) per Rule H6. There are technically two specific histologies to consider: NET (either 8240 or 8249) and insulinoma, NOS (8151). Following the H Rules, Rule H6 instructs one to code the histology with the numerically higher ICD-O-3 code (8240 or 8249). Coding this histology to NET (8240 or 8249) does not seem to reflect the most accurate classification of this tumor, but applying the current rules, this is the only histology that can be coded. There is no current guideline in the Other Sites schema or the ICD-O-3.2 Implementation Guidelines instructing us to ignore the pathological diagnosis of a NET for these tumors (even though insulinomas are NETs). The only SINQ that currently exists (SINQ 20150019) states the histology can be coded as either a NET or an insulinoma in these cases. How are registrars to consistently code histology for these tumors without a rule clarification? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
Code the tissue/pathology histology over the clinical diagnosis. Because of implementation timelines, a comprehensive revision to Other Sites rules will not be available 2022. A limited revision is planned and histology tables will be added for select sites. The General Instructions will also be revised for Other Sites. |
2020 |
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20200021 | Solid Tumor Rules/Histology--Head & Neck: What is the histology of human papillomavirus (HPV)--associated multiphenotypic carcinoma? See Discussion. |
Histologic Type: HPV-associated multiphenotypic carcinoma. Overall, the morphology, immunohistochemistry, and HPV testing results support the diagnosis of an HPV-related multiphenotypic carcinoma. This entity has been described in the sinonasal region, where it behaves more indolently than its other salivary gland carcinoma counterparts (e.g., adenoid cystic carcinoma), with local recurrence but rare metastases. |
Assign code 8072/3 for HPV-associated multiphenotypic carcinoma. WHO Classification of Head and Neck Tumors, 4th edition, lists sinonasal tract HPV-related carcinoma with adenoid cystic-like features as a subtype of non-keratinizing squamous cell carcinoma (NKSCC).Use text fields to record the details. |
2020 |
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20200059 | Reportability--Kidney: Is Bosniak 4 cystic lesion of right kidney reportable, and would the first CT date be the date of diagnosis? See Discussion. |
CT a/p read by radiologist shows: "Bosniak 4 cystic lesion of right kidney." Follow-up MRI a month later reads "right kidney cystic lesion with enhancing mural nodule concerning for cystic renal cell carcinoma (RCC)." Urologist consult used the same wording of "Bosniak 4 cystic lesion" and "concerning for renal cell carcinoma." Treatment discussed but due to patient health status recommended repeat imaging. Repeat CT few months later reads: "cystic right renal lesion with enhancing nodule similar to most recent prior and suspicious for cystic RCC." Though "suspicious for cystic RCC" per latest imaging is reportable, Bosniak 4 is "clearly malignancy, ~100% malignant" by definition, so is the case actually reportable with the first CT a/p date as date of diagnosis? |
2023 Bosniak 4 is defined as "clearly malignant cystic mass." The case is reportable as of the first date it is diagnosed as a Bosniak 4 lesion unless further workup (especially biopsy or resection) disproves the CT findings. https://radiopaedia.org/articles/bosniak-classification-system-of-renal-cystic-masses?lang=us |
2020 |
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20200050 | Surgery of Primary Site/Multiple primaries--Breast: Should the Surgery of Primary Site for the 2020 diagnosis be coded 51 (Modified radical mastectomy without removal of uninvolved contralateral breast) when a partial mastectomy and axillary lymph node dissection are performed for a 2011 right breast primary and a subsequent 2020 right breast primary is treated with a total mastectomy only? See Discussion. |
The patient underwent a partial mastectomy and sentinel lymph node biopsy, followed by an axillary lymph node dissection for the first right breast primary in 2011. The separate 2020 right breast primary was treated with a total mastectomy and removal of one involved axillary lymph node. The operative report only refers to this as a non-sentinel lymph node, with no mention of other axillary findings. Cumulatively, this patient has undergone a modified radical mastectomy since there were likely no remaining axillary lymph nodes. If the Surgery of Primary Site data item is cumulative, does the order of surgeries matter? It is unclear whether this question should be directed to SINQ (for coding in a SEER registry) or to CAnswer Forum because both have addressed similar surgery related questions in the past and and there is no guidance regarding this specific situation. |
Yes, assign surgery of primary site code 51 for the 2020 diagnosis in this case. Code the cumulative effect of all surgeries to the primary site. This means that for the 2020 primary, code the cumulative effect of the surgery done in 2011 plus the surgery performed in 2020. Use text fields on both abstracts to record the details. |
2020 |
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20200009 | First course treatment/Surgery of Primary Site--Corpus uteri: Is an omentectomy performed with a hysterectomy for an endometrial primary site recorded under Surgery of Other Site? See Discussion. |
Per SEER 20140003, an omentectomy is not recorded under Surgery of Other Site when performed with a hysterectomy for an endometrial primary. Is this still correct? CoC appears to have different guidelines stating in a forum that an omentectomy is coded in data item Surgical Procedure to Other Site. I would like to confirm SEER guidelines. Is this one of those unique situations that SEER and STORE differ? Our state follows SEER guidelines and would like to communicate the appropriate rules to our facilities. |
Continue to record an omentectomy performed with a hysterectomy under Surgery of Primary Site and not as a separate procedure under Surgical Procedure of Other Site. The guidance In SINQ 2014003 and 20091118 is unchanged. |
2020 |
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20200044 | Reportability/Histology--Eye: Is conjunctival intraepithelial neoplasia, moderate to severe, reportable and if so, what are the histology and behavior codes? See Discussion. |
Left Eye Conjunctiva, biopsy (01/23/2018): Conjunctival intraepithelial neoplasia moderate to severe. Is intraepithelial neoplasia moderate to severe the same as coding 8077/2? |
Report this case as 8077/2. Our expert pathologist consultant reviewed this and confirmed it is reportable. Here is some of his rationale. The pathologist's designation as "moderate to severe" indicates there are areas of 2/3 of full thickness epithelial change, so the criteria to report are met. |
2020 |
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20200080 | Reportability/Histology--Pancreas: Is a diagnosis of insulin-producing (insulinoma) epithelioid neoplasm reportable if made 2021 and later? If so, is the histology coded as 8151/3 per the ICD-O-3.2 Coding Table? See Discussion. |
The ICD-O-3.2 Implementation Guidelines and ICD-O-3.2 Coding Table indicate that insulinoma, NOS has changed behavior from /0 to /3 for cases diagnosed 2021 and later. However, the ICD-O-3.2 Implementation Guidelines do not indicate whether this change applies to tumors described as above. Insulinomas are generally neuroendocrine tumors/neoplasms, so it seems any neuroendocrine tumor described as an insulinoma should be collected as 8151/3, but does that apply to an epithelioid tumor/neoplasm also described as insulinoma? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
If the diagnosis includes insulinoma, it is reportable and coded 8151/3. Insulin-producing epithelioid neoplasm alone, without mention of insulinoma, is not reportable. |
2020 |