Report | Question ID | Question | Discussion | Answer | Year |
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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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20200036 | Reportability--Skin: Is malignant proliferative trichilemmal tumor (PTT) reportable, and if so, do we apply the matrix rule and code it to 8103/3? A literature search reveals these do exist, but are extremely rare. |
Malignant PTT (8103/3) of the skin is not reportable. A neoplasm originating in the skin with histology coded to 8103 is not reportable. See 1.b.i. on page 7 in the 2018 SEER manual for a complete list, https://seer.cancer.gov/manuals/2018/SPCSM_2018_maindoc.pdf |
2020 | |
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20200073 | Solid Tumor Rules (2018)/Histology--Colon: Should the mixed adenoneuroendocrine carcinoma (MANEC) row in Table 1 include the still often used (yet older) terms of adenocarcinoma and carcinoid, adenocarcinoid, etc. for clarity? See Discussion. |
The Terms and Definitions Introduction discusses how these are older terms, but pathologists may still use them. In our region, pathologists do, in fact, still use these terms. Can these terms be added to Table 1? For registrars who do not reference the Introduction every time they code histology but go directly to Table 1, coding consistency would likely improve if such terms were added in the Table. This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The next update to the Solid Tumor rules will include adding the following four terms to Colon Table 1 as synonyms for Mixed adenoneuroendocrine carcinoma 8244
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2020 |
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20200046 | Reportability--Vulva: Is well differentiated vulvar intraepithelial neoplasm (dVIN) reportable? See Discussion. |
Is this histologic terminology synonymous with 8071/2 Differentiated-type vulvar intraepithelial neoplasia? Per the 7/20/2018 updates to the 2018 ICD-O-3 Histology list, the reportability flag was changed from N to Y for Differentiated-type vulvar intraepithelial neoplasia as well as Differentiated penile intraepithelial neoplasia, both 8071/2. It appears that both SINQ 20180020 and the second half of SINQ 20160069 are no longer valid and should be deleted. |
Report well-differentiated vulvar intraepithelial neoplasm (8071/2). Our expert pathologist consultant regards this as reportable. Well-differentiated is synonymous with differentiated in this context. The older SINQ questions have been removed. |
2020 |
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20200015 | Tumor Size--Clinical--Breast: Does information from any type of biopsy take precedence over an imaging report? See Discussion. |
For example, a patient has a 2.6 cm breast tumor on MRI; a core biopsy measuring 0.7 cm is positive for infiltrating duct carcinoma. Rule #1 states "Use the largest measurement of the primary tumor from physical exam, imaging, or other diagnostic procedures before any form of treatment." However, Rule #9 seems to imply that size from an "incisional biopsy" takes precedence over imaging, even though it is known to be less than the entire tumor in size. |
We do not recommend using the size from a core biopsy for clinical tumor size. A core biopsy does not necessarily obtain enough tissue to know the actual tumor size. Since there is imaging for this patient, it is preferable to record clinical tumor size from the imaging report in this case. The instructions will be clarified in the next revision of the SEER manual. |
2020 |
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20200007 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient is simultaneously diagnosed with systemic mastocytosis and chronic myelomonocytic leukemia (CMML-0) on a single bone marrow biopsy? See Discussion. |
The Hematopoietic and Lymphoid Neoplasms Database (Heme DB) definition for systemic mastocytosis with an associated hematological neoplasm (SM-AHN, 9741/3) states SM-AHN is a variant of systemic mastocytosis that arises with a myeloid disease of non-mast cell lineage (e.g., MDS, MPN, etc.) and that, However, SINQ 20130172 conflicts with the Heme DB stating the systemic mastocytosis and the associated hematological neoplasm are a single primary coded to a single histology (9741/3) per Rule M2. |
Abstract a single primary when the diagnosis is systemic mastocytosis with an associated clonal hematogoical non-mast cell lineage disease (SM-AHNMD) (9741/3). However, if the patient has a previous history of myelodysplastic syndrome, myeloproliferative neoplasm, myelodysplastic/myeloproliferative neoplasm or acute leukemia, abstract the SM-AHNMD as a second primary as stated in the Heme DB. SINQ 20130172 represents a single primary as there is no mention of a prior history of myelodysplastic syndrome, myeloproliferative neoplasm, myelodysplastic/myeloproliferative neoplasm or acute leukemia. |
2020 |
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20200077 | Solid Tumor Rules (2018)/Histology--Kidney: What is the histology code for succinate dehydrogenase-deficient renal cell carcinoma (SDHD)? See Discussion. |
Table 1 of the 2018 Kidney Solid Tumor Rules (STR) lists succinate dehydrogenase-deficient renal cell carcinoma as histology code 8312, but in the ICD-O-3.2 Coding Table it is listed as histology code 8311. No changes were made in the Kidney STR. As a result, the histology change described in the ICD-O-3.2 Coding Table conflicts with Table 1. Succinate dehydrogenase-deficient renal cell carcinoma (SDHD) is listed in Table 1 as a synonym for renal cell carcinoma, NOS (8312). However, the ICD-O-3.2 Coding Table lists this as a related term for histology code 8311/3. This related term was not discussed in the Implementation Guidelines, and no change was noted in the STR. While it seems we should continue to follow the STR, without clarification as to why this histology change was not implemented in STR, achieving consistency will be problematic if registrars jump straight to the ICD-O-3.2 Coding Table to code histology for cases diagnosed 2021 and later. If this code cannot be used for cases diagnosed prior to 2021, should that clarification be included in the STR? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
When creating table 1, our GU SME's stated Succinate dehydrogenase-deficient renal cell carcinoma (SDHD) is a rare neoplasm and is coded to RCC, NOS until such time a new code is proposed in the 5th Ed BB. ICD-O-3.2 added this term to 8311 as a related term BUT there is no documentation that these neoplasms are different and should be on separate lines in table 1 making them separate primaries. Its likely IARC made the decision to group these rare genetic histologies into one code. SEER is waiting for confirmation from GU experts. If it's valid, the RCC row will be updated in columns 2 and 3 with applicable dates each histology is valid. |
2020 |
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20200010 | Solid Tumor Rules (2018)/Histology--Head & Neck: How is histology coded for a glossotonsillar sulcus tumor with both squamous cell carcinoma and mucoepidermoid carcinoma? See Discussion. |
Patient had a radical pharyngectomy showing a glossotonsillar sulcus tumor with high grade squamous cell carcinoma and adjacent high grade mucoepidermoid carcinoma. The pathologist commented, the tumor is composed of high grade mucoepidermoid carcinoma and high grade conventional-type squamous cell carcinoma that are immediately adjacent to one another. Given that the tumors are arising so close together and could represent a single neoplastic process with divergent morphologies, they are staged together. Employing Solid Tumor Manual Rule M1 (single primary if unable to determine if there is a single or multiple tumors), it was determined that this should be reported as a single tumor because the pathologist referred to the case as both a tumor singular and tumors pleural. However, the Solid Tumor Manual Histology Rules for a Single Tumor do not appear to have an instruction for coding this histology combination. |
Abstract multiple primaries using 2018 Head and Neck Solid Tumor Rule M8 as these are separate tumors described as arising close together, and are on different rows in Table 3. Code histology separately as squamous cell carcinoma (8070/3) and mucoepidermoid carcinoma (8430/3). This appears to be a collision tumor. Collision tumors are counted as two individual tumors for the purpose of determining multiple primaries. Collision tumors were originally two separate tumors that arose in close proximity. As the tumors increased in size, they merged or overlapped each other. While more common in the colon, they can occur in other sites as well. |
2020 |
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20200030 | Solid Tumor Rules/Multiple primaries--Lung: How many primaries should be accessioned for the following patient scenario? 1) 09/2014 Left upper lobe (LUL), unifocal, localized acinar adenocarcinoma (8550/3) treated with lobectomy. 2) 04/2016 Right lower lobe (RLL), unifocal, localized acinar adenocarcinoma (8550/3) treated with wedge resection. 3) 04/2019 (within 3 years, but masked full date) Left lower lobe (LLL), unifocal, non-small cell carcinoma (8046/3) with brain metastasis. See Discussion. |
Rule M4 does not seem to apply because Note 1 defines clinically disease free to mean no evidence of recurrence in the same lung on follow-up. Patient had been disease free in the left lung after 09/2014 diagnosis. The 04/2019 diagnosis was in a different lung than the 4/2016 diagnosis. The next applicable rule is either M11 or M14 depending on how we should compare the new 2019 tumor: to the most recent prior tumor in 2016 or to both prior tumors. |
Abstract three primary tumors according to the 2018 Solid Tumor Rules as follows : 2014: LUL, single primary using M2 2016: RLL, multiple primary; abstract second primary using M11 (different lung) 2019: LLL, multiple primary after reapplying rules using M4 when comparing to the same lung in 2014. Abstract this tumor as it has been more than three years and it appears the patient had no clinical evidence of disease in the left lung until 2019. |
2020 |
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20200071 | Solid Tumor Rules (2018)/Histology--Breast: Rule H13 of the 2021 Breast Solid Tumor Rules (a new H Rule added in the December 2020 revision) indicates metaplastic carcinoma is coded when both metaplastic carcinoma and carcinoma No Special Type (NST) are present. Should Rule H13 also address lobular carcinoma so the histology for a single tumor with metaplastic carcinoma and lobular carcinoma is correctly coded to metaplastic carcinoma (8575)? See Discussion. |
Rule H13 states to code the histology to metaplastic carcinoma when there is metaplastic carcinoma (or a subtype/variant) and invasive carcinoma NST. This rule makes no mention of lobular carcinoma. However, in Table 3, Note 2 for metaplastic carcinoma (8575) states metaplastic carcinoma, NOS and subtypes are almost always mixed with invasive mammary carcinoma, NST and at times lobular carcinoma. These tumors should be coded to metaplastic regardless of percent invasive mammary carcinoma or lobular carcinoma present. While Table 2 (the mixed histology code table) does include an entry for metaplastic carcinoma AND carcinoma NST OR lobular carcinoma, it is unclear why lobular carcinoma has not been added to Rule H13 as well. If a single tumor has metaplastic plus lobular carcinoma, Rule H13 does not apply and one has to continue through the rules. Unfortunately, the next rule registrars would be tempted to use is Rule H18: Code the histology that comprises greater than 50% of tumor when two histologies are on different rows in Table 3. This Rule does not state it does NOT apply to metaplastic carcinoma (only mucinous). So, if for some reason the lobular was greater than 50%, the incorrect histology would be coded (unless the registrar happened to remember Note 2 in the metaplastic carcinoma entry in Table 3). This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
Lobular carcinoma was unintentionally excluded from M13. It will be added in the 2022 update. It is important registrars learn to use the tables and read the notes. |
2020 |