Report | Question ID | Question | Discussion | Answer | Year |
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20200003 | Histology--Penis: What is the histology code of a glans penis primary with the final diagnosis squamous cell carcinoma, verrucous type? See Discussion. |
Penile mass excision shows final diagnosis of squamous cell carcinoma, verrucous type. Subsequent partial penectomy has a final diagnosis of squamous cell carcinoma, verrucous type and the summary cancer data lists Both the final diagnosis and summary cancer data indicate a histology code of 8051/3 (squamous cell carcinoma, verrucous type / verrucous carcinoma). However, this site and histology combination triggers edit IFN4911. Edit documentation indicates that for sites C600-C609 (all penile sites) use histology code 8051 and do not use 8054. Review of the 2018 ICD-O-3 Histology Updates table does not indicate these terms are synonymous. |
Code squamous cell carcinoma, verrucous type of the penis as verrucous carcinoma (8051/3). In WHO Classification of Tumors of the Male Urinary System and Male Genital Organs, 4th edition, tumors of the penis, verrucous carcinoma is described as an extremely differentiated keratinizing papillomatous and acanthotic neoplasm; it accounts for 2-3% of penile squamous cell carcinomas. The coding of condylomatous carcinoma and warty carcinoma changed from 8051/3 to 8054/3 in 2018 for penile sites only in the 2018 ICD-O-3 New Codes, Behaviors, and Terms-Updated 8/22/18. Override the edit until the edit issue is explored. |
2020 |
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20200035 | Reportability/Ambiguous Terminology--Brain and CNS: Is the expression differential considerations a synonym for differential diagnoses? See Discussion. |
Example: An MRI Spine showed a large expansile mass arising from the sella turcica and extending into the suprasellar cistern, but the radiologist only noted: The leading differential considerations include pituitary macroadenoma or a large suprasellar base meningioma. The patient was subsequently pathologically diagnosed with a pituitary adenoma. It is unclear if the diagnosis date should be coded to the MRI date. There are two existing SINQ questions regarding the term consider. SINQ 20061094 confirms a diagnosis that is considered to be is reportable because it is unambiguous, but SINQ 20081033 states the phrase malignancy is highly considered is not a reportable ambiguous term. How should we interpret differential considerations? If differential considerations is equivalent to a differential diagnosis, then this patient was clinically diagnosed on imaging. However, if differential considerations is not reportable, then there was no diagnosis prior to the resection. |
In an ideal situation, the radiologist should be consulted to determine what he/she meant by "differental considerations." If that is not possible, given the context and usage, "differential considerations" in this case can be interpreted as differential diagnoses. And since the two differential considerations are both reportable, this case is reportable as of the date of the MRI. |
2020 |
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20200068 | Summary Stage 2018/Extension--Colon: Are colon primaries coded as local or regional (direct extension) on Summary Stage based on invasion into the pericolorectal tissues? For example, is a case with an ascending colon tumor that extends into the pericolorectal tissues, pT3, local or regional by direct extension? |
Code as Localized using the SEER Summary Stage Manual, Colon and Rectum, Note 6. Localized is for subsites that are not peritonealized, including the posterior side of the ascending colon, or when the pathologist does not further describe the "pericolic/perirectal tissues" as either "non-peritonealized pericolic/perirectal tissues" vs "peritonealized pericolic/perirectal tissues" fat and the gross description does not describe the tumor relation to the serosa/peritoneal surface, and it cannot be determined whether the tumor arises in a peritonealized portion of the colon. Refer to the coding instructions in both EOD and Summary Stage for a list of sites that are nonperitonealized or peritonealized. . |
2020 | |
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20200048 | Solid Tumor Rules/Multiple Primaries--Lung: How many primaries are accessioned when a patient is diagnosed with right lower lobe invasive acinar adenocarcinoma (8551/3) in 2018 and treated with lobectomy, followed by a 2019 right middle lobe cancer (NOS, 8000/3) diagnosed as new stage 1 primary by cancer conference? See Discussion. |
Lung Rule M14 appears to be the first rule that applies to this case and instructs the user to abstract a single primary. However, we were hoping for confirmation that a cancer (NOS) or malignancy (NOS) would not be a distinctly different histology that may qualify for Lung Rule M8. Currently, these histologic terms are not included in the Table 3 options or mentioned in the preceding notes. |
Use M14 and code a single primary. Per our SME, carcinoma or cancer, NOS is not an acceptable diagnosis which is why 8000 and 8010 were not included in the tables or rules. We assume there was no tissue diagnosis for the 2019 diagnosis. We recommend searching for more information or better documentation on this case. |
2020 |
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20200025 | Reportability/Ambiguous terminology--Bone: Is a case reportable when the imaging described a left first rib mass as ? See Discussion. |
The radiologist noted the mass was most compatible with a chondroid lesion, which is not reportable on its own, but can the subsequent term be used to accession this as reportable if only one malignant etiology is provided by the radiologist? Or does the statement imply that this is only one of several possible etiologies? |
Review this case with the involved physicians to determine their opinion on the bone mass. Review the plans for further evaluation and treatment (if any) to determine whether the physicians view this case as a chondroid lesion, chondrosarcoma, or something else. If it is not possible to obtain further information, do not report the case at this time. If further information becomes available, review the case again for reportability. |
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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20200062 | Solid Tumor Rules (2018)/Multiple Primaries--Lung: How many primaries should be reported when a patient has a 7/2016 diagnosis of right lower lobe lung mucinous adenocarcinoma, treated with Erlotinib and Avastin? In 4/2020, a liver biopsy finds metastatic high grade neuroendocrine carcinoma, clinically stated to be metastatic lung cancer, with no evidence of a new primary lung tumor on PET (liver the only site of disease)? See Discussion. |
We think this should be a single primary because the Solid Tumor rules do not apply to metastases. However, we are not sure whether or not the instructions outlined for prostate (SINQ 20180088, 20130221), that indicate we are to accession a new metastatic tumor only with a small cell neuroendocrine histology after an adenocarcinoma, also applies to lung primaries. We are aware of a phenomenon in which lung adenocarcinoma cases treated with Erlotinib can transform to small cell, but do not know whether it impacts the number of reportable primaries. |
Accession two primaries, adenocarcinoma [8140/3] and small cell neuroendocrine carcinoma [8041/3] per Rule M8 of the Lung Solid Tumor Rules, as these histology codes are on different rows in Table 3 of the rules. This is consistent with similar prior SINQ questions. |
2020 |
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20200087 | Solid Tumor Rules (2018)/Histology--Thyroid: What is the correct histology code for a micropapillary thyroid carcinoma for cases diagnosed 1/1/2021 and later? See Discussion. |
The 2021 ICD-O-3.2 Update includes papillary microcarcinoma (8341/3) as the preferred term for thyroid primaries (C739). However, there are multiple SINQ entries instructing registrars not to use code 8341/3 for diagnoses of micropapillary carcinoma of the thyroid (including SINQ 20071076, 20081127, 20110027, 20150023, and 20180008). SINQ 20150023 specifically indicates: Per the WHO Tumors of Endocrine Organs, for thyroid primaries/cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult (1 cm or less in diameter) and was found incidentally. WHO does not recognize the code 8341 and classifies papillary microcarcinoma of the thyroid as a variant of papillary thyroid carcinoma and codes histology to 8260. If the primary is thyroid and the pathology states papillary microcarcinoma or micropapillary carcinoma, code 8260 is correct. Does this clarification apply to cases diagnosed 2021 and later? If WHO feels the term micropapillary still does not refer to a specific histologic type for the thyroid, why is 8341/3 listed as a preferred term for this morphology/site combination? For cases 2021 and later, should a diagnosis of Incidental papillary thyroid microcarcinoma (3 mm) in left lower pole, be coded as 8341/3 per the ICD-O-3.2, or as 8260/3 per clarification in multiple SINQ entries? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
Continue to code micropapillary thyroid carcinoma to 8260/3 until instructed otherwise. This coding instruction is based on input from expert endocrine pathologists. This issue will be revisted based on the 4th Ed WHO Endocrine Tumors and updated if needed. |
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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20200067 | Summary Stage 2018/Extension--Colon: What is the Summary Stage for adenocarcinoma of cecum where the tumor extends into the proximal portion of attached vermiform appendix? See Discussion. |
2020 Diagnosis: Patient had a right hemicolectomy showing adenocarcinoma of cecum, tumor extends into proximal portion of attached vermiform appendix. Tumor invades through muscularis propria into pericolorectal tissues (NOS). Regional lymph nodes: 06/39. Primary Tumor EOD: Where does the appendix involvement come into coding or will this be based on the pericolorectal tissue (NOS) invasion? What is my Summary Stage? I know it is at least 3 due to regional ln involvement, but the appendix involvement is making me question 3 vs 4. |
Assign code 4, Regional by BOTH direct extension AND regional lymph node(s) involved. In this case, the Regional component for Summary Stage 2018 is based on Note 6, under Colon and Rectum where Regional is defined as: -Mesentery -Peritonealized pericolic/perirectal tissues invaded [Ascending Colon/Descending Colon/Hepatic Flexure/Splenic Flexure/Upper third of rectum: anterior and lateral surfaces; Cecum; Sigmoid Colon; Transverse Colon; Rectosigmoid; Rectum: middle third anterior surface] -Pericolic/Perirectal fat |
2020 |