Report | Question ID | Question | Discussion | Answer | Year |
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20200013 | Solid Tumor Rules (2018)/Multiple primaries--Colon: Solid Tumor Rules 2018, Colon Rule M7, bullet 3 indicates that (if neither bullet 1 or 2 apply) a new tumor at the anastomotic site must be stated to arise in the mucosa (confirmed in SINQ 20190096) to qualify as a new primary. However, there is often no clear statement of tumor arising from or involving mucosa (unless the new tumor is limited to the mucosa) noted by pathologists in our region. Do any of the following examples imply a new tumor arising in mucosa per Rule M7, bullet 3? See Discussion. |
Examples: 1) New tumor at the ileocolic anastomosis, described as a, Circumferential centrally ulcerated mass with raised borders. Tumor extension: Tumor invades through muscularis propria into subserosal adipose tissue, no involvement of the serosal surface identified. The only mention of mucosa on the resection is the uninvolved enteric mucosa or uninvolved colonic mucosa in the otherwise uninvolved portions of the ileum/colon. If neither bullet 1 or 2 apply, is this a new primary per M7 bullet 3? 2) Right colon with anastomosis site. Tumor site: Anastomosis. Tumor extension: Tumor invades through the muscularis propria. Gross description does not describe mucosa, only noting, at the central area of anastomosis is an ill-defined, slightly raised, tan-brown to purple mass measuring 2.2 x 2 cm, which is nearly circumferential, causing obstruction at the site of anastomosis. If neither bullet 1 or 2 apply, is this a new primary per M7 bullet 3? 3) Polyp at ileocolonic anastomosis, polyp biopsy final diagnosis was, Invasive moderately differentiated colonic adenocarcinoma in association with adenoma. No mention of mucosa on the biopsy final diagnosis or gross description. Clinical info indicates, There is an ulcerated 5 cm mass at the ileo-colonic anastomosis that was biopsied. If neither bullet 1 or 2 apply, is this a new primary per M7 bullet 3? |
Following the 2018 Colon Solid Tumor Rules M7 and M8: Example 1: Assuming the first and second tumors are not different histologies or they occurred less than or equal to 24 months apart (M7 Bullets 1 and 2 do not apply), abstract a single primary as the pathology states uninvolved enteric mucosa or uninvolved colonic mucosa (no involvement noted). Example 2: Assuming the first and second tumors are not different histologies or they occurred less than or equal to 24 months apart (M7 bullets 1 and 2 do not apply), abstract a single primary as there is no mention of mucosal involvement. Example 3: Assuming the first and second polyps/tumors are not different histologies or they occurred less than or equal to 24 months apart (M7 bullets 1 and 2 do not apply), abstract a single primary as there is no mention of mucosal involvement. Of note in the case of the polyp, tumors coded as adenocarcinoma in a polyp, should be treated as adenocarcinoma (8140) for cases prior to 2018. Also, if the pathologist states the new tumor/polyp originated in the mucosa, it is a new primary. The rules which address "recurrence or new tumor at the anastomosis were created with the input of several gastrointestinal expert pathologists (CAP, AJCC, and WHO). Pathologists should be following CAP reporting guidelines and include information such as mucosal involvement in the final diagnosis and/or synoptic report. We can revisit this question that all polyps start in the mucosa and if needed, revise the rules to state this. |
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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20200027 | Reportability--Ambiguous Terminology: Should either of the terms, strongly characteristic of or most certainly, be used to accession a case as reportable when they are used to describe a malignancy and no other information is available? See Discussion. |
SINQ 20130140 indicates a histologic diagnosis that is characteristic of a specified malignancy is reportable because this is equivalent to the term, diagnostic of. Does the same logic apply to a clinical diagnosis that is strongly characteristic of a malignancy on imaging? SINQ 20180104 indicates the term, almost certainly, is not a reportable ambiguous term. If a radiologist notes a mass was most certainly malignant, is this adequate to accession this as reportable? Is a clinically certain diagnosis equivalent to diagnostic of? Or are the modifiers almost and most irrelevant because the terms certainly and certain are not on the ambiguous terminology list? |
Look for more information. What is the plan for each of these patients? Consult with the physician and search for further information to assist with the decision. If no further information can be obtained, accession both of these cases based on the imaging reports. If more information becomes available later, review and revise as applicable. |
2020 |
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20200053 | Solid Tumor Rules (2018)/Multiple primaries--Bladder. Would the metastatic diagnosis indicate a new primary? If the metastatic diagnosis indicates a new primary, would the primary site be C688 and date of diagnosis 11/14/18? See Discussion. |
7/8/16 Urinary bladder, biopsy: Non-invasive low grade papillary urothelial carcinoma. Muscularis propria (detrusor muscle) is not identified. 9/2/16 Urinary bladder, bladder tumor, transurethral resection: High grade papillary urothelial carcinoma. No definite invasion identified. Muscularis propria (detrusor muscle) is identified and not involved by tumor. 1/7/17 A\S\Bladder: Noninvasive low grade papillary urothelial carcinoma. Granulomatous cystitis, consistent with BCG (Bacillus Calmette-Guerin) treatment. Lamina propria is not involved with tumor. Detrusor muscle is not identified. 4/4/17 Dome: Papillary urothelial carcinoma, low grade. No evidence of invasion. Muscularis propria is not present. Patient is clearly followed for at least a year but no further information until 19 months later, 11/14/18, when biopsy of lung indicates metastatic disease. 11/14/18 Lung, right lower lobe, mass, biopsy: Metastatic urothelial carcinoma. Immunohistochemical analysis results (CK7 positive, CK20 focally positive, P63 positive, GATA3 positive, TTF1 negative and NAPSIN-A negative) support the diagnosis |
Do not use the solid tumor rules to assess the 2018 diagnosis. See Note 1 on page 20 of the Urinary Sites Solid Tumor Rules, https://seer.cancer.gov/tools/solidtumor/Urinary_STM.pdf The 2018 diagnosis proves that this patient had invasive bladder cancer. Change the behavior on the abstract to /3 and use text fields to record the details. |
2020 |
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20200065 | Tumor Size/Corpus uteri--Endometrium: Is clinical tumor size coded to the endometrial stripe measurement or thickening in the endometrium. See Discussion. |
Example: Pelvic ultrasound-19 mm thickened endometrium; bilateral ovaries unremarkable. Case was coded to 19 mm for clinical tumor size. I have always been taught NOT to use "endometrial stripe" or "thickening" measurements for clinical size. Can you confirm. Also, is this noted on any of the SEER resources such as SEER training or in the SEER tumor size guidelines? I wanted to point them out to a reference if it is available. |
We consulted with an expert GYN pathologist. He confirmed our thinking that endometrial stripe or thickening does not represent clinical tumor size. We will add this to a future edition of the SEER manual for reference. |
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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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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20200024 | Reportability/Histology--Fallopian tube: Is germ cell neoplasia in situ reportable? If so, is the histology and behavior 9064/2? See Discussion. |
Pathology report dated 10/17/2019: Final Diagnosis: Fallopian tubes and gonads, right and left, excision: Dysgenetic gonadal tissue with nests and tubules of atypical germ cells suspicious for gonadoblastoma and at least germ cell neoplasia in situ; and segments of fallopian tube (pending expert consultation). |
Report germ cell neoplasia in situ as 9064/2. Override the site/type edit. |
2020 |
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20200002 | Reportability/In situ--Prostate: Has there been a change in reportability for prostatic intraepithelial neoplasia (PIN III) (C619)? The 2018 SEER Manual notes: Collection stopped effective with cases diagnosed 01/01/2001 and later; however, on the casefinding list effective 10/01/2019, code D07.5, carcinoma in situ of prostate, is listed as reportable. |
PIN III is not reportable in accordance with the 2018 SEER Manual; however, carcinoma in situ of the prostate is reportable as they represent different histology codes. The casefinding list is used to search for reportable cases and is not the same as a reportable list. |
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 |