Report | Question ID | Question | Discussion | Answer | Year |
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20200084 | Primary Site/Histology--Sarcoma: Do the clarifications in the 2018 ICD-O-3 Update Table regarding undifferentiated high-grade pleomorphic sarcoma (8830/3) apply to cases diagnosed 1/1/2021 and later with the implementation of ICD-O-3.2? See Discussion. |
In the 2018 ICD-O-3 Update Table, undifferentiated high-grade pleomorphic sarcoma and undifferentiated high-grade pleomorphic sarcoma of bone (C40_) were both listed as a New Term for histology 8830/3. There was no site restriction for a diagnosis of undifferentiated high-grade pleomorphic sarcoma. Therefore, it appears the diagnosis could easily be applied to a soft tissue tumor. This histology is used by pathologists in our region for soft tissue tumors as well as bone tumors. However, in the ICD-O-3.2 Table an entry (or synonym) was not provided for a tumor outside the bone. The ICD-O-3.2 Table only lists undifferentiated high-grade pleomorphic sarcoma of bone for site codes C40_ and C41_ as a synonym for histology 8830/3. This also is not listed in the ICD-O-3.2 Implementation Guidelines. As a result, it is unclear whether a diagnosis of undifferentiated high-grade pleomorphic sarcoma of the soft tissue can be coded to 8830/3 and/or can be a synonym for the preferred term (8830/3, Malignant fibrous histiocytoma). Can a diagnosis of undifferentiated high-grade pleomorphic sarcoma of the soft tissue be coded to 8830/3, C49_ as it was per the 2018 ICD-O-3 Update Table? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
8802/3 applies to soft tissue tumors and 8830/3 applies to tumors arising in bone. The 2018 ICD-O update lists undifferentiated pleomorphic sarcoma as code 8802/3 and 8830/3 applies to undifferentiated high grade pleomorphic sarcoma of bone and is specific to C40 _. This is still valid in ICD-O-3.2. The 2018 update also noted undifferentiated pleomorphic sarcoma, NOS was a new term for 8830 based on WHO documentation available at that time. However that is incorrect and ICD-O-3.2 provides the correct codes. |
2020 |
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20200069 | Solid Tumor Rules (2018)/Histology--Breast: What histology code is used for an in situ encapsulated papillary carcinoma with an invasive carcinoma, NST? See Discussion. |
In Table 3 (Specific Histologies, NOS/ NST, and Subtypes/Variants), the entry for papillary carcinoma, NOS includes a change in column 3 of the 2018 Breast Solid Tumor Rules that conflicts with the H Rules. It is not accounted for in the change log. No explanation is offered as to why this change was made. This is a major change because encapsulated papillary carcinoma is frequently associated with carcinoma NST, and we have not been collecting these as such. Encapsulated papillary carcinoma (8504) in column 3 now includes an indented entry, with invasive carcinoma, NST/invasive duct carcinoma 8504/3. However, most encapsulated papillary carcinomas are in situ or there is no definitive statement of invasive encapsulated papillary carcinoma, so when in situ and invasive tumors are present, we are instructed to code the invasive histology (which would be the invasive carcinoma (NST), 8500/3). How are registrars to arrive at the correct histology without a new H rule or a clarification regarding this update being documented in the change log? Does the same change/addition apply to solid papillary carcinoma? These are often also associated with carcinoma, NST. Again, without an explanation regarding the change mentioned above, it is difficult to understand why the change was made. This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
In situ encapsulated papillary arising in or with invasive carcinoma, NST (a single tumor) is a single invasive histology. Use rule H14 and code the histology per Table 3. A note as been added to the 2023 breast rule H8 instructing when there is a single tumor with histology of in situ encapsulated papillary with invasive carcinoma or solid papillary carcinoma with invasove, continue through the rules. See H14 and code the appropriate histology per Table 3. Histologic types are becoming more complex and often have both in situ and invasive components but have a single code to identify them. |
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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20200056 | Reportability--Gallbladder: Is Intracholecystic papillary neoplasm (ICPN) with low-grade intraepithelial neoplasia reportable? The primary site is gallbladder. |
Intracholecystic papillary neoplasm (ICPN) with low-grade intraepithelial neoplasia is not reportable. The WHO assigns a behavior of 0 to these neoplasms. |
2020 | |
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20200043 | Histology/Behavior--Bladder: Is the behavior of a bladder tumor with low-grade papillary urothelial carcinoma /2 or /3? See Discussion. |
Transurethral resection: Microscopic Diagnosis: Bladder, transurethral resection: Low-grade papillary urothelial carcinoma Gross Description: Received in formalin labeled with the patient's name and bladder tumor is a 3.0 x 2.0 1.0 cm aggregate of friable tan tissue biopsies. The specimen is submitted in toto, cassettes This is all the information there is on this path report. Extent of Disease (EOD) instructions state inferred description of noninvasive: No statement of invasion (microscopic description present) SEER 2018 Appendix C Bladder Coding Guidelines state code behavior 3 if the only surgery performed is a transurethral resection of the bladder (TURB) documenting that depth of invasion cannot be measured because there is no muscle in the specimen OR the pathology report does not mention whether the submucosa is free of tumor or has been invaded by tumor. |
For cases diagnosed 2021 or later Code the behavior as in situ (/2) when the diagnosis is low grade urothelial carcinoma and there is no information regarding invasion. The SEER Manual Appendix C Bladder Coding Guidelines revision reflects this change. No changes have been made to EOD at this time. The guidelines have been updated as follows. Low grade urothelial carcinoma with no other information: Code to /2. High grade urothelial carcinoma with no other information: Code to /3. For cases diagnosed prior to 2021 Code the behavior as malignant (/3) for a bladder tumor with low-grade papillary urothelial carcinoma. |
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 |
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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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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 |
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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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20200058 | Surgery of Primary Site/Surgery Codes, NOS--Pancreas: What exactly is an extended pancreatoduodenectomy? Must the entire pancreas be resected in order to use code 70? What minimal requirements must be met to use code 70? How should a Whipple with cholecystectomy, partial omentectomy, common hepatic excision, portal vein resection, and lymphadenectomy be coded? |
According to our research, a pancreaticoduodenectomy (PD) includes an en bloc resection of the pancreatic head, the common bile duct, the gallbladder, the duodenum, the upper jejunum, the distal portion of the stomach and the adjacent lymph nodes. The extended PD procedure includes extended lymphadenectomy, extended organ resection, and extended vascular resection and reconstruction. Code 70 could be assigned without the entire pancreas being resected. A Whipple procedure removes the head of the pancreas, duodenum, stomach and gallbladder and part the common bile duct. The portal vein resection is probably part of the common bile duct excision. If the omentectomy was performed for treatment of this primary, record it in "Surgical Procedure of Other Site." Record the lymphadenectomy in the lymph node data items. |
2020 |