Home
| Report | Question ID | Question | Discussion | Answer | Year |
|---|---|---|---|---|---|
|
|
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 | |
|
|
20200083 | Reportability/Histology--Kidney: Is hybrid oncocytic chromophobe tumor reportable for cases diagnosed 2021 and later? If so, how is the histology coded? See Discussion. |
The ICD-O-3.2 Coding Table includes hybrid oncocytic chromophobe tumor as a related term for histology code 8317 (Renal cell carcinoma, chromophobe type). However, this related term is not discussed in the implementation guidelines as being a new term/reportable tumor. The Solid Tumor Rules do not indicate a hybrid oncocytic chromophobe tumor is reportable; however, if a registrar only looked at the ICD-O-3.2 Coding Table, it may seem as though this histology should be collected. The term hybrid oncocytic chromophobe tumor was not included in the Solid Tumor Rules as a subtype/variant of RCC, or as an equivalent term for chromophobe RCC. There is a SINQ (20180047) that states not to report renal hybrid oncocytic tumor, despite the fact these tumors exhibit mixed features of both oncocytoma and chromophobe RCC. For cases diagnosed 2021 and later, should the clarification in the SINQ apply? Or should the ICD-O-3.2 Coding Table be used which indicates this is a reportable diagnosis? If the standard setters decided not to implement use of hybrid oncocytic chromophobe tumor for 2021, can clarification be added to the Solid Tumor Rules or Implementation Guidelines? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
Hybrid oncocytic chromophobe tumor is listed in ICD-O-3.2 as 8317/3 which indicates it is reportable if diagnosed in 2021 or later. For cases diagnosed 1/1/2021 and later, use ICD-O-3.2 for reportability. See page 16 of the NAACCR 2021 Implementation Guidelines. Between publication of ICD-O-3.2 and updates made to solid tumor histology tables, additional terms were added based on review by the IARC ICD-O committee. These changes were not made available in time to correct the tables. All related terms or synonyms may not be included in the histology tables and ICD-O-3.2 should be used in tandem with the solid tumor rules. |
2020 |
|
|
20200033 | Solid Tumor Rules (2018)/Multiple primaries--Breast: How many primary tumors should be abstracted for a 2018 breast excision with a final diagnosis of invasive mucinous adenocarcinoma (0.7 cm) with ductal carcinoma in situ (DCIS) present as discontinuous foci, spanning 12 cm? See Discussion. |
If the term discontinuous foci means separate tumors, then rule M14 would apply making these multiple reportable tumors. |
Abstract two primaries, invasive mucinous and DCIS, using 2018 Solid Tumor Rules for Breast, M14, as the discontinuous foci are separate tumors in this example and the histologies are on different rows of Table 3 of the rules. |
2020 |
|
|
20200079 | Solid Tumor Rules (2018)/Primary Site--Brain and CNS: Should the updated note for optic nerve glioma be included in both the 2018 Solid Tumor Rules for Malignant Central Nervous System (CNS) and Peripheral Nerves, Note 6, and the Non-Malignant CNS Tumors, Note 5? See Discussion. |
Should the updated Note 5 from the Non-malignant CNS regarding optic nerve glioma also be incorporated into Note 6 for Malignant CNS rules (the pilocytic astrocytoma note)? This was one of the major issues identified in the SEER*Educate Workshop. Registrars have demonstrated they do not consistently think to look at the Non-malignant CNS schema when they see the term glioma and continue to misclassify optic nerve gliomas as malignant. This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The 2022 Solid Tumor Update will include a new note in the Terms & Definitions, Introduction section that will state: See the Non-malignant CNS rules when the primary site is optic nerve and the diagnosis is either optic glioma or pilocytic astrocytoma. The behavior is non-malignant and coded 9421/1. |
2020 |
|
|
20200074 | Solid Tumor Rules (2018)/Histology--Head & Neck: What specific table(s) in the 2021 Head and Neck Solid Tumor Rules if any, apply to tumors of the lip? See Discussion. |
Lip has not been added to any of the site-specific histology tables, nor has any other instruction been provided for coding tumors in this site. Coding histology for lip primaries is difficult because registrars do not know where to look first. The Solid Tumor Rules indicate one should use the tables first, but then do not inform registrars what table to use for a lip primary (i.e., a specific table, any table, no table). This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The tables are based on WHO H&N chapters which do not include lip. There are inherent issues in determining reportability for lip primaries based on site and histology. The decision was made prior to release of the 2018 rules to exclude a histology table for lip. We are consulting both our dermatology and H&N pathology experts to explore adding a lip site-specific table to the rules. |
2020 |
|
|
20200047 | Stage-related Data Item/Lymphovascular Invasion--Ovary: The 2018 SEER Program Coding and Staging Manual states that LVI is coded 8 (Not applicable) for Ovary (Schema 00551). What is the reason for having lymphovascular invasion (LVI) coded "8" for Ovary? See Discussion. |
This direction is also in SEER*RSA for Ovary. Researching a possible explanation for this, we found that LVI is an independent predictor of progression and survival in patients with primary epithelial ovarian cancer at early stage but not at advanced stage. However, studies also recommend that routine evaluation of LVI in ovarian cancer is highly recommended in daily practice. |
The coding instructions were developed and implemented in concert with the AJCC Cancer Staging Manual, 7th edition, and updated with the 8th edition as per the 2018 STORE Manual and were based on sites where distinguishing between lymphatic/small vessel invasion and venous/large vessel invasion was not medically appropriate. SEER required LVI for penis and testis cases only beginning in 2016; sites other than penis or testis are coded 8 unless required by state or central registries. The list for use of code 8 has been changed for 2021 and will no longer include Ovary. |
2020 |
|
|
20200045 | Diagnostic confirmation--Heme & Lymphoid Neoplasms: Is Diagnostic Confirmation coded to 5 or 8 based on a patient diagnosed as multiple myeloma by a physician based on a bone marrow biopsy stating plasma cell neoplasm? See Discussion. |
Bone marrow, right iliac crest (aspirate smear, touch preparation, clot section and core biopsy): Hypercellular marrow (40-50%) with plasma cell neoplasm (see Comment): " No evidence of metastatic carcinoma. " Adequate iron storage. Comment: CBC data shows normocytic anemia. Flow cytometric analysis of bone marrow detects a kappa restricted plasma cell population that expresses CD138 and CD38. CD56 is positive. CD19 and CD20 are negative. T lymphocytes are immunophenotypically unremarkable. Polyclonal B lymphocytes are detected. Blast gate is not significantly increased. Immunohistochemical stains are performed on the biopsy core and clot section for greater sensitivity and further architectural assessment with adequate controls. CD138 positive plasma cells comprise > 70% of the total cellularity. AE1/AE3 is negative. Taken together, the morphologic and immunophenotypic findings are consistent with a diagnosis of plasma cell neoplasm. Trilineage hematopoietic activity as are seen. |
This would be a Diagnostic Confirmation of 8 based on the physician's diagnosis. The Pathology report mentions plasma cell neoplasm only. By itself, plasma cell neoplasm is not reportable because it includes a variety of diseases, some that are not reportable, and some that are (See Hematopoietic Database under Plasma Cell Neoplasm.) The physician probably has other information, including imaging, which may show lytic lesions. He/she is probably using clinical findings, plus findings from the bone marrow, and diagnosing this patient with multiple myeloma. |
2020 |
|
|
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 |
|
|
20200031 | Histology/Behavior--Breast: How are histology and behavior coded for a case originally diagnosed as in situ and later an invasive tumor with a different histology is diagnosed but still a single primary using Breast Solid Tumor Rule M10? See Discussion. |
SINQ 20200022 indicates that cases originally diagnosed as in situ do not have a new primary when a new invasive tumor with a different histology is diagnosed within 5 years. Should histology and/or behavior get updated for the in situ breast primary? |
Update the histology and behavior based on the invasive tumor when an invasive tumor is diagnosed within 5 years of an in situ tumor in the same breast. This will be updated in the 2021 revisions of the Breast Solid Tumor Rules. |
2020 |
|
|
20200028 | EOD 2018/EOD Primary Tumor/EOD Mets--Lung: Is EOD Primary Tumor coded to 500 and EOD Mets 10 when there are bilateral lung nodules with nodules in same lobe as the primary tumor? How is EOD Primary Tumor coded when separate tumor nodes are in an ipsilateral lung but there is no documentation as to whether it is in the same or different ipsilateral lobe from the primary tumor? |
Assign 999 to EOD Primary Tumor if this is the only information you have for your case.The mention of nodules does not automatically mean that you have separate tumor nodules. There are many reasons for the appearance of nodules in the lung, some of which are not due to cancer. Unless you have further information on whether the physician has determined that they are related to the lung cancer, then assume that they are not related. Assign 00 to EOD Mets. Do not code EOD Mets to 10 since you cannot determine whether those nodules are based on the tumor or not. If you are able to obtain more information, then you can update the EOD Primary Tumor and EOD Mets. Regarding the second question, if separate tumor nodules are noted, you cannot assume that they are due to tumor. Further information, or clarification, is needed on whether the separate tumor nodules are related to the lung cancer. Without further information, code EOD Primary Tumor to 999. There is also some information in the CAnswer Forum since Separate Tumor Nodules are a Site-Specific Data Item: http://cancerbulletin.facs.org/forums/forum/site-specific-data-items-grade-2018/96061-lung-separate-tumor-nodules |
2020 |
An official website of the United States government
