Report | Question ID | Question | Discussion | Answer | Year |
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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 |
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20200028 | 2018 EOD Primary Tumor/2018 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 | |
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20200032 | Date of Diagnosis--Brain and CNS: How is the Date of Diagnosis coded when an MRI clinically diagnoses a borderline brain tumor on 4/4/2020, but the subsequent biopsy pathologically diagnoses a malignant brain tumor on 5/20/2020? See Discussion. |
Clinically, the patient was felt to have a pineocytoma (borderline tumor) on imaging, but the subsequent biopsy proved a pineal germinoma (malignant tumor). The Date of Diagnosis instructions state to code the month, day and year the tumor was first diagnosed, clinically or microscopically, by a recognized medical practitioner, but it does not indicate whether differences in behavior alter the diagnosis date. For brain and central nervous system tumors, should the diagnosis date be the first date a tumor is SEER reportable? Or should the diagnosis date for those tumors ultimately proven to be malignant, be the date the malignancy was diagnosed? |
This tumor was first diagnosed on 4/4/2020 according to the information provided. The pineocytoma was reportable based on a behavior of /1; it was later confirmed as a pineal germinoma; update both the histology and behavior on the abstract as better information was obtained, retaining the original date of diagnosis. |
2020 |
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20200023 | Solid Tumor Rules (2018)/Histology--Endometrium: Is the histology for a serous carcinoma, high-grade endometrial primary 8441/3 (serous carcinoma) or 8461/3 (high grade serous carcinoma)? See Discussion. |
Path report reads: 7/15/2019 A. Endometrium, curettings: Serous carcinoma, high grade. B. Endometrial polyp, curettings: Serous carcinoma, high grade. If coded to 8461/3, according to AJCC, this would not be an ideal code (since it is outdated). Also, endometrium is not included in the suggested site codes for 8461/3 according to the 8/22/2018 ICD-O-3 update. |
Code histology for this endometrial primary to serous carcinoma 8441/3. Capture "high grade" in the grade field as instructed in the grade coding manual. "High grade serous carcinoma" has specific clinical and histopathologic features found in ovarian tumors. |
2020 |
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20200016 | Reportability/Histology--Vulva: Is Extramammary Paget neoplasm (intraepithelial glandular neoplasm) reportable? See Discussion. |
Patient had a vulvar biopsy with final diagnosis of Extramammary Paget neoplasm (intraepithelial glandular neoplasm). No invasion identified. We are unable to contact the pathologist or physician for clarification. Although this terminology is not listed in the ICD-O-3, web search results refer to this as a possible synonym for Paget disease with associated VIN III, which is reportable. |
According to our subject matter expert, vulvar extramammary Paget neoplasm (intraepithelial glandular neoplasm) represents an in situ malignancy and should be reported. He states "The traditional terminology should be 'extramammary Paget disease' to describe an in situ adenocarcinoma arising from extramammary glands in vulvar mucosa. I am not so sure about "extramammary Paget NEOPLASM", which may include all three Pagetoid processes: the traditional Paget disease, the Pagetoid spreading of an anal adenocarcinoma and a Pagetoid spreading of an urothelial carcinoma from the urethra. Regardless, all these entities are considered at least in situ carcinomas." We recommend that you review clinical records and imaging for the clinical scenarios mentioned above. |
2020 |
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20200018 | Reportability: Is ASIN-H (high-grade anal squamous intraepithelial neoplasia) equivalent to anal intraepithelial neoplasia, III (AIN III)? |
High-grade anal squamous intraepithelial neoplasia (ASIN-H) is synonynous with anal intraepithelial neoplasia, grade III (AIN III). |
2020 | |
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20210002 | Multiple Primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned for a patient diagnosed with therapy-related myelodysplastic syndrome (t-MDS) (9920/3) in 2015 followed by a 2020 diagnosis of myelodysplastic syndrome, NOS (MDS, NOS) (9989/3)? See Discussion. |
Patient has a history of B-cell lymphoma with multimodality treatment in 2002. Lab work in 2015 showed multilineage dysplasia leading to a diagnosis of therapy-related myelodysplastic syndrome. Patient presents in 2020 for a bone marrow biopsy now showing low-grade MDS. The MDS appears to have the same multilineage dysplasia previously identified. MDS, NOS is not listed in the Heme DB as a possible transformation of t-MDS, nor is it listed as a Same Primary for t-MDS. Likewise, t-MDS is not listed as a more specific myelodysplastic syndrome, a transformation of MDS NOS, or a Same Primary as MDS, NOS. The first M rule that applies to this case is M15, and the Multiple Primaries Calculator indicates that the MDS, NOS should be a new primary. |
Abstract separate primaries using Rule M15 of the Hematopoietic and Lymphoid Neoplasms (Heme) Manual. The Heme Database states: Excluded from this category are progression of myeloproliferative neoplasms (MPNs) and evolution of primary MDS or primary MDS/MPN to acute myeloid leukemia (AML); in each of these latter cases evolution to AML is part of the natural history of the primary disease and it may be impossible to distinguish natural progression from therapy-related changes. There is no indication of transformation. |
2021 |
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20210015 | Solid Tumor Rules (2007/2021)/Multiple Primaries--Anus: Have the disease free interval criteria been met for the following case scenario. A patient was diagnosed with anal intraepithelial neoplasia (AIN) III in 7/2018 that was treated with local tumor destruction, followed by Pap smears and biopsies that prove AIN I or AIN II through 2020, before being diagnosed with a reportable AIN II or AIN III in 2021. See Discussion. |
Since AIN I is not reportable and AIN II is not reportable until 2021, we are not sure if we can say the patient was disease free because there was no intervening reportable tumor (AIN III), or was never disease free because there was evidence of related disease (lower grade dysplasia). |
The 2021 AIN III is not a new primary. According to our GI pathology expert, findings of AIN I and/or AIN II following a diagnosis of AIN III indicates the patient was never NED and indicates persistent disease. . |
2021 |
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20210075 | Reportability: What American College of Radiology Reporting and Data Systems (RADS) can be used to determine reportability? See Discussion. |
LI-RADS (liver), PI-RADS (prostate), and TI-RADS (thyroid) can be used to determine reportability. BI-RADS (breast) and Lung-RADS cannot be used to determine reportability. Can these systems below to determine reportability? C-RADS (from CT colonography) NI-RADS (head & neck) O-RADS (ovarian-adnexal) |
The following cancer cases are reportable unless there is information to the contrary. –Liver cases with an LI-RADS category LR-4 (reportable since 2021) or LR-5 (reportable since 2016) –Prostate cases with a PI-RADS category 4 or 5 (reportable since 2017) The following are not reportable without additional information. –Breast cases designated BI-RADS 4, 4A, 4B, 4C or BI-RADS 5 –Lung cases designated Lung-RADS 4A," 4B, or 4X –Liver cases based only on an LI-RADS category of LR-3 –Colon cases with only C-RADS information (C-RADS category C4 is not reportable by itself) –Head and Neck cases with only NI-RADS information (NI-RADS category 3 is not reportable by itself) –Ovarian or fallopian tube cases with only O-RADS information (none of the O-RADS categories are reportable without additional information) –Thyroid cases with only TI-RADS information (none of the TI-RADS categories are reportable without additional information) |
2021 |
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20210072 | Hormone Therapy--Breast: How are hormone therapy (HT) and other related data items coded when a patient had a previous breast primary and is still on HT when diagnosed with a new breast primary? See Discussion. |
In this scenario, we record that HT began for the second primary on the date of diagnosis, and the Systemic/Surgery Sequence ends up usually being coded 4 because the HT continues even if the specific agent may be changed. This does not seem to meet the definition of neoadjuvant therapy for the second primary so we approach the staging and grade coding as just clinical/pathological? For example, if the tumor size at surgery is a little larger than estimated on imaging, we would use the pathologic size for our staging. The tumor size and grade of the second primary are not being changed by the ongoing HT. Do we have the right approach? |
For this example: 1. Code HT as treatment on the date of diagnosis for the second primary. 2. Code Systemic/Surgery Sequence as 4. 3. Do not code neoadjuvant data items as neoadjuvant started/completed. The HT given would not qualify for neoadjuvant therapy since the intent of the HT was not neoadjuvant. The HT would affect the second primary, but it is still not neoadjuvant. 4. Code clinical and pathological tumor size accordingly, based on the imaging and the pathological findings. 5. Code Extent of Disease data items based on the pathological findings since pathological findings take priority over clinical and this is not neoadjuvant therapy. |
2021 |