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20210041 | Reportability/Behavior--Paraganglia: Is a 2021+ diagnosis of paraganglioma reportable if the grading of adrenal pheochromocytoma and paraganglioma (GAPP) score falls outside the stated requirements for malignancy? See Discussion. |
Patient was diagnosed with a retroperitoneal paraganglioma on April 2021 mass resection. Final diagnosis included the comment: Based on the modified grading of adrenal pheochromocytoma and paraganglioma (GAPP), the GAPP score is 1. Scores greater than or equal to 3 are malignant. We are aware that paraganglioma is classified as malignant for cases diagnosed in 2021+, however it is unclear how the pathologist's interpretation of the GAPP score may affect the behavior of this case. |
Report retroperitoneal paraganglioma based on ICD-O-3.2 histology/behavior that lists paraganglioma, NOS as 8680/3 for cases diagnosed 2021 and forward. While GAPP is a predictor of metastatic potential, it does not factor into behavior, thus reportability. |
2021 |
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20210045 | Update to Current Manual/Neoadjuvant Treatment: What codes should be used for Neoadjuvant Therapy--Clinical Response and Neoadjuvant Therapy--Treatment Effect when the neoadjuvant therapy is still in progress at the time the case is initially abstracted as with rapid reporting. There is no code for neoadjuvant therapy still in progress and code 9 generates an edit for Neoadjuvant Therapy--Clinical Response. |
Assign code 8 for Neoadjuvant Therapy--Clinical Response and assign a code 9 for Neoadjuvant Therapy--Treatment Effect when the treatment is still in progress. Revise these codes after the treatment has been completed. We will update the manual to include these instructions. |
2021 | |
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20210030 | Primary site--Breast: Patient was diagnosed with invasive ductal carcinoma of the left breast. Site of mass is 2:00 to 3:00. What is the correct site code, C504 upper outer quadrant (UOQ) or C50.8 (overlapping)? |
Assign C504, UOQ, for a left breast primary mass at 2:00 to 3:00. See the illustration in the SEER Coding Guidelines for breast, https://seer.cancer.gov/manuals/2021/AppendixC/Coding_Guidelines_Breast_2021.pdf |
2021 | |
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20210078 | Solid Tumor Rules (2018/2021)/Multiple Primaries--Skin Cancer: How many primaries are assigned for sebaceous carcinomas using the Solid Tumor/Multiple Primaries/Histology Rules? Does this scenario represent eight separate primaries? See Discussion. |
Details 4/15/2018: Right abdominal wall mass excision: infiltrating sebaceous carcinoma. Noted to have a history of Muir-Torre/Lynch syndrome. 1/21/2019: Two left upper back mass excisions and two lower back (laterality not specified) mass excisions: infiltrating sebaceous carcinomas 8/7/2019: Excision of multiple sebaceous carcinomas from the right posterior back, left posterior thigh, left anterior abdominal wall, left anterior thigh, right scrotum, right lower abdominal fold, all positive for sebaceous carcinoma on pathology report 9/30/2020: Right gluteal mass, left gluteal mass, back (NOS) excisions: sebaceous carcinomas. 10/14/2020: Right back excision: sebaceous carcinoma. Op note: History of Lynch syndrome with multiple sebaceous carcinomas, recurrent back mass, site of prior mass resection. 10/18/2021: Right thigh excision: sebaceous carcinoma Proposed primaries using MP/H Other Sites Rules #1: 4/15/2018: C445-1 #2: 1/21/2019: C445-2, separate from #1 per M8, same as 1/21/19 C445-9 per M18 #3: 8/7/2019: C445-1, separate from #1 per M10, separate from #2 per M8 #4: 8/7/2019: C447-2, separate from #1 & #3 per M8, separate from #2 per M12 #5: 8/7/2019: C632, separate from #1 per M10, separate from #2-#4 per M11 #6: 9/30/2020: C445-2, separate from #1 & #3 per M8, separate from #2, #4 & #5 per M10 #7: 9/30/2020: C445-1, separate from #2, #4 & #6 per M8, separate from #1, #3 & #5 per M10; I do not think the back, NOS (C445-9) is a new primary per M18. #8: 10/18/2021: C447-1, separate from #2, #4 & #6 per M8, separate from #1, #3, #5 & #7 per M10 |
Assign the number of primaries following the Other Sites Solid Tumor Rules. Based on sites, laterality and or timing there are 8 primaries. This is similar to SINQ 20061112 that advised to follow the Multiple Primaries/Histology rules for sebaceous carcinoma. According to the WHO Classification of Skin Tumors, 5th edition, there is a 30-40% risk of local tumor recurrence, and 20-25% risk of distant metastasis. In only one instance did a physician refer this as a recurrence in the available notes. |
2021 |
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20210001 | SEER*RSA/Required data items--Melanoma: The site-specific data item, Ulceration, states it is required by "All" in SEER*RSA but in the NAACCR Data Dictionary table it states is it required by SEER, Commission on Cancer (CoC), and Canadian Cancer Registry (CCCR), not the National Program of Cancer Registries (NPCR). Does the definition of "All" in SEER*RSA not include NPCR? Also, please explain the difference between Required by: "All" and "Required by CCCR/Canada, COC, NPCR, SEER" (all listed out). |
Use the NAACCR Data Dictionary Required Status Table or refer to standard setter requirements. Do not use SEER*RSA to determine which data items are required to be collected or transmitted. Though "All" in SEER*RSA generally refers to the standard setters including CoC, NPCR, CCCR, and SEER, some items in SEER*RSA need updating; this is planned for 2022. |
2021 | |
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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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20210043 | Reportability--Fallopian Tube: Is a diagnosis of serous tubal intraepithelial neoplasm (neoplasia) (STIN) equivalent to serous tubal intraepithelial carcinoma (STIC)? Does the designation of high or low grade have any effect on potential reportability? See Discussion. |
Patient has left salpingo-oophorectomy showing fallopian tube with focal high grade serous intraepithelial neoplasm. In reviewing some journal articles, the term STIN is being used to describe both STIC and serous tubal intraepithelial lesion (STIL). We will likely continue to see this term used, so it would be nice to have some clarity. |
Serous tubal intraepithelial neoplasm (neoplasia) (STIN) is not equivalent to serous tubal intraepithelial carcinoma (STIC). Report STIN only when stated to be high grade. STIC is reportable. Do not report STIL. According to our expert pathologist consultant, STIL and STIN are broad descriptive terms that reflect proliferation of epithelial cells with varying degrees of atypia, with the most developed, STIC, reflecting convincing neoplastic change. |
2021 |
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20210055 | Tumor Size--Pathologic/EOD 2018: How is Tumor Size--Pathologic coded when Extent of Disease (EOD) Primary Tumor is 800 (No evidence of primary tumor) and there has been no surgery to the primary site? See Discussion. |
The SEER Manual states to assign Tumor Size--Pathological code 000 when EOD Primary Tumor is coded to 800 (No evidence of primary tumor) for any schema. However, the definition of Tumor Size--Pathologic states that it records the size of a solid primary tumor that has been resected. If the primary site has not been resected (does not meet the pathologic staging criteria), then it seems that Tumor Size Pathologic should be 999 when EOD Primary Tumor is coded as 800. |
Assign code 999 for Tumor Size--Pathologic when there is no surgery of the primary site. Code 999 includes "No excisional biopsy or tumor resection done." |
2021 |
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20210074 | Update to Current Manual/Neoadjuvant Therapy--Pancreas: How are the neoadjuvant items coded for a patient who has unresectable pancreatic cancer and starts chemotherapy but will be evaluated after X cycles to see if patient may become a surgical candidate? |
Assign the neoadjuvant therapy data items as if the patient had neoadjuvant therapy. Neoadjuvant Therapy data item would be coded either code 1 or 2 depending on whether the chemotherapy was completed or not. In this case, they are a surgical candidate by having the chemotherapy with the plan from the beginning to evaluate the chemotherapy after X cycles to see if surgery can be performed. After the patient is evaluated, update the abstract as needed. |
2021 | |
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20210011 | Primary site: Is C720 the correct primary site for a diagnosis of a paraspinal neuroblastoma on autopsy in a nine month old with Noonan syndrome? See Discussion. |
Autopsy/Pathology Report (2020) excerpts External Examination Nervous System: There is an 8.5 cm mass located in the right thoracic paraspinal area. Final Anatomic Diagnosis Clinical History: Paraspinal mass suspicious for neuroblastic tumor (detected by imaging studies) Nervous System: Right thoracic paraspinal neuroblastoma, poorly differentiated |
Assign primary site code C473 for this case based on the information provided (peripheral nerves and autonomic nervous system of thorax). From our expert pathologist consultant: The origin of neuroblastomas is generally in the adrenal medulla or one of the sympathetic ganglia on either side of the vertebral column (although they have been reported in many other locations given the migration of the neural crest cells embryologically). |
2021 |
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