Report | Question ID | Question | Discussion | Answer | Year |
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20220048 | First Course Treatment/Immunotherapy--Other Therapy: Should all therapies given as part of a clinical trial be coded as Other Therapy (NAACCR #1420), or only those that cannot be classified in one of the other treatment categories (systemic therapy, surgery, radiation) or as ancillary treatments? Does it matter what is listed in SEER*Rx under Primary Sites or Remarks regarding FDA approvals? See Discussion. |
The SEER Manual states that the Other Therapy data item identifies treatments given that cannot be classified as surgery, radiation, systemic therapy, or ancillary treatment; and the instructions for code 2, Other-Experimental, say to assign this for any experimental or newly developed treatment, such as a clinical trial, that differs greatly from proven types of cancer therapy. Does this mean that only unclassifiable treatments should be coded in Other Therapy, even if given as part of a clinical trial? For example, if a patient is given a drug as part of a trial that is categorized in SEER*Rx as immunotherapy, should it be assigned both Immunotherapy (NAACCR #1410) code 1 and Other Therapy code 2, or only coded in Immunotherapy since it is classified as such? How should a clinical trial drug be coded if it has a treatment classification in SEER*Rx, but the type of cancer being treated is not listed under the Primary Site or Remarks sections as being FDA approved? A real case scenario is atezolizumab given for colon cancer as part of a trial; this drug's category is Immunotherapy in SEER*Rx but colon is not listed under Primary Sites or in the Remarks detailing FDA approvals. |
When a drug is being administered as part of a clinical trial and it is not yet approved as treatment for the cancer site for which it is being administered, code in Other Therapy. Do not code it as Immunotherapy (for the example provided). While a drug may be approved to treat one type of malignancy, it may be in clinical trials to determine its value in treating other malignancies. Coding as immunotherapy is misinformation in this case since there are other types of approved immunotheraputic agents. |
2022 |
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20220024 | Update to Current Manual/Residence at diagnosis: Would an exchange student be a temporary resident of the SEER area or a non-resident? See Discussion. |
A 17 year old exchange student was brought into the hospital with appendicitis. The patient had an appendectomy; there was no follow up treatment. 5/27/2006 pathology report of vermiform appendix: Adenocarcinoid appendix <5 mm tumor limited to appendix. The patient has no record in Lexis Nexus and no social security number. The address is a post office box; additionally, the patient’s birthplace is Switzerland and is lost to follow up. |
Code the residence where the student is living for exchange students temporarily living in the U.S. Code the temporary address if known or the Post Office Box if unknown. We will add this scenario to the next release of the SEER manual. |
2022 |
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20220006 | Histology/Brain and CNS: How is histology coded for a 2021 diagnosis of “neuroepithelial tumor with PATZ1-EWSR1 fusion, not elsewhere classified” found during a right thalamic mass resection? See Discussion. |
Patient has a remote history of a right thalamic mass status-post two resections; reported as malignant oligodendroglioma (pathology not received) and chemo/radiation therapy, who recently presented with persistent headaches. Imaging revealed a 3.4 cm heterogeneous lobulated right thalamic mass with coarse calcifications and a probable cystic component. Pathologist indicates the histologic and immunophenotypic features of this neoplasm are that of relatively circumscribed neuroepithelial tumor without high grade features (mitotic activity, microvascular proliferation, necrosis). Molecularly this neoplasm is characterized by a PATZ1-EWSR1 fusion, which has recently been proposed to be a distinct neuroepithelial tumor entity with a broad histological spectrum. |
Assign 8000/1. Neuroepithelial tumor with PATZ1-EWSR1 fusion, not elsewhere classified, is not recognized as a distinct entity at this time. It is not listed in ICD-O-3.2 or in the 5th edition of the WHO CNS classification. |
2022 |
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20220043 | First Course Treatment/Neoadjuvant Therapy--Melanoma: How are the three Neoadjuvant Therapy data items (Neoadjuvant Therapy, Neoadjuvant Therapy--Clinical Response, Neoadjuvant Therapy--Treatment Effect) coded when a patient is diagnosed with melanoma in the lymph nodes with no primary skin site identified? The physician gives immunotherapy as neoadjuvant therapy with planned and carried out surgical resection of involved lymph nodes following completion of immunotherapy. There is no "planned definitive surgical resection of the primary site" as no primary site was found, |
Assign code 0 to each of the three Neoadjuvant Therapy data items in this situation. We will add an example to the coding instructions for these data items in the next release of the manual. |
2022 | |
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20220005 | Reportability--Ambiguous Terminology: Can the term “at most” preceding a statement of a reportable diagnosis be used to accession a case? See Discussion. |
A January 2022 endometrium biopsy and curettage both show final diagnosis of “mild cytologic atypia and glandular crowding, at most endometrioid intraepithelial neoplasia.” Any subsequent surgery path is unlikely to provide clarification. |
Do not report the case in this scenario based on the diagnosis alone of mild cytologic atypia and glandular crowding, at most endometrioid intraepithelial neoplasia. "At most" is not an ambiguous term for reportability. It appears that "at most" in this case refers to the worst possible option within other possible options (differential diagnosis). Differential diagnoses are "educated guesses" or hypotheses and are usually not reportable unless proven otherwise. As there is no clear statement of the diagnosis in this case, we recommend that you seek additional information, for example, clinical diagnosis, treatment, and patient care. |
2022 |
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20220008 | Reportability/Histology--Soft Tissue: Is atypical spindle cell neoplasm, primitive myxoid mesenchymal tumor of infancy (PMMTI) from the soft tissue of the leg in August of 2019, reportable? |
Primitive myxoid mesenchymal tumor of infancy (PMMTI) is reportable. PMMTI is listed in the new WHO 5th edition Classification of Soft Tissue and Bone Tumors under round cell sarcomas. This is a variant of BCOR sarcomas. There is a new ICD-O histology code assigned for cases diagnosed in 2022 or later (9368/3). Code this 2019 case to round cell sarcoma, undifferentiated 8803/3. Use text fields to explain the details. |
2022 | |
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20220027 | Reportability/Heme & Lymphoid Neoplasms--CNS: Is ALK-positive histiocytosis, primary site Central Nervous System (CNS), reportable, and is the correct histology code 9750/3? See Discussion. |
2022 case: Surgical Pathology Report-spinal cord tumor, biopsies: ALK-positive neoplasm most consistent with ALK-positive histiocytosis. |
Report this 2022 case of ALK-positive histiocytosis using histology code 9751/3, Langerhans cell histiocytosis, disseminated. Use text fields to document that this is a case of ALK-positive histiocytosis. This term may be assigned a new code once the 5th edition of the Hematopoietic WHO Blue Book is released. |
2022 |
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20220017 | Histology--Thyroid: What is the correct histology code for a thyroid resection showing papillary carcinoma, tall cell variant with oncocytic features with 30% of largest tumor (right) is tall cell variant and both foci contain benign multinucleated giant cells? See Discussion. |
There is an ICD-O histology code for papillary carcinoma, tall cell (8344/3) as well as papillary carcinoma, oxyphilic cell (8342/3). Per SINQ 20150045, the term oncocytic is synonymous with oxyphilic in this context. The term “variant” can be used for the Other Sites (non-updated STR sites) primaries when the ICD-O-3.2 (or ICD-O-3 for older cases) includes the term “variant” in the histology name. The MPH General Instructions did not include the term “variant” as a term that can be used to code histology. |
Code papillary carcinoma, tall cell variant with oncocytic features to papillary carcinoma, tall cell (C73.9) (8344/3). The WHO Classification of Endocrine Organs states that this variant is composed of cells that are as tall as they are wide, and show abundant eosinophilic (oncocytic-like) cytoplasm. Tall cells must account for greater than or equal to 30% of all tumor cells. |
2022 |
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20220013 | Reportability/Histology--Kidney: What is the histology and behavior of a papillary renal neoplasm with reverse polarity? See Discussion. |
Patient had a partial nephrectomy with final diagnosis of papillary renal neoplasm with reverse polarity. Diagnosis comment states: Papillary renal neoplasm with reverse polarity is currently considered to be a histologic variant of papillary renal cell carcinoma; however, recent studies suggest that it has a very indolent clinical behavior. |
Report papillary renal neoplasm with reverse polarity as 8260/3. According to the WHO Classification of Urinary and Male Genital Tumors, 5th edition, this is a distinctive pattern of papillary renal cell carcinoma that has been recently recognized. These tumors have recurrent mutations of KRAS, differing from typical papillary renal cell carcinoma. We recommend that you include with reverse polarity in your histology text to differentiate this entity from others classified in 8260/3. |
2022 |
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20220007 | Histology: Is there any guidance on using STRATA Oncology testing (molecular tumor profiling tests), such as StrataNGS and StrataEXP, to code SSDIs, histology, etc? I do not see anything in STR, SEER Program Manual, SINQ, or CAnswerForum. We are seeing the testing with our 2021 paths. |
We recommend that you do not use information from these molecular tumor profiling tests until they become a standard diagnostic tool. If/when that happens, we will add information to the various manuals. |
2022 |