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.
First Course Treatment/Radiation Therapy: How should Lutathera be coded? CoC states XRT- Radioisotopes and SEER states Other Treatment.
Lutathera is a radioconjugate consisting of the tyrosine-containing somatostatin analog Tyr3-octreotate (TATE) conjugated with the bifunctional, macrocyclic chelating agent tetra-azacyclododecanetetra-acetic acid (DOTA) and radiolabeled with the beta-emitting radioisotope lutetium Lu 177 with potential antineoplastic activities.
Update to the current manual: Code Lutathera as radiation (isotopes NOS code 13). We will make this change in the next version of the SEER manual.
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.
Histology--Lung: Is it acceptable to code histology as 8042/3 for a 2020 lung primary when the pathology report states only "oat cell carcinoma?" See Discussion.
In the old 2007 Multiple Primaries/Histology rules, Lung Equivalent Terms and Definitions section, oat cell carcinoma (8042) was listed as one of the obsolete terms that was no longer recognized for small cell carcinoma. That note is not in the current 2018 Solid Tumor Manual lung chapter, and ICDO-3.2 lists oat cell carcinoma as the preferred term for code 8042/3. Would rule H4, Note 2 apply -- only one histology present, if not listed in Table 3 use ICD-O and all updates, to code oat cell carcinoma as 8042/3?
While oat cell carcinoma is an outdated term, if that is all the pathology report states, code histology as 8042/3.
Yes, Rule H4 applies: the diagnosis was a single histology. H4 instructs you to refer to the solid tumor H table, and if the term is not found there, check ICD-O and ICD-O updates. All possible histologic types that could occur in the lung may not be included in the table.
Histology/Behavior--GI Tract: What is the difference between high grade dysplasia and severe dysplasia for tumors in the cervix and gastrointestinal (GI) tract? Are these terms synonymous with in situ/behavior code /2? See Discussion.
In the WHO Classification of Female Genital Tumors, 5th edition, for the uterine cervix squamous intraepithelial lesions, there is related terminology for high grade squamous intraepithelial lesion HSIL (CIN3) 8077/2 and it is severe squamous dysplasia; squamous cell in situ. However, in the online WHO Classification of Digestive System Tumors, 5th edition, there is no related terminology for esophageal high-grade squamous dysplasia, 8077/2. Can you collect cases of severe dysplasia the same as cases of high grade dysplasia?
According to a leading GI pathologist, severe dysplasia is equivalent to high grade dysplasia in the GI tract.
Surgery of Primary Site--Melanoma: How is Surgery of Primary Site coded when a path specimen is labeled as a “staged excision” for a cutaneous melanoma. See Discussion.
Patient was diagnosed on biopsy with lentigo maligna melanoma of the nasal dorsum. The only available documentation of the subsequent surgery is a single pathology report with the nasal dorsum “staged excision (debulking specimen)” and four additional “staged excision” specimens of the same site.
Is it safe to assume this is a Mohs surgery? Would it be safe to assume staged excisions of sites other than skin of face, are also Mohs surgery?
Interpret a "staged excision" for cutaneous melanoma as a type of Mohs surgery.
Skin surgery codes are currently under review and revision. Document details in available text fields.
First Course Treatment--Lymphoma: Is the first round of systemic therapy coded as first course of therapy or is it all the therapy given to achieve remission for a lymphoma case with multiple treatments? See Discussion.
Lymphoma case diagnosed in 2021: The patient had first round of systemic therapy as documented in the treatment plan and a post-chemotherapy PET scan that showed residual disease. The patient then had a different combination of systemic therapy and still had some residual disease. The patient was given a third round of different combination of systemic therapy in preparation for stem cell transplant. According to the physician post-stem cell transplant note, the patient achieved complete remission.
Is the first course of therapy the first round of systemic therapy only or is it all the therapy given to achieve remission? It seems like only the first round of systemic therapy is first course of therapy for both leukemia and lymphoma in the hematopoietic manual. I thought all treatment for all hematopoietic cases was first course until remission achieved or progression was evident.
Code all treatments the patient received as first course of treatment. For lymphoma and leukemia, first course of treatment may include first-line, second-line, consolidation, maintenance, salvage, etc., any treatment to achieve remission.
We have added this to the agenda for the 2024 updates to the Hematopoietic Manual and Database.
Tumor Size/Neoadjuvant Treatment: If a patient discontinues neoadjuvant therapy and then has surgery, how is the pathologic tumor size coded with the pathologic tumor size greater than the clinical tumor size? Currently, we are instructed to code 999 for the pathologic tumor size when neoadjuvant therapy is given; what happens when neoadjuvant chemotherapy is discontinued after 3 cycles (plan for 4 cycles)?
Assign 999 for pathologic tumor size when patient has received neoadjuvant therapy, even when neo-adjuvant therapy is not completed. Describe the details in text fields.
Reportability/Histology--Anal Canal: For cases diagnosed in 2021, is anal intraepithelial neoplasia (AIN) II reportable? There is conflicting information regarding the reportability for AIN II. SINQ 20210048 says to report AIN II but the 2021 SEER Manual Appendix E states intraepithelial neoplasia (8077/2 and 8148/2) must be unequivocally stated as grade III to be reportable.
AIN II is reportable for 2021. Squamous intraepithelial neoplasia, grade II is listed in ICD-O-3.2 as 8077/2 making it reportable for cases diagnosed in 2021. AIN is a type of squamous intraepithelial neoplasia.
The wording in Appendix E of the 2021 SEER manual (must be unequivocally stated as grade III to be reportable) was left over from earlier versions and is not correct for 2021 diagnoses. Follow the guidance in SINQ 20210048.
Solid Tumor Rules/Histology--Parotid: How is histology coded for a myoepithelial carcinoma ex-pleomorphic adenoma of the parotid?
Patient has a 2021 left parotidectomy showing myoepithelial carcinoma ex-pleomorphic adenoma. Is this coded to myoepithelial carcinoma (8982/3) or carcinoma ex-pleomorphic adenoma (8941/3)? It is unclear how to arrive at the correct histology code using the current Solid Tumor Rules.
Code myoepithelial carcinoma ex pleomorphic adenoma as carcinoma ex pleomorphic adenoma (CXPA) (8941/3) using Head and Neck Solid Tumor Rule H1 as this is a single histology. The WHO Classification of Head and Neck Tumors, 5th ed., describes CXPA as a rare epithelial and/or myoepithelial malignance arising in association with a primary or recurrent pleomorphic adenoma. The histologic type of the carcinoma component is usually recorded, in this case, myoepithelial carcinoma.