Report | Question ID | Question | Discussion | Answer | Year |
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20220001 | Solid Tumor Rules (2022)/Histology--Bladder: Can the term configuration be used to code the more specific histology for bladder primaries diagnosed 2022 and later? See Discussion. |
In the September 2021 Urinary Sites Solid Tumor Rules update, the term configuration was removed from the “DO NOT CODE histology when described as” list. However, it was not added as a term that can be used to code the more specific histology for urinary tumors. Can configuration be used to code the more specific histology 8130 (papillary urothelial carcinoma) when the diagnosis is urothelial carcinoma, tumor configuration: papillary? |
Beginning with cases diagnosed 1/1/2022, the term "configuration" can be used to code histology for urinary sites only. At the request of the AJCC urinary experts, the instructions were changed to allow configuration to be used to code histology. |
2022 |
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20220021 | Solid Tumor Rules/Multiple Primaries--Brain and CNS: How many primaries are accessioned, and what M Rule applies, for a 2012 diagnosis of left cerebral transitional meningioma (9537/0) that transforms to an atypical meningioma (9539/1) in 2022? See Discussion. |
The patient underwent a resection of the transitional meningioma in 2012, but residual tumor was left behind. The patient was on surveillance until imaging showed growth of the residual tumor. The resection in 2022 proved atypical meningioma. Rule M2, the first rule that applies, indicates this situation represents a single primary (a single tumor). However, Rule M4 states the transformation from a benign meningioma to a borderline meningioma would only be a single primary if the meningioma was a NOS. This patient has microscopic confirmation of a meningioma showing different subtypes/variants (listed in Column 3, Table 6). Should this be accessioned as multiple primaries based on the transformation and distinctly different histologies? |
Non-malignant CNS rule M4 applies, this is a single primary. This scenerio is covered in Example 2: A meningioma 9530/0 transforms into an atypical meningioma 9539/1. |
2022 |
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20220009 | First Course Therapy/Reason for No Surgery of Primary Site: What code should be used for Reason for No Surgery of Primary Site in 2020 in situations affected by the pandemic when abstracting all sites? See Discussion. |
Example: Patient scheduled for left nephrectomy on 3/10/20 due to left renal papillary renal cell carcinoma diagnosed on 2/11/20 via needle core biopsy. Abstract indicated surgery was cancelled due to the pandemic. Abstract also indicated the surgery was not rescheduled. |
There is no available code that fits this situation. We recommend assigning code 6 (Surgery of the primary site was not performed; it was recommended by the patient’s physician, but was not performed as part of the first course of therapy. No reason was noted in patient record.) and documenting the situation in a text field. |
2022 |
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20220032 | Reportability/Histology--Testis: Is micropapillary serous borderline tumor reportable? Pathology states Testis (C621) radical orchiectomy: Micropapillary serous borderline tumor. |
We consulted an expert genitourinary pathologist who advises that micropapillary serous borderline tumor of the testis is reportable. He states "it is the same neoplasm as in the ovary. It arises from tissue (tunica vaginalis) surrounding the testis so is a paratesticular neoplasm." Please note: not all borderline tumors are reportable and this diagnosis is an exception because it is assigned /2 in ICD-O-3.2. It is reportable for cases diagnosed Jan 1, 2021 and later. |
2022 | |
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20220002 | Solid Tumor Rules (2018, 2021)/Histology--Cervix: For cases diagnosed 1/1/2022 and later, how is histology coded for the following three cervix cases relating to p16? See Discussion. |
The 2022 SEER Manual indicates the p16 status (positive or negative) can be used to code more the specific histology for squamous cell carcinoma, human papilloma virus (HPV) positive (8085) and squamous cell carcinoma, HPV negative (8086). However, the histology coding instructions in the Other Sites schema have not been updated and the 2022 SEER Manual does not cover all situations commonly encountered in the registry. Does the clarification regarding p16 apply to these other situations?
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For cases diagnosed beginning 1/1/2022, assign histology based on new codes and terms for the examples of cervical cancer using the available p16 results as follows. 1. Adenocarcinoma, HPV-independent, NOS (C53._) (8484/3) 2. Carcinoma, squamous cell, HPV-associated (C53._) (8085/3) 3. Carcinoma, squamous cell, HPV-independent (C53._) (8086/3) The 2022 SEER Manual states: Beginning with cases diagnosed 01/01/2022 forward, p16 test results can be used to code squamous cell carcinoma, HPV positive (8085) and squamous cell carcinoma, HPV negative (8086). Use the available results as the rules for Other Sites have not been updated yet. The SSDI Manual data item p16 for Cervix schema also states that p16 is based on testing results and not a physician statement. We can address these situations in a future version of the Solid Tumor Rules. The Other Sites rules will provide document priority when coding hsitology: biopsy vs. resection, cytology vs. histology, primary site vs. mets or regional site. |
2022 |
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20220036 | Solid Tumors Rules/Histology--Head and Neck: How is histology coded for head and neck primaries when a tumor is diagnosed as an invasive squamous cell carcinoma with multiple subtypes? See Discussion. |
Example Case 1: 2022 mobile tongue tumor biopsy shows squamous cell carcinoma, basaloid non-keratinizing type. Example Case 2: 2022 base of tongue mass biopsy shows squamous cell carcinoma, basaloid non-keratinizing type, p16 positive. Table 5, Note 2 (Head and Neck Equivalent Terms and Definitions) instructs us to code non-keratinizing squamous cell carcinoma which is p16 positive to 8085 (Squamous cell carcinoma HPV-positive), ignoring the non-keratinizing subtype. Does p16 or HPV positivity also take priority over multiple subtypes (basaloid non-keratinizing type)? |
Assign 8083/3, basaloid squamous cell carcinoma (BSCC), in both examples. It is more important to capture the variant than to code 8085 or 8086. WHO Classification of Head and Neck Tumors, 5th ed., states that BSCC is a distinctive form of SCC, characterized by prominent basaloid morphology, squamous differentiation, and aggressive behavior. Some primary sites capture p16 status as a Site Specific Data Item; you may record the p16 results when that is the case. |
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 | |
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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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20220047 | Solid Tumor Rules/Multiple Primaries--Head and Neck: Is a patient with 2020 neck mass, squamous cell carcinoma (SCC), p16-negative, who then had a biopsy of the right tonsil (C09.9) in July 2022, SCC p16-positive, one or two primaries? Is this coded to 8070/3 using pre-2022 rules or a new, second primary p16-positive, 8085/3. See Discussion. |
History provided by the oncologist Right neck mass since 2019; 04/07/20, initial biopsy p16-negative SCC, delay of treatment due to patient preference, agreed to biopsy of tonsil and work-up August 2022; right tonsil biopsy: p16-positive, G2 SCC, nodal mass at that time >6 cm with extensive extranodal extension, Stage III (cT2, cN3, cM0, p16-positive); based on this history, was staged as a tonsil primary and p16-positive. Patient details 1. March 2020, CT neck and chest revealed a 0.5 x 2.7 x 2.3 cm low-density necrotic nodal mass at right neck level 2 suspicious for metastatic disease. There was a slight asymmetric increased size of the right palatine tonsil. There are a few sub-4 mm pulmonary nodules which are nonspecific. 2. April 7, 2020, FNA of right neck mass with pathology revealed p16-negative SCC 3. April 20, 2020, PET/CT revealed 3 x 2 cm right-sided level 2 node with FDG avidity 4. May 5, 2020, flexible laryngoscopy showed no obvious primary lesion 5. May 2020, after evaluation by a medical oncology, patient declined any treatment 6. June 17, 2022, return visit in medical oncology after PET/CT demonstrates significant progression in the neck; patient definitively declines chemo, but would like surgical opinion. Now has more rapidly progressive disease with skin breakdown and weeping from malignant lesion right neck. 7. June 22, 2022, radiation oncology consultation 8. July 15, 2022, tonsil biopsy: Invasive squamous cell carcinoma, moderately differentiated with LVI, p16-positive 9. Patient now agreeing to treatment with radiation: Tooth extractions 8/30/2022, radiation planning 9/14/2022 10. Patient consulted with cancer specialist who explained surgery is not recommended given level of extranodal extension and risk of seventh cranial nerve paralysis and fistula formation with surgical excision and who recommended chemoradiation 11. September 9, 2022, patient presented for radiation CT simulation/treatment planning and informs treatment team. Patient declined/refuses concurrent chemotherapy despite recommendations from two cancer institutions. |
Abstract a single primary of the tonsil. The diagnosis date is April 7, 2020. Assign 8070/3 for the histology. Metastases were found in 2020 before the primary of tonsil was determined in 2022. The oncologist information confirms this. |
2022 |
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20220012 | EOD 2018/Lymph Nodes--Corpus Uteri: Are lymph nodes found on imaging post-surgery included in Extent of Disease (EOD) Regional Nodes if surgery is already completed? See Discussion. |
11/16/20: Patient diagnosed with endometrial cancer on by MRI of the pelvis; 11.5 cm uterine mass consistent with cancer with no lymphadenopathy. 1/6/21: Patient had a total abdominal hysterectomy/bilateral salpingo-oophorectomy and pelvic lymph node dissection. Operative report stated patient had mildly enlarged bilateral pelvic nodes. Path report: Endometrioid adenocarcinoma with invasion of the serosa. Five bilateral pelvic nodes were sampled and negative. Originally, staging had patient as node negative. 1/22/21: Patient had post op imaging done that showed metastatic retroperitoneal, aortocaval, and possibly left iliac lymph nodes. Physician changed staging to include the lymph node involvement. |
EOD includes all information available within four months of diagnosis in the absence of disease progression or upon completion of surgery(ies) in first course of treatment, whichever is longer. Since the imaging was within the four-month window, and the nodes could have been positive during surgery but not assessed by the surgeon, use the information from the imaging. Assign code 600 for EOD Regional Nodes for involvement of the aortocaval and retroperitoneal nodes (para-aortic nodes), size unknown. |
2022 |