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Report Produced: 11/06/2024 10:23 AM

Report Question ID Question Discussion Answer Year
20071012 Reportability--Melanoma: Is a skin excision final diagnosis of "melanocytic tumor with uncertain malignant potential" reportable if the path COMMENT states the initial shave biopsy diagnosis was "melanocytic tumor with uncertain malignant potential [minimal deviation melanoma]"? See Discussion.

SKIN, RIGHT FOOT, EXCISION: CHRONIC SCARIFICATION WITH RESIDUAL ATYPICAL MELANOCYTES IN THE DERMIS IDENTIFIED, BUT COMPLETELY EXCISED.

Comment: The prior outside biopsy report indicates that the lesion was a melanocytic tumor of uncertain malignant potential (minimal deviation melanoma) measuring at least 2.5 mm in depth. There was apparently no in situ component. Special stains performed here are similar, with positive reactivity for Melan A and S-100. The cells are atypical, but there are reactive changes, making it impossible to accurately assess the true nature of the lesion in this biopsy. If this is a minimal deviation melanoma, it would be classified as a T3 (T3a since there is no description in the outside report of ulceration) lesion. The atypical melanocytes extend to a depth of 1.1 mm in this 2 mm deep biopsy, but are completely excised, both at the deep margin and at all of the peripheral margins (closest margin is superior, with clearance of 7 mm).

PATH FROM INITIAL BIOPSY: Diagnosis: Rt dorsal foot, shave biopsy: Melanocytic tumor of uncertain malignant potential (see comment). Tumor depth at least 2.5mm Deep margin involved. Comment: As a primary lesion, I would favor that this represents a melanocytic tumor with indeterminate biologic potential also known as minimal deviation melanoma. The lesion does extend to the deep margin and wider excision is recommended.

 This case is not reportable. Based on the information provided, there is no definitive diagnosis of malignancy. 2007
20071016 MP/H Rules/Multiple Primaries--Bladder: The new multiple primary rule M7 states that tumors diagnosed more than three years apart are multiple primaries. Does this apply to in situ bladder tumors that occur more than three years apart and to an in situ tumor that occurs three years after an invasive tumor?

For cases diagnosed 2007 or later, use the MP/H rules in order. Rule M6 comes before rule M7.

M6 states that bladder tumors with certain histologies are a single primary. It is a single primary regardless of timing if there is any combination of:

  • papillary carcinoma [8050]

  • transitional cell carcinoma [8120-8124]

  • papillary transitional cell carcinoma [8130-8131]

    • Rule M7 applies to bladder tumors with histologies other than those listed above. If you have such a case, rule M7 applies to in-situ tumors and to an in situ three years after an invasive.

    		 2007
    		20071065 MP/H Rules/Multiplicity Counter--Lung: If metastatic tumors are not counted in this field, should the multiplicity counter be coded to 01 for a case with a primary left lower lobe of lung tumor with a satellite tumor in the left upper lobe?

    For cases diagnosed 2007-2013:

    No, code multiplicity counter to 02 [two tumors present]. According to the multiple primary rules, these two lung tumors are reported as a single primary. Record the number of tumors reported as a single primary in Multiplicity Counter.

    Multiplicity Counter no longer required by SEER as of 1/1/2013.

    		 2007
    		20071125 Radiation Therapy--Prostate: Is the regional treatment modality XRT best coded to 50 (brachytherapy, NOS), 53 (LDR) or 54 (HDR) when the documentation indicates only "I-125 seeds" to the prostate? Assign code 53 [Brachytherapy, interstitial, LDR] for seeds to the prostate. Seeds are always low dose because they are left in place and the radioactivity decays over time. 2007
    		20071028 MP/H Rules--Lung: Why the term "nodule" is not included as an equivalent term along with tumor, mass, lesion and neoplasm in the 2007 lung multiple primary rules?

    Answer revised July 2008

    For cases diagnosed 2007 or later:

    For the purpose of applying the Lung MP/H rules, the word "Nodule" can be used interchageably with "Tumor," "Mass," "Lesion" and "Neoplasm." HOWEVER, this does NOT apply to casefinding or staging.

    This revision will be added to the next version of the MP/H rules. Sinq question 20071028 will be revised.

    		 2007
    		20071039 Histology--Hematopoietic, NOS: If an initial bone marrow diagnosis is "...more compatible with CMML/MPD" and within three months the final diagnosis per the oncologist is "MPD/CMML with acute myeloid leukemia transformation," is histology coded to CMML or AML? See Discussion.

    09/06 BM Bx elsewhere was "compatible with MDS but more compatible with CMML/MPD" per MD notes.

    10/06 BM Bx "...poor prognosis MDS, best classified as RAEB-2"

    11/06 BM Bx "myeloproliferative CMML with leukemic transformation"

    (on evaluation for BMT)

    12/12/06 Pt was admitted with rapidly progressive disease & was started on chemo to try to get into remission for BMT. Final dx by oncologist is "MPD/CMML with acute myeloid leukemia transformation".

    For cases diagnosed prior to 1/1/2010:Code CMML for this case. Code the histology at initial diagnosis. This patient had rapid progression, but the initial diagnosis was "more compatible with CMML/MPD."

    For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

    		 2007
    		20071117 MP/H Rules/Histology--Brain: How many primaries are reported and what is the histology for a single brain tumor described as a low grade astrocytoma at the time of the initial partial resection and a low grade glioneuronal neoplasm at the time of the subsequent total resection? See Discussion. On 4/20/07 a partial resection of a brain tumor is interpreted as low grade astrocytoma. Patient has a gross total resection on 8/13/07 with this diagnosis: low grade glioneuronal neoplasm (see comment). Comment: This case has been reviewed at ---. Dr. agrees with our interpretation (low grade glioneuronal neoplasm, possibly a dysembryoplastic neuroepithelial tumor).

    For cases diagnosed 2007 or later, this is a single primary. A single tumor is always a single primary.

    Assign histology code 9400/3 [Astrocytoma, low grade]. This diagnosis was not revised or amended based on the later surgery. It is possible that the malignant component was entirely removed during the first surgery.

    		 2007
    		20071079 MP/H Rules/Recurrence--Breast: Do we use a pathologists comment of "recurrent ductal carcinoma" found in the pathology report for a new specimen to determine whether the new specimen actually represents a new primary or recurrent disease? See Discussion.

    The patient had a left breast cancer LIQ, ductal with DCIS. Nodes (-) diagnosed in 1998

    Treatment: Lumpectomy-clear margins

    Refused radiation

    Hormone therapy: Tamoxifen

    Present: June 2007

    Left breast-invasive ductal ca, UOQ

    Pathology report comments: Recurrent ductal ca.

    Left axillary nodes (+)

    For cases diagnosed 2007 or later, apply the 2007 MP/H breast rules. Go to the multiple tumors module and begin with rule M4. Stop at rule M5: tumors diagnosed more than 5 years apart are multiple primaries.

    The only time you can accept a pathologist's statement of recurrence is when the statement is made based on a review of the slides from the previous diagnosis compared to the slides from the current diagnosis.

    		 2007
    		20071080 First Course Treatment--Liver: Given that agents can be used that are not chemotherapy drugs, how should treatment be coded for a procedure called a "chemoembolization" when the agent used is not documented? This issue was discussed among the national standard setters and per the SEER website this issue has been resolved as follows: When "chemoembolization" is done but the agents used are not chemotherapy drugs, then treatment should be coded as "Other Therapy." See http://seer.cancer.gov/tools/codingmanuals/embolization.html 2007
    		20071100 Type of Multiple Tumors--Colon: How is this field coded for a case in which the patient is found to have two in situ polyps and an adenocarcinoma arising in a polyp all in the same segment of the colon? See Discussion. Code 30 would not count the fact that these are polyps. Code 31 states "AND a frank adenocarcinoma." What would be the correct code? Assign code 30 [In situ and invasive] in this case. Code 31 does not apply here because frank adenocarcinoma is not present. 2007