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Report Produced: 04/03/2025 22:21 PM

Report Question ID Question Discussion Answer Year
20021151

Reportability: A "gastrointestinal stromal tumor" (GIST) is not always stated to be "malignant" in the path report even though the tumor appears to meet criteria for malignancy. Is the tumor SEER reportable? See discussion.

Evaluation of Malignancy and Prognosis of Gastrointestinal Stromal Tumors: A Review. Miettinen, M. et al, Human Pathology 2002 May; 33(5) 478-83). This article states there is an increasing number of GISTs because the majority of tumors previously diagnosed as gastrointestinal smooth muscle tumors (leiomyomas, leiomyoblastomas and leiomyosarcomas) are now classified as GISTs. It states that gastrointestinal autonomic nerve tumors (GANTs) are also GISTs based on their KIT positivity and presence of KIT-activating mutations. This article also states that a GIST is probably malignant if it meets the following criteria: 1) Intestinal tumors: Maximum diameter >5 cm or more than 5 mitoses per 50 HPFs. 2) Gastric tumors: Maximum diameter >10 cm or more than 5 mitoses per 50 HPFs.

Some of the path reports that meet these criteria use the word "malignant", and others do not. Some of the cases that are not called "malignant" in the path diagnosis are signed out clinically as "malignant."

The case is reportable if a pathologist or clinician confirms a diagnosis of cancer. If there is no such confirmation, the case is not SEER reportable.

 2002
20021197 Scope of Regional Lymph Node Surgery--Breast: How should this field be coded when a mastectomy that removed 3 sentinel lymph nodes is later followed by an axillary lymph node dissection that removed 17 lymph nodes? Should all of the lymph node information be coded to this field, even though the Number of Regional Lymph Nodes Examined field will be coded to the number of lymph nodes from the most definitive surgery (17)?

For cases diagnosed 1/1/2003 and after: Yes, all of the lymph node information should be coded to the Scope of Regional Lymph Node Surgery field using code 7 [Sentinel node biopsy and code 3, 4, or 5 at different times].

The Number of Regional Lymph Nodes Examined field no longer exists for this time frame.

 2002
20021022 Histology (Pre-2007): What code is used to represent the histology "non oat cell carcinoma"?

For tumors diagnosed 2001-2006:

Code the Histology field to 8046/3 [non-small cell carcinoma] if the pathologist does not provide a more specific histologic type. "Non oat cell" is a synonym for "non-small cell."

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2002
20021036 EOD-Extension--Urinary Tract: Can the rules used to code bladder extension involving the term "no involvement of muscularis/and no mention of subepithelium/submuscosa" be used to code extension for other urinary tract primaries, such as ureter?

For cases diagnosed 1998-2003:

No. The inferred descriptions of noninvasion apply to bladder cases only.

 2002
20021185 Surgery of Primary Site--Major salivary gland: How do you code Surgery of Primary Site for a submandibular gland primary when the operative report refers only to an excision of the submandibular "tumor" while the pathology report states the submandibular "gland" was removed? See discussion. The gross description on the pathology report indicates that the specimen consists of a "submandibular gland." A further description on the pathology report included, "the specimen was sectioned exposing a focally cystic mass that nearly replaces the entire specimen." For cases diagnosed on 1/1/2003 or after: Code the Surgery of Primary Site field to 40 [Total parotidectomy, NOS; total removal of major salivary gland, NOS], per the pathology report's gross description of the specimen unless the operative report description of procedure indicates that the removal was less than total. 2002
20021061 Multiple Primaries/Histology--Mycosis Fungoides/Cutaneous T cell Lymphoma: Physicians often use the terms cutaneous T cell lymphoma (CTCL) and mycosis fungoides interchangeably and yet the SEER Single versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table indicates that these 2 diagnoses represent separate primaries. Do these cases represent one primary? If so, what histologic type should they be coded to?

For cases diagnosed prior to 1/1/2010:The patient does not have two different malignancies. Code the Histology field to 9700/3 [mycosis fungoides], the specific type of cutaneous T cell lymphoma. Mycosis fungoides is one of several types of cutaneous T cell lymphoma. Physicians often refer to mycosis fungoides by the "umbrella term" cutaneous T cell lymphoma.

The table indicates that the broad category of "T/NK-cell NHL" (which includes CTCL) and mycosis fungoides are presumably separate primaries because several entities are included in that broad category. In the specific case cited above, one entity (CTCL) within the broad category (T/NK-cell NHL) and mycosis fungoides are not separate primaries.

For cases diagnosed 2010 forward, 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.

 2002
20020052 EOD-Extension--Lung: How do you code extension for a lung tumor described on bronchoscopy as "obstructing the RUL and intruding into the right bronchus intermedius. Small tumor nodules distally in midline of anterior trachea wall"?

For cases diagnosed 1998-2003:

Code the EOD-Extension field to 85 [Metastasis] because the tumor nodules are discontinuous from the primary tumor.

 2002
20021011 Reportability/Histology (Pre-2007)/Behavior Code/Primary Site: How would you code these fields for a case in which an infant presents with a skin rash, enlarged spleen, palpable abdominal mass, inconclusive bone marrow biopsy and a skin biopsy that was positive for "Langerhans cell histiocytosis"? See discussion. The pathologist states, "I would consider this case a malignancy, although it does not always behave as such. Lesions in babies often act in a malignant manner."

For tumors diagnosed prior to 2007:

If the pathologist states this is a malignancy, the case is reportable. Code the Histology field to 9751/3 [Langerhans cell histiocytosis, NOS] and change the Behavior Code from 1 to 3. Code the Primary Site field to skin [C44._].

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2002
20021016 Histology (Pre-2007)/Behavior Code: What code is used to represent the histology "foci of well differentiated intramucosal carcinoma [carcinoma in situ] arising on the surface of a tubular adenoma"? The pathologist referred to this colon biopsy as "in situ".

For tumors diagnosed prior to 2007:

Assign histology code 8210 [adenocarcinoma in a tubular adenoma] and behavior code 2 [in situ]. "In situ" is specified by the pathologist.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2002
20021122 Histology (Pre-2007)--Breast: For a path diagnosis of ductal carcinoma in situ, cribriform type with apocrine features, does the term "apocrine" modify the term cribriform or does it represent another type of ductal carcinoma in situ? See discussion. It can be difficult to determine if two terms mentioned in a pathology report are describing different aspects of the same morphology or if the two terms are describing two different morphologies.

For tumors diagnosed prior to 2007:

Code the Histology field to 8401/2 [Apocrine carcinoma in situ]. According to our pathologist consultant "Because apocrine is the more unusual tumor, and pulling it out of the cribriform category keeps the latter a little cleaner (because most cribriform ductal carcinoma in situ is not particularly apocrine), I am inclined to code to the histology to apocrine ductal carcinoma in situ."

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2002