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20200028 | 2018 EOD Primary Tumor/2018 EOD Mets--Lung: Is EOD Primary Tumor coded to 500 and EOD Mets 10 when there are bilateral lung nodules with nodules in same lobe as the primary tumor? How is EOD Primary Tumor coded when separate tumor nodes are in an ipsilateral lung but there is no documentation as to whether it is in the same or different ipsilateral lobe from the primary tumor? |
Assign 999 to EOD Primary Tumor if this is the only information you have for your case.The mention of nodules does not automatically mean that you have separate tumor nodules. There are many reasons for the appearance of nodules in the lung, some of which are not due to cancer. Unless you have further information on whether the physician has determined that they are related to the lung cancer, then assume that they are not related. Assign 00 to EOD Mets. Do not code EOD Mets to 10 since you cannot determine whether those nodules are based on the tumor or not. If you are able to obtain more information, then you can update the EOD Primary Tumor and EOD Mets. Regarding the second question, if separate tumor nodules are noted, you cannot assume that they are due to tumor. Further information, or clarification, is needed on whether the separate tumor nodules are related to the lung cancer. Without further information, code EOD Primary Tumor to 999. There is also some information in the CAnswer Forum since Separate Tumor Nodules are a Site-Specific Data Item: http://cancerbulletin.facs.org/forums/forum/site-specific-data-items-grade-2018/96061-lung-separate-tumor-nodules |
2020 | |
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20200041 | Reportability--Brain and CNS: Is an intradural T12/L1 capillary hemangioma reportable? See Discussion. |
Example: MRI found an intradural, extra-axial mass at T12/L1 with possible intramedullary component. Resection of the intradural intramedullary and extramedullary spinal cord tumor found a capillary hemangioma pathologically. The microscopic description on the path report describes a tumor with extensive vascularity involving the dura. Should we equate the statement of capillary to mean the tumor is arising in a blood vessel as we do for venous hemangioma (non-reportable per SINQ 20130001)? Or should it be reportable as C700, 9131/0 because it is described as involving the dura (intradural, intramedullary and extramedullary)? |
Reportability of capillary hemangioma depends on the site of origin. If it originates in the dura, it is reportable. If it originates in a blood vessel, it is not reportable. The site of origin is not clear in the information provided. Sites of involvement are mentioned, but not the site of origin. Capillary could refer to the site of origin or to the propensity of this tumor to form tiny blood vessels. If the site of origin cannot be confirmed as dura, do not report this neoplasm. |
2020 |
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20200002 | Reportability/In situ--Prostate: Has there been a change in reportability for prostatic intraepithelial neoplasia (PIN III) (C619)? The 2018 SEER Manual notes: Collection stopped effective with cases diagnosed 01/01/2001 and later; however, on the casefinding list effective 10/01/2019, code D07.5, carcinoma in situ of prostate, is listed as reportable. |
PIN III is not reportable in accordance with the 2018 SEER Manual; however, carcinoma in situ of the prostate is reportable as they represent different histology codes. The casefinding list is used to search for reportable cases and is not the same as a reportable list. |
2020 | |
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20200064 | Primary site--Heme &Lymphoid Neoplasms: What is the primary site of two extraosseous plasmacytomas, with positive pathology of right orbit and left lung. The patient's bone marrow biopsy, flow, and peripheral blood smear were negative. Is this coded as 9732/3, multiple myeloma (Primary Site and Histology Rule PH2) with the primary site as C809 (PH27)? Or is the primary site C421 since code 9732 says primary site is always C421, though bone marrow came back as negative? |
Assign the primary site to C421 since that is the only allowable primary site for plasma cell myeloma, even though the bone marrow was negative. According to the revised criteria from the WHO Blue Book for Hematopoietic and Lymphoid Neoplasms (2017), the presence of multiple plasmacytomas is plasma cell myeloma (9732/3). |
2020 | |
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20200029 | Systemic/Surgery Sequence: The note associated with code 4 in Systemic Treatment/Surgery Sequence in the 2018 SEER Manual says: Code 4 is intended for situations with at least two episodes or courses of systemic therapy. Does this mean two different types of systemic therapy before and after surgery? See Discussion. |
For example, chemotherapy and immunotherapy administered first, followed by surgery, then immunotherapy and hormone therapy after surgery. Or is code 4 used for two administrations of chemotherapy before surgery and two more courses after surgery? |
Assign code 4 for the example you describe. Code 4 also applies to cases with one course of chemotherapy before surgery and another course after surgery. |
2020 |
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20200073 | Solid Tumor Rules (2018)/Histology--Colon: Should the mixed adenoneuroendocrine carcinoma (MANEC) row in Table 1 include the still often used (yet older) terms of adenocarcinoma and carcinoid, adenocarcinoid, etc. for clarity? See Discussion. |
The Terms and Definitions Introduction discusses how these are older terms, but pathologists may still use them. In our region, pathologists do, in fact, still use these terms. Can these terms be added to Table 1? For registrars who do not reference the Introduction every time they code histology but go directly to Table 1, coding consistency would likely improve if such terms were added in the Table. This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
The next update to the Solid Tumor rules will include adding the following four terms to Colon Table 1 as synonyms for Mixed adenoneuroendocrine carcinoma 8244
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2020 |
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20200018 | Reportability: Is ASIN-H (high-grade anal squamous intraepithelial neoplasia) equivalent to anal intraepithelial neoplasia, III (AIN III)? |
High-grade anal squamous intraepithelial neoplasia (ASIN-H) is synonynous with anal intraepithelial neoplasia, grade III (AIN III). |
2020 | |
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20200034 | Solid Tumor Rules (2018)/Histology--Breast: How should histology be coded for 2020 breast lumpectomy final diagnosis of invasive ductal carcinoma? Summary Cancer Data and CAP Summary states: Invasive carcinoma with the following features: Histologic type: Tubular adenocarcinoma. See Discussion. |
Per the 2018 Solid Tumor Rules instructions, Final Diagnosis and Staging Summary (synoptic report) have equal coding priority. However, it is unclear which takes priority, or if this should be a combination of components, when the histologies are two different specific histologic types per Table 3 of the Breast Solid Tumor Rules Manual. |
In this case, the pathologist states two different histologies. Per the H rules, when there are different histologies, code the histology which comprises the majority of tumor. Use H16 and code histology stated to be more than 50% of tumor OR H17, code 8523 when percentage is not stated or unknown. |
2020 |
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20200042 | Solid Tumor Rules (2018)/Histology--Brain and CNS: How is the histology coded when the diagnosis comment for a posterior fossa tumor resection states: Taken together, these findings are indicative of medulloblastoma with extensive nodularity? See Discussion. |
Example: Posterior fossa tumor resection final diagnosis was medulloblastoma, WHO Grade IV. The diagnosis comment notes the current tumor resection reveals large irregular reticulin-free nodules with streams of neoplastic cells in a fibrillary background in association with narrow reticulin-rich internodular strands of poorly differentiated neoplastic cells. Taken together, these findings are indicative of medulloblastoma with extensive nodularity. The diagnosis comment provided only one histology. Per the 2018 Solid Tumor Manual, Malignant CNS, Priority Order for Using Documentation to Identify Histology instructions, an addendum or comment has priority over the final diagnosis. Although indicative is not listed on any ambiguous terminology list, is this an ambiguous diagnosis that must be ignored? Or does the diagnosis comment in this case provide a single, specific diagnosis of medulloblastoma with extensive nodularity? |
Code as medulloblastoma, nodular (9471/3) based on the findings from both the comment and final diagnosis. |
2020 |
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20200023 | Solid Tumor Rules (2018)/Histology--Endometrium: Is the histology for a serous carcinoma, high-grade endometrial primary 8441/3 (serous carcinoma) or 8461/3 (high grade serous carcinoma)? See Discussion. |
Path report reads: 7/15/2019 A. Endometrium, curettings: Serous carcinoma, high grade. B. Endometrial polyp, curettings: Serous carcinoma, high grade. If coded to 8461/3, according to AJCC, this would not be an ideal code (since it is outdated). Also, endometrium is not included in the suggested site codes for 8461/3 according to the 8/22/2018 ICD-O-3 update. |
Code histology for this endometrial primary to serous carcinoma 8441/3. Capture "high grade" in the grade field as instructed in the grade coding manual. "High grade serous carcinoma" has specific clinical and histopathologic features found in ovarian tumors. |
2020 |
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