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Report Produced: 01/11/2025 15:41 PM

Report Question ID Question Discussion Answer Year
20220037

Histology--Brain and CNS: What is the histology code of a primary papillary epithelial tumor of the sella (PPETS)?  See Discussion.

The pathology report states this is a rare entity described in case reports and not incorporated into the WHO classification of tumors. A subsequent endocrinology note stated “papillary tumor, benign by path; tumor was not an adenoma; based on one Mayo study, the recurrence risk is low.”

Assign code 8000/0.  This is an emerging histology and not yet recognized by the World Health Organization. Document the details in text fields. It might also be useful to document this SINQ question in text.

 2022
20220038

Solid Tumor Rules/Histology--Thyroid:  What is the histology code for sclerosing mucoepidermoid carcinoma with eosinophilla in the left thyroid and papillary thyroid carcinoma in the right thyroid?  See Discussion.

The left thyroid lobectomy/isthmusectomy returned a diagnosis of sclerosing mucoepidermoid carcinoma with eosinophina, 6.5 cm, replacing nearly the entire left lobe of the thyroid.

The patient has a completion thyroidectomy of the right lobe and returned the diagnosis of papillary thyroid carcinoma, 0.5 mm, in maximum dimension.

The endocrinologist describes it as "co-exsisting" and states the tumor is iodine non-avid.

Abstract two primaries and assign code 8260/3 (papillary adenocarcinoma, NOS) to the right thyroid using Solid Tumor Rules, Other Sites, Rule H14, and 8430/3 (mucoepidermoid carcinoma) to the left thyroid as these are separate tumors with different histology types according to WHO Classification of Tumors of Endocrine Organs, 4th edition.

 2022
20220024

Update to Current Manual/Residence at diagnosis:  Would an exchange student be a temporary resident of the SEER area or a non-resident?  See Discussion.

A 17 year old exchange student was brought into the hospital with appendicitis.  The patient had an appendectomy; there was no follow up treatment.  5/27/2006 pathology report of vermiform appendix:  Adenocarcinoid appendix <5 mm tumor limited to appendix.

The patient has no record in Lexis Nexus and no social security number.  The address is a post office box; additionally, the patient’s birthplace is Switzerland and is lost to follow up.

Code the residence where the student is living for exchange students temporarily living in the U.S.  Code the temporary address if known or the Post Office Box if unknown.  We will add this scenario to the next release of the SEER manual.

 2022
20220028

Reportability/EOD--Ovary:  Bilateral ovary shows gonadoblastoma with germ cell neoplasia in situ (9064/2). Pathology report clearly states in situ. Is this case reportable?

If this case is reportable, how would you code Extent of Disease (EOD) Primary Tumor and SEER Summary Stage (SS)? In situ code 000 for primary tumor and code 0 for SS 2018 is not given as an option. 

Report germ cell neoplasia in situ (9064/2). Assign 999 for EOD Primary Tumor and assign 9 for SS2018.

This particular histology is in the Soft Tissue Abdomen and Thoracic schema where EOD PT 000 and SS2018 0 are not available. This histology will be moved to the Ovary schema after redefining certain schemas and thus making the more accurate choices for EOD and SS2018 available. The schema redefine is planned for 2024 implementation.

 2022
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
20220019

Solid Tumor Rules/Histology--Thyroid:  What is the correct histology code for a papillary carcinoma, encapsulated with columnar cell features?  See Discussion.

There is an ICD-O histology code for papillary carcinoma, columnar cell (8344/3) as well as papillary carcinoma, encapsulated (8343/3). Per Rule H13, the terms “with features of” may be used to identify a subtype.

Considering these two subtypes, and knowing there is no specific histology code for this combination, is the first rule that applies H17 (code the numerically higher histology code)?

Code to papillary carcinoma, encapsulated (C73.9) (8343/3) using Solid Tumor Rules, Other Sites, Rule H11, code the histology when only one histologic type is identified.  The usage of features is describing the cellular architecture of the encapsulated papillary carcinoma and does not necessarily indicate a specific histologic type. We consulted with our endocrine specialist pathologist who agrees and indicated terminology used in thryoid neoplasms is inconsistent.

 2022
20220043

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.

 2022
20220034

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.

 2022
20220030

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.

 2022
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