Tumor Tip of the Week 04-07-2023 Meningioma - Omega Healthcare

Tumor Tip of the Week 04-07-2023 Meningioma

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Scenario #1: *Software updated to v23

  • 04-01-2023 CT Head: There is a tiny 4 mm enhancing lesion that appears to be dural based inferior lateral left frontal lobe most likely a small meningioma. Recommend follow-up perhaps in 12 months.
  • 04-18-2023 Physician recommend Active Surveillance, patient agrees.

Various Fields to consider:

Field Answer Rationale
Primary Site C700 Solid Tumor Rules Non-malignant CNS Table 3: Reportability of Non-Malignant Cranial Nerve (CN) Tumors Note 2: Neoplasms, commonly meningiomas, arising in the dura/meninges of an intracranial nerve are coded to cerebral meninges C700
Laterality 2 SEER Program Coding and Staging Manual 2023 Laterality Pages 98-100 Laterality describes the side of a paired organ or side of the body on which the reportable tumor originated Sites for Which Laterality Codes Must Be Recorded= C700 Cerebral meninges, NOS (Effective with cases diagnosed 01/01/2004) STORE 2023 Laterality page 52, page 131  
Lymphovascular Invasion 8 SEER Program Coding and Staging Manual 2023 Lymphovascular Invasion pages 136-136 Use code 8 For non-malignant brain (intracranial) and CNS tumors STORE 2023 Lymphovascular Invasion page 145
Grade Clinical 1 Grade Coding Instructions and Tables Version 3.0 Grade ID 24-Grade Clinical Instructions Note 6: CNS WHO classifications use a grading scheme that is a “malignancy scale” ranging across a wide variety of neoplasms rather than a strict histologic grading system that can be applied equally to all tumor types. Code the WHO grading system for selected tumors of the CNS as noted in the AJCC 8th edition Table 72.2 when WHO grade is not documented in the record A list of the histologies that have a default grade can also be found in the Brain/Spinal Cord CAP Protocol in Table 1: WHO Grading System for Some of the More Common Tumors of the CNS, Table 2: WHO Grading System for Diffuse Infiltrating Astrocytomas and Table 3: WHO Grading Meningioma https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocoltemplates For benign tumors ONLY (behavior 0), code 1 can be automatically assigned for all histologies. This was confirmed by the CAP Cancer Committee
Grade Pathological 9 Grade Coding Instructions and Tables Version 3.0 Grade ID 24-Grade Pathological Instructions Note 7: Code 9 (unknown) when: No resection of the primary site (see exception in Note 6, Surgical resection, last bullet)
Date of First Course of Treatment (CoC) 04-18-2023 STORE 2023 Page 209 “If active surveillance or watchful waiting is selected as the first course of treatment (RX Summ– Treatment Status [1285] = 2) record the date this decision is made.”

Scenario #2: Diagnosed 2023

  • Operative Report: Left frontal craniotomy for resection of tumor-We inspected the remainder of the cavity for any evidence of residual tumor of which none was found. 
  • Path Report: Left brain excision-Left frontal lobe, 4.2cm Meningioma, meningothelial type, WHO G1,

Question: What is the primary site?

  • C711 Frontal Lobe
  • C700 Cerebral Meninges

Answer: C700 Cerebral Meninges


SEER Inquiry System – Question 20021031

  • Code the Primary Site field to C70.0 [cerebral meninges], the suggested site code for most meningiomas. Meningiomas arise from the meninges, not the brain (although they can invade brain). ICD-O-3 does not differentiate the specific location of the brain that the meninges cover https://seer.cancer.gov/seer-inquiry/inquiry-detail/20021031/

Scenario #3: Diagnosed 2023

  • 2 separate meningiomas occurring midline of the brain (Primary site C700 Laterality 5) and the other in the right temporal region (Primary site C700 Laterality 1)

Question: How many primaries?

Answer: Single


2023 Solid Tumor Rules Non-Malignant CNS

  • Multiple cerebral meningiomas (same histology or NOS and subtype/variant) are a single primary.
  • Laterality is not used to determine multiple primaries.
  • Timing is not used to determine multiple primaries.

Scenario #4: Diagnosed 2023

  • MRI Brain: shows a 4mm mass along right frontal lobe consistent with meningioma. [primary site C700 Cerebral Meninges]
  • Spinal MRI shows 5mm mass at C4-5 level consistent with meningioma [primary site C701 Spinal Meninges]

Question:  How many primaries?

Answer: Multiple


2023 Solid Tumor Rules Non-Malignant CNS

  • Rule M7 Abstract multiple primariesii when multiple tumors are present in any of the following sites:
  • Cerebral meninges C700 AND spinal meninges C701

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