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.
MP/H Rules/Histology--Breast: Which report and diagnosis should be used to code the histology if an excisional biopsy that removes the majority of the tumor has a diagnosis of "carcinoma," and the subsequent lumpectomy diagnosis is "microscopic residual disease consistent with infiltrating duct carcinoma"?
For cases diagnosed 2007 or later, code histology for this case to 8010 [carcinoma]. The histology is coded from the pathology report with the most representative specimen (the most tumor tissue) even when the most representative specimen has a less specific histology.
MP/H Rules/Histology--Colon: When the microscopic description indicates a colon tumor is "tubulovillous," but the final diagnosis only states "adenocarcinoma," is the histology coded to 8263/3 [adenocarcinoma in a tubulovillous adenoma]?
For cases diagnosed 2007 or later:
Yes. This is an example of a site-specific exception to the general rule to code only from the final diagnosis. The Colon Histology Rules specifically state that "other parts of the pathology report" may be used to identify a tumor arising from a polyp, adenomatous polyp, villous adenoma, or tubulovillous adenoma.
Radiation Therapy: How is radiation coded when it is "recommended" but the patient dies before radiation is started? See Discussion.
Code 0 seems appropriate but then we would lose the fact that it had been recommended. All of the other modalities give an option for 'recommended but patient died prior to treatment.' Is there a reason this option is not given for radiation?
Code Radiation (Rx Summ--Radiation) to 0 [None; diagnosed at autopsy].
SEER does not collect the Reason For No Radiation field. However, those who abstract using software that captures this data item can identify these cases. Code 5 [radiation not administered because patient died] reflects this situation.
Radiation (Rx Summ-Radiation) is a SEER field. This field is derived from the data collected in Rad-Boost Rx Modality and Rad-Regional TX Modality. These fields do not include a choice for "radiation not given because the patient died prior to treatment." Therefore, this information cannot be coded in the Radiation field.
MP/H Rules/Multiple Primaries: When the pathology report from a FNA or other biopsy states an "in situ" carcinoma and the patient waits more than 60 days for a more definitive procedure which documents an "invasive" carcinoma, is this reported as two primaries?
For cases diagnosed 2007 or later:
No. When the invasive component is discovered as part of the work-up phase leading to treatment decisions, the case should not be abstracted as a multiple primary. In the rare instance when a patient has not been treated and is still having diagnostic work-up greater than 60 days after the malignancy is diagnosed, do not count the invasive diagnosis as a new primary.
Reportability--Hematopoietic, NOS: If the bone marrow biopsy diagnosis is not reportable and cytogenetics studies indicate no clonal abnormality, is a case reportable if only the flow cytometry results show a "small monoclonal B-lymphocyte population consistent with a lymphoid component of a lymphoplasmacytic lymphoma or Waldenstrom macroglobulinemia"? See Discussion.
Bone marrow bx final diagnosis: Markedly hypercellular marrow consisting primarily of erythroid hyperplasia and, also, diffusely distributed small lymphocytes. Addendum comment: Flow cytometry demonstrated a small monoclonal B-lymphocyte population consistent with a lymphoid component of a lymphoplasmacytic lymphoma or Waldenstrom's Macroglobulinemia. Addendum comment: Cytogenetic analysis states no clonal abnormality was apparent. Normal female karyotype.
Question 1: Is this case reportable, and if so, what histology?
Question 2: Is there a hierarchy when flow cytometry and cytogenetics are done, but do not agree?
For cases diagnosed prior to 1/1/2010:This case is not reportable at this point. A lymphoid component is not equivalent to a diagnosis of a reportable disease. In order to be a malignant, reportable disease, the condition must be monoclonal and irreversible. Cytogenetics were negative for malignancy (i.e. no monoclonal abnormality identified which is the criteria used to establish this diagnosis). Use all information available when determining reportability.
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.
Histology--CLL/SLL: What is the correct histology code for a lymph node described in the pathology report comment section as "phenotypically consistent with chronic lymphocytic leukemia"? See Discussion.
Current rules instruct us to select the lymphoma code for lymph node and/or tissue with the dual diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma. We have a cervical lymph node biopsy with that dual diagnosis, however, the pathology comment states that after immunohistochemistry testing, the lymph node is "phenotypically consistent with chronic lymphocytic leukemia." No bone marrow or blood work-up is performed.
For cases diagnosed prior to 1/1/2010:Code Small Lymphocytic Lymphoma. The current rules have not changed. Code to lymphoma because the diagnosis was made on a lymph node.
"Phenotypically consistent" means the lymph node contains CLL/SLL, not some other hematopoietic or metastatic disease.
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.
CS Lymph Nodes--Melanoma: If the primary site is coded to C449 because no primary skin lesion is identified for a melanoma case, are any positive lymph nodes assumed to be regional?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code the CS Lymph Nodes field to 80 [Lymph Nodes, NOS].
Although it is in the CS LN field, use the code for Lymph Nodes, NOT OTHERWISE SPECIFIED when you don't know whether the nodes are regional or distant. There are separate codes to use when you definitely know that the nodes are regional.
CS Extension--Prostate: Can the phrase "hard, fixed prostate" be interpreted as clinical extracapsular extension and coded to 50 [extension or fixation to other structures]? See Discussion.
Patient had a "hard, fixed prostate" with needle core bx positive for Gleason grade 4+5=9 adenocarcinoma extensively involving gland. PSA was 87.5. Lymphadenectomy showed 3 positive pelvic/obturator lymph nodes. No prostatectomy was done and no physician TNM staging documented.
Do we need a specific clinical description of other organs to which the prostate is fixed in order to code CS Clinical Extension 50, or does the statement "hard, fixed prostate" qualify? If not, how would we code extension for this seemingly advanced cancer?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Assign extension code 50 [extension or fixation to adjacent structures] based on the term "fixed." Fixation to a particular structure(s) does not have to be specified in order to use code 50.
Do not use the statement "hard" to determine CS extension.
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