MP/H Rules/Histology--Rectum: When not specifically mentioned as part of the histology, is the adenoma a second histologic type, or just a further physical description of the tumor? See Discussion.
Rectal tumor resection (APR) path report final dx: "mucinous carcinoma, see comment". The comment is the CAP-format tumor summary, which states "histologic type: adenocarcinoma with extensive mucin production (mucinous or colloid carcinoma). Additional pathologic findings: adenomas - tumor arises in a tubulovillous adenoma".
If you follow the rules and only use the final dx, you would code a different histology than if you use the 'additional path findings.'
For cases diagnosed 2007 or later
Other Sites histology rule H12 applies in this case. Assign histology code 8263 [adenocarcinoma in tubulovillous adenoma].
Use information from the CAP protocol and from comments associated with the final diagnosis to code histology.
The fact that the malignancy arose in a polyp can be taken from anywhere in the medical record; not limited to the final diagnosis.
Based on the information provided for this case, the histology is adenocarcinoma with extensive mucin production (mucinous or colloid carcinoma) arising in a tubulovillous adenoma.
MPH Rules/Behavior--Breast: Would a positive right axillary node following DCIS of the right breast indicate the presence of a new primary? See Discussion.
How would you abstract the information from 2007? A patient with a strong family history of breast cancer had bilateral simple mastectomies in 2000, after a suspicious mammogram. Results showed DCIS in the rt breast; no malignancy in the left breast. Now in 2007, the patient has a right axillary lymph node removed - positive for carcinoma of breast origin. Comment says, "recurrent breast carcinoma in rt axillary node from patient's known history of DCIS." Is this a new primary? Is this a diagnosis date in 2007? Is the site C509 and laterality right side?
For cases diagnosed 2007 or later:
A metastasis was diagnosed in 2007. The 2007 MP/H rules do not apply to metastases.
Change the behavior code of the 2000 diagnosis. The breast cancer diagnosed in 2000 must have been invasive based on the metastasis in 2007.
MP/H Rules/Histology--Colon: How do you use Rule H5 or H6 to code "moderately diff adenoca with mucinous component"?
For cases diagnosed 2007 or later, code the histology 8140 [Adenocarcinoma]. Rule H6 applies because the final diagnosis is not "mucinous adenocarcinoma" and the percentage of mucinous adenocarcinoma is not stated.
Rule H13 does not apply because "component" is not a term that indicates a specific histology.
Computed Ethnicity: Should the Name--Alias field be used when generating Computed Ethnicity?
No, "Alias" is not used and should not be used to generate Computed Ethnicity. Computed Ethnicity records the ethnicity based on last name and/or maiden name using a computer algorithm. Alias is not part of the algorithm.
Race, ethnicity/Spanish surname or origin: If birthplace is Brazil or Portugal, patient's last name is on the Spanish Surname list, and there is no text to further clarify ethnicity, what is the correct Spanish Ethnicity code: 0 or 7? See Discussion.
See also SINQ 20081075.
Assign code 7 [Spanish surname only] when the last name is on the Spanish Surname list. This includes cases for which the birthplace is Brazil, Portugal or the Philippines and there is no text to further clarify ethnicity.
The instruction to use code 0 [Non-Spanish/Non-Hispanic] in the SEER manual on page 51 (#2) applies when the only information available is the birthplace or a statement of "Portuguese," "Brazilian" or "Filipino."
CS Lymph Nodes--Breast: Now that code 50 [fixed/matted ipsilateral axillary LNS, NOS] is obsolete, how is this field coded for a case in which there are clinically matted lymph nodes, no neoadjuvant therapy, and no lymph node size on the available pathology report?
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.From the American College of Surgeons: The pathologic information always takes precedence over the clinical information when there is no neoadjuvant therapy. The size reference is that this is not ITC or micromets. Clinically, I don't think you can have fixed or matted nodes that aren't greater than micromets. This would be coded to 52. The mapping for all of these codes is not taken from this, but from the value of SSF3 per the note at the bottom of the table. See CS Lymph Nodes note 2.
CS Extension: How is CS Ext coded for the following?
Rretroperitoneal primary
Cystic mucinous tumor with intraepithelial carcinoma
There is no CS Extension code for intraepithelial ca in the retroperitoneal scheme.
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.According to the American College of Surgeons I & R system, assign code 10 [confined to site of origin] for intraepithelial carcinoma of the retroperitoneum.
MP/H Rules: Does the presence of metastases affect the application of the MP/H rules? See Discussion.
Single lung tumors presenting in each lung but the patient also presents with bone mets? Would rule M6 apply? Or do the bone mets represent additional tumors?
For cases diagnosed 2007 or later, the MP/H rules do not apply to metastases. Ignore metastases when applying the rules.
For the case above, use rule M6 and abstract as two primaries (right lung and left lung). The bone mets are ignored.
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