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20091032 | Surgery of Primary Site--Ovary: How should this field be coded for an ovarian primary when there is a BSO and only the fundus of uterus is removed (not a full hysterectomy)? | Assign surgery code 52 [Bilateral (salpingo-) oophorectomy; WITH hysterectomy]. Code 52 does not exclude a partial hysterectomy. | 2009 | |
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20091043 | Multiple primaries--Lymphoma: Should a second primary lymphoma be accessioned if the reporting hospital disagrees with the final diagnosis stated on a review of slides? See Discussion. |
Example: Patient had an original diagnosis of small lymphocytic lymphoma (9670/3) of lung in 1986 and later presents with small B-cell non-Hodgkin lymphoma (9670/3) of small bowel in 2008 at Hospital A. Slides sent for review at Hospital B where patient was also seen. Slides there read as low grade B-cell lymphoma most consistent with extranodal marginal B-cell lymphoma of mucosal associated tissue (MALT Lymphoma). Hospital A's pathology report stated that immunostains would exclude mantle cell lymphoma and MALT lymphoma and the original pathology report has not been amended to match the outside path diagnosis. Is this a second primary of MALT lymphoma (9699)? |
For cases diagnosed prior to 1/1/2010:The 2008 diagnosis is not a new primary according to the Definitions of Single and Subsequent Primaries for Hematologic Malignancies (the tri-fold heme table) using the pathology report diagnosis from the facility where the procedure was performed (Hospital A). Since Hospital A disagreed with the slide review and did not amend their diagnosis based on the slide review, do not use the slide review diagnosis in this case. 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. |
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20091041 | CS Lymph Nodes--Ovary: Are positive lymph nodes removed from "colon tissue" during a modified posterior pelvic debulking regional or distant? If regional, what is the appropriate CS LN code? |
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.Pericolonic lymph nodes are "regional" lymph nodes for an ovarian primary. If you do not have enough information to assign codes 12-30, assign code 50 [Regional lymph nodes, NOS]. |
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20091113 | MP/H Rules/Histology--Breast: How is histology coded when a nipple biopsy shows Paget disease but the mastectomy specimen shows only infiltrating ductal carcinoma in the breast tissue and the nipple is negative for Paget disease? See Discussion. | Biopsy of nipple showed Paget disease. Subsequent mastectomy showed two tumors proven to be infiltrating ductal carcinoma. Nipple is negative. Per MP/H rule M9, this is all counted as a single primary. Do we code histology from the most representative specimen and lose the information about the Paget disease? | For cases diagnosed 2007 or later, code the histology 8541/3 [Paget disease and infiltrating duct carcinoma]. Paget disease of the nipple and infiltrating duct are separate tumors. For each tumor, take the histology from the most representative specimen. The biopsy is the most representative specimen for the Paget disease. The mastectomy is the most representative specimen for the infiltrating duct. According to the multiple primary rules, tumors that are Paget disease and duct are a single primary (M9). According to the histology rules, assign code 8541/3 (H26). | 2009 |
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20091059 | CS Tumor Size--Breast: How is this field coded for DCIS that is present in scattered small foci over five of eight slides, and the greatest aggregate dimension measures 0.5 cm? See Discussion. | Breast biopsy was prompted by abnormality seen on mammography. Would this be an example of when to code 996 (mammographic/xerographic diagnosis only, no size given; clinically not palpable) applies for the CS Tumor Size field? | 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 code 005 [0.5 cm] in this case. According to the General Instructions for CS tumor size, it is acceptable to code an aggregate size stated by the pathologist (see instruction 4.i). |
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20091014 | MP/H Rules/Histology--Melanoma: Please clarify what we should code when we see the term 'spitz or spitzoid' in association with melanomas. See Discussion. |
Path reports often diagnose "melanoma with spitzoid features." There is no code for this in ICD-O-3. Would it be melanoma NOS with a specific type for MP/H rule H9 (with features of...), or would we stop at H3? Could the matrix principle apply, changing 8770/0 (one of the synonyms is Spitz nevus) to 8770/3 (although no Spitz synonyms are specifically listed under this code)? What if the path report says "melanoma arising in a Spitz nevus"? |
For cases diagnosed 2007 - 2020 Assign code 8720/3 [Malignant melanoma] for melanoma with Spitzoid features, Spitzoid variant of nevoid melanoma, melanoma arising in Spitz nevus, or Spitzoid melanoma. The WHO Classification of Tumors groups these with Nevoid melanomas and codes them to 8720/3. According to WHO, "Nevoid melanoma is a subtype of malignant melanoma of the skin that is distinctive in that the primary lesion mimics many of the architectural features of a common compound or intradermal nevus ... or a Spitz nevus... These lesions are defined not as atypical nevi, but as melanomas because they involve the dermis and have the potential for metastasis." |
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20091058 | MP/H Rules/Histology--Kidney: How is histology coded when it is described in the pathology report as "Histologic type: Clear cell (conventional) renal cell carcinoma. Percent of sarcomatoid component: 10%"? See Discussion. | MP/H rules for kidney, Table 1 lists both clear cell and sarcomatoid as specific types of renal cell carcinoma. The MP/H terms and definitions for kidney state that clear cell is architecturally diverse. For this case, does the sarcomatoid component represent a subtype of clear cell that has not been assigned an ICD-O code, and thus histology should be coded to 8310? Or does the sarcomatoid component represent a specific type of renal cell carcinoma for which rule H6 would apply? Should histology be coded 8255 for this case? | For cases diagnosed 2007 or later, assign code 8310 [clear cell adenocarcinoma] according to rule H5. Renal cell, clear cell and sarcomatoid are mentioned in the diagnosis. Sarcomatoid is referred to as a component. Component is not one of the terms listed in rule H5 that indicate a more specific type. Ignore sarcomatoid in this case. Use table 1 to identify clear cell as a specific renal cell type. Code the specific type (clear cell) according to rule H5. | 2009 |
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20091111 | Grade--Breast: How is this field coded for an "invasive ductal carcinoma, well differentiated, low nuclear grade"? | Assign code 1 [Grade 1, well differentiated]. Use the table in the 2007 SEER Manual on page C-607. Both "low grade" and "well differentiated" are coded 1 in the grade field. | 2009 | |
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20091130 | MP/H Rules/Histology--Breast: What is the correct histology code and MP/H rule used for 1) infiltrating ductal carcinoma, mucinous type and 2) infiltrating ductal carcinoma with features of tubular carcinoma? See Discussion. |
There is confusion as to which rule applies. Should the histologies be coded to 8480/3 [mucinous adenocarcinoma] and 8211/3 [tubular adenocarcinoma] respectively per rule H12? Rule H12 states to code the most specific histologic term; "type" and "with features of" are used in the pathologic diagnosis and are both terms that can be used to code the specific histology. Or would the histology be coded 8523 for both examples per rule H17 because neither histologic codes 8480/3 or 8211/3 are included as examples of duct carcinomas, nor are they included in Table 2? |
For cases diagnosed 2007 or later, code 8523 [infiltrating duct mixed with other types of carcinoma] for
1. Infiltrating ductal carcinoma, mucinous type and 2. Infiltrating ductal carcinoma with features of tubular carcinoma
The infiltrating ductal types in Rule H12 are listed (8022, 8035, 8501-8508) and do not include mucinous or tubular. We cannot use this rule. The first rule that applies to these single tumors is H17, code to 8523. If you look up 8523 in the numerical morphology section of ICD-O-3, you will see similar examples included in the definition of this code. |
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20091066 | Multiplicity Counter--Lung: How is this field coded when there is no evidence of the primary tumor? See Discussion. | Patient presented with large mediastinal mass. CT showed no intraparenchymal lung tumor. Biopsy of mediastinal mass revealed adenocarcinoma consistent with lung primary. | Code Multiplicity Counter to code 99 [Unknown]. | 2009 |
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