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20021202 | Primary Site--Head & Neck (Middle ear): How do you code site for a skull based tumor consistent with a low grade papillary adenocarcinoma of "endolymphatic sac origin"? | Code Primary Site to C30.1 [Middle ear]. The endolymphatic sac is part of the inner ear labyrinth located with in the petrous portion of the temporal bone. | 2002 | |
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20021112 | Multiple Primaries/Histology--Hematopoietic, NOS: The subsequent primary table for 2001 and later indicates that 9863/3 [acute myelogenous leukemia (AML)] followed by 9980/3 [refractory anemia (RAEB)] is a new primary, but 9989/3 [myelodysplastic syndrome, NOS (MDS)] is not. Is the case below two primaries? See discussion. | Bone marrow bx states: The morphologic blast count of 7% exceeds 5%, traditionally used to define relapse in the setting of acute leukemia. Given the clinical hx that the pt's peripheral blood counts had initially normalized after induction therapy, the recent fall in counts is worrisome for the possibility of early relapse. Alternatively, therapy may have simply reverted the pt's marrow from AML to a precursor myelodysplastic syndrome (such as RAEB given the blast count) from which the AML arose, with the falling counts being progression of the underlying MDS. The identification of significant dysplasia in the bone marrow at the time of diagnosis would tend to support the possibility of an underlying MDS. Clinically, it is unlikely to make a difference whether one regards the present situation as early relapse or progression of an underlying MDS. The final clinical diagnosis is "Myelodysplasia, classified as RAEB." | For cases diagnosed prior to 1/1/2010: This case demonstrates a relapse of AML. The original classification of Histology as 9863/3 [AML] is correct. There is no second primary based on the information provided for this case. For cases diagnosed 2010 forward, 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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20021151 | Reportability: A "gastrointestinal stromal tumor" (GIST) is not always stated to be "malignant" in the path report even though the tumor appears to meet criteria for malignancy. Is the tumor SEER reportable? See discussion. |
Evaluation of Malignancy and Prognosis of Gastrointestinal Stromal Tumors: A Review. Miettinen, M. et al, Human Pathology 2002 May; 33(5) 478-83). This article states there is an increasing number of GISTs because the majority of tumors previously diagnosed as gastrointestinal smooth muscle tumors (leiomyomas, leiomyoblastomas and leiomyosarcomas) are now classified as GISTs. It states that gastrointestinal autonomic nerve tumors (GANTs) are also GISTs based on their KIT positivity and presence of KIT-activating mutations. This article also states that a GIST is probably malignant if it meets the following criteria: 1) Intestinal tumors: Maximum diameter >5 cm or more than 5 mitoses per 50 HPFs. 2) Gastric tumors: Maximum diameter >10 cm or more than 5 mitoses per 50 HPFs. Some of the path reports that meet these criteria use the word "malignant", and others do not. Some of the cases that are not called "malignant" in the path diagnosis are signed out clinically as "malignant." |
The case is reportable if a pathologist or clinician confirms a diagnosis of cancer. If there is no such confirmation, the case is not SEER reportable. |
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20021010 | Histology (Pre-2007): What code is used to represent the histology adenocarcinoma with "areas of" papillary architecture and "foci of" squamous differentiation? Even though "areas of" and "foci" are non-majority terms, should histology be coded to the combination code of adenocarcinoma with mixed subtypes [8255/3]? |
For tumors diagnosed prior to 2007: Code the Histology field to the majority of the tumor, which is 8140/3 [adenocarcinoma, NOS]. The terms "areas of" and "foci of" should be ignored because they are not terms that reflect the majority of the tumor. Therefore, we cannot use rule A on page 2 of Coding Complex Morphologic Diagnoses because this diagnosis does not represent a complex morphology. For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules. |
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20021137 | Multiple Primaries (Pre-2007)--Soft Tissue: Does SEER agree that one primary of the soft tissues of pelvis [C49.5] should be reported when a pathologic diagnosis for bilateral herniorrhaphies is "right and left inguinal hernias with low grade spindle cell sarcoma"? | For tumors diagnosed prior to 2007:
Yes. This is one primary and should be coded to C49.5 [Connective, subcutaneous and other soft tissue of pelvis]. According to Rule A in ICD-O-3, the type of tumor ("sarcoma") indicates origin from a particular tissue, resulting in the primary site code of C49.5 [Inguinal region, NOS] for this sarcoma.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules. |
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20021129 | Histology/Date of Diagnosis--Hematopoietic, NOS: What code is used to represent histology for a June 2001 diagnosis of "myelodysplastic syndrome" followed by a September 2001 bone marrow biopsy diagnosis of "myelodysplasia evolving into an acute leukemic state"? | For cases diagnosed prior to 1/1/2010: Code the Histology field to 9989/3 [myelodysplastic syndrome] and the Date of Diagnosis field to June 2001. For cases diagnosed 2010 forward, 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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20021165 | EOD-Size of Primary Tumor--All Sites: Is there a hierarchy for using information from clinical tests (scans, radiography) to determine clinical tumor size? When the size on a radiographic report prior to pathologic diagnosis is smaller than the size of the tumor on the radiographic report that is post pathologic diagnosis, which tumor size should be used? See discussion. | Which size should be used for these examples? 1) Tumor size on a mammogram is smaller than the tumor size on an ultrasound. 2) CT of the lung reveals a 2.5 cm RUL malignancy in June. A biopsy in July confirms a malignancy. A CT is done in August prior to initiating RT which reveals a 3.1 cm RUL nodule. |
For cases diagnosed 1998-2003:
Generally, code the EOD-Size of Primary Tumor field to the largest size identified in any scan. Use the largest tumor size for most cases. There is no hierarchy for multiple imaging studies, with the exception of the two situations represented in the question examples. 1). Code the size stated on the mammogram, even if that size is smaller than the one specified on the ultrasound. Generally the mammogram size is more accurate for breast cases than ultrasound. 2). Code the EOD-Size of Primary Tumor field to 2.5 cm. In this example, the second scan was the same type as the first. Usually there is not that much of a difference in size between the same tests, unless the tumor has an aggressive histology. The example does not mention the histology. With certain histologies, such as small cell of the lung, a rapid growth in a short amount of time is the normal process. The fact that the size increased that much in a short period of time, using the same type of scan, is an indication of a rapidly growing tumor. It would be better to use the size on the initial scan to code the EOD-Size of Primary Tumor. |
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20021018 | First Course Treatment--Prostate: How do you code "watchful waiting" in these fields for prostate primaries? | For cases diagnosed 1/1/2003 and later: When "watchful waiting" is the first course of therapy for prostate cancer, code the case as follows:
Date Therapy Initiated: 000000 Surgery of Primary Site: 00 Scope of Regional Lymph Node Surgery: 0 Surgical Procedure of Other Site: 0 Reason for No Cancer-Directed Surgery: 1 Radiation: 0 Chemotherapy: 00 Hormone Therapy: 00 Immunotherapy: 00 Hematologic Transplant and Endocrine Procedures: 00 Other Cancer Directed Therapy: 0 |
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20021166 | EOD-Extension--Kidney: If a "tumor thrombus" in a renal vein is discontinuous from the primary tumor in the kidney, is it still coded to 60 [Tumor thrombus in a renal vein, NOS], rather than 85 [Metastasis]? | For cases diagnosed 1998-2003:
Code the EOD-Extension field to 60 [Tumor thrombus in a renal vein, NOS]. A thrombus can be a bolus of tumor cells within a large vein that may or may not still be connected/contiguous with the primary tumor. However, both a discontinuous and contiguous thrombus are coded to 60. |
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20021168 | Histology (Pre-2007)--Corpus Uteri: What code is used to represent the histology "endometrioid carcinoma with squamous differentiation" for an endometrium primary? | For cases diagnosed 2004-2006:
Endometrioid adenocarcinoma with squamous differentiation is coded 8570 [Adenocarcinoma with squamous metaplasia].
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules. |
2002 |
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