EOD-Extension--Meninges: How do you code extension for a malignant meningioma that invades into the adjacent brain tissue?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 60. Code 60 is defined as a brain tumor that extends into the meninges. It is also the appropriate code to use for a tumor that extends from the meninges to the brain.
Grade, Differentiation--All Sites: Why was the decision made not to code all "3-component differentiation systems" the same way that Bloom-Richardson is coded? For example, SEER codes a low grade BR to 1 for the Differentiation field and a low grade for other grading systems to 2. See discussion.
Our Pathologist Consultant agrees with SEER's guideline to code the Bloom-Richardson and B&R modifications of low, intermediate and high to 1, 2 and 3 respectively and thinks all 3-component systems should be coded that same way because it better represents the differentiation of the tumor. In his opinion, coding all other 3-component systems to a differentiation of 2, 3 and 4 respectively, is overstating the degree of differentiation.
The rules for coding histology are approved and used by all of the major standard setters through agreements reached in the NAACCR Uniform Data Standards Committee. This issue is under review by our medical advisors and a special committee. Changes will be taken to the Uniform Data Standards Committee for review and approval.
EOD-Extension--Lymphoma: How do you code stage and EOD for an extranodal lymphoma with bilateral involvement of a paired site? See discussion.
For example, we frequently see cases of lymphoma occurring in bilateral orbits, or both lungs. This issue was discussed at a 1991 SEER meeting with the tentative answer being that lymphoma involving both organs of a paired site will be coded as stage I (e.g., both eyes or both lungs), as this would be contiguous disease. However, an extranodal lymphoma involving tissue of both limbs (e.g., soft tissue of both arms) will be coded as stage IV because this represents wide areas of involvement that have no connection.
For cases diagnosed 1998-2003:
Bilateral involvement of an extralymphatic paired organ is coded as involvement of a single extralymphatic organ or site for lymphomas. The EOD extension code would be at least 11 (Stage IE). Staging lymphomas of any site depends on whether one or more lymph node regions and/or extralymphatic organs are involved, and whether sites on one or both sides of the diaphragm are involved.
Histology (Pre-2007)--Breast: What code is used to represent the histology "infiltrating lobular carcinoma, solid and classical subtypes"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8520 [Lobular carcinoma].
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.
Histology/Grade, Differentiation--Lymphoma/Leukemia: Do you agree with coding a diagnosis of Nasal NK/T cell lymphoma to 9719/38?
For cases diagnosed prior to 1/1/2010:Yes. Code the Grade, Differentiation field to 8 [NK cell] rather than 5 [T-cell]. Code the Histologic Type to 9719/38 [NK/T-cell lymphoma, nasal and nasal-type with Cell indicator of NK (8)].
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.
EOD-Extension--Head & Neck (Tonsil): How should the EOD-Extension field be coded for bilateral tonsil involvement? See discussion.
Tonsillectomy and bilateral radical neck dissections were done. The path diagnosis was left and right tonsils: squamous cell carcinoma, bilateral tonsils with negative inked surgical margins of resection. Physical exam and operative findings did not mention any extension beyond the tonsils.
We originally coded the EOD-Extension field to 30 for a bilateral tonsil primary. The case failed the SEER Edit IF41 (Primary Site/Lat/EOD). According to that edit, if laterality is 4 then the EOD-Extension field must not be 00 through 30.
We recoded the EOD-Extension field to 99 in order to comply with the SEER edit.
For cases diagnosed 1998-2003:
Code EOD extension as 30 [Localized, NOS] and laterality as 4 [Bilateral involvement]. The next update to the SEER edits will allow this combination.
Histology (Pre-2007)/Terminology: Are "pattern", "architecture", and "architectural pattern" terms that indicate a majority of tumor?
For tumors diagnosed 2004 to 2006:
The terminology "Architectural pattern: ____________," when used in the final pathology diagnosis, indicates a subtype that can be coded. This type of format in a pathology report is based on a College of American Pathologists (CAP) protocol. Disregard "pattern" and "architecture" when not used in accordance with the CAP protocol. See www.cap.org for cancer protocols.
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.
Primary Site: What code is used to represent the primary site for a "teratocarcinoma with features of embryonal carcinoma" removed from the thigh muscle in a patient with x-ray negative testicles? See discussion.
The case was reviewed by AFIP and called "extratesticular." Per our pathology consultant, the site should be coded to unknown because it is very doubtful that the tumor was primary in the soft tissue of the thigh. According to him, such tumors don't originate exclusively in the testes, but tend to occur along the central axis such as the mediastinum or retroperitoneum. If an extratesticular tumor arises in either of these areas, the primary site should be code to the mediastinum or the peritoneum rather than to unknown. Lesions primary in the testicle may also undergo maturation with fibrosis and involution. This process often leaves little evidence of the original tumor in the testis.
Code the Primary Site field to C809 [unknown] for this case. The thigh tumor is a metastatic site.
Surgery of Primary Site--Breast: Does the presence of axillary lymph node(s) in a "simple mastectomy" specimen impact the coding of the Surgery of Primary Site field for breast primaries?
Yes. Determine whether there is, in fact, at least a portion of axillary tissue present. If axillary lymph nodes (not internal mammary nodes) are present in the specimen, code the Surgery of Primary Site field to 51 [Modified Radical Mastectomy WITHOUT removal of uninvolved contralateral breast]. If there are no axillary lymph nodes present in the specimen, code the Surgery to Primary Site field to 41 [Total (simple) mastectomy WITHOUT removal of uninvolved contralateral breast].
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