Primary Site: How do you code the primary site when the tumor is identified in a bladder that was reconstructed using a stomach augmentation procedure and the pathology report states, "Bladder/prostate: adenocarcinoma arising within gastric mucosa, with the following features: highly infiltrative through the bladder wall"?
Code the Primary Site field to bladder [C67.9]. Code the location of the tumor as the primary site.
EOD-Lymph Nodes: If chemotherapy or radiation is given prior to the excision of an involved lymph node, should the size of the metastasis within the lymph node be coded from the subsequent surgical pathology report? See discussion.
For several sites, the size of the metastasis in an involved lymph node is integrated into the EOD-Lymph Node field. Should the size of the metastasis mentioned on the pathology report be ignored if the patient received radiation or chemotherapy prior to having the lymph node removed?
For cases diagnosed 1998-2003:
Record the size of a lymph node metastasis described in the pathology report for cases that had pre-surgical treatment. However, if both the pre-treatment and post-treatment size of the lymph node metastases are available, use the larger size when coding the EOD-Lymph Node field.
EOD Fields--Lymphoma: Was MALT Lymphoma [9715/3 (ICD-O-2) and 9699/3 (ICD-O-3)] inadvertently excluded from SEER EOD manual, top of page 180?
For cases diagnosed 1998-2003:
Yes. Use the scheme on page 180 for MALT lymphoma. The ICD-O-2 morphology code 9715 was omitted in error. It should have been added when the EOD was printed in 1998.
EOD-Pathologic Extension--Prostate: Does capsular invasion (code 32) take priority over apex extension (code 34) on prostate primaries? See discussion.
On prostatectomy, adenocarcinoma involves left apex and also left mid lobe where it focally invades capsule. Do we code extension to 34 - the highest numerical code, or to 32 to capture the capsular invasion? Do codes 33 and 34 represent a subset of code 31, and would code 32 represent greater tumor involvement?
For cases diagnosed 1998-2003:
Code the EOD-Pathologic Extension field to 32 [Invasion into (but not beyond)prostatic capsule] when there is both capsular and apex invasion of the prostate.
Although numerically lower, code 32 takes precedence over codes 33 [arising in the apex] and 34 [extending to the apex]. Codes 33 and 34 are "subsets" of code 31 [Into prostatic apex/arising in prostatic apex].
Grade, Differentiation--Prostate: Has SEER officially changed the conversion code for Gleason score 7 to poorly differentiated [grade 3]?
For cases diagnosed prior to 2003, there has been no change in SEER standards for converting a Gleason score to a grade. As described in the SEER Program Code Manual, Gleason score 7 is converted to moderately differentiated [grade 2]. ONLY if the pathology report lists moderately poorly differentiated IN ADDITION to the Gleason's score 7, would you code the case as 3.
For cases diagnosed in 2003 and later, please see question number 20031123.
Reportability/Diagnostic Confirmation--Melanoma: Would a shave biopsy diagnosis of "highly suggestive of early melanoma", followed by a re-excision diagnosis of "no residual disease", be SEER reportable if the clinician referred to the case clinically as a melanoma? If so, what would the Diagnostic Confirmation be? See discussion.
Pathology report from a shave biopsy states: "...markedly atypical junctional melanocytic proliferation. Changes highly suggestive of early melanoma arising adjacent to superficial congenital nevus." The re-excision pathology report states "biopsy proven melanoma" in the "Clinical History" section of the report (which is a reference to the original shave biopsy). The re-excision final pathology diagnosis states "no evidence of melanoma." The physician states that he thinks this is a melanoma. Should it be reported? Should Diagnostic Confirmation be coded to 1 or 8?
The case is reportable because the physician documented a clinical diagnosis of malignant melanoma. Code the Diagnostic Confirmation field to 8 [Clinical diagnosis only (other than 5, 6 or 7)].
EOD-Size of Primary Tumor--Corpus Uteri: If both the width and depth of the tumor are provided, do we code the largest dimension in the tumor size field? If the width dimension is not provided, can we code the depth of the tumor in the tumor size field? See discussion.
Example: An endometrial primary is described as having, "a soft lobulated tumor diffusely involving the entire endometrium, extending 2.0 cm into the myometrium."
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 999 [unknown] for this case because this field is supposed to reflect the dimension for tumor width and not tumor depth. Tumor depth is coded in the EOD-Extension field.
Spanish Surname or Origin: If Asians, Blacks and Whites with non-Spanish surnames are born in a Spanish country, is this field coded to Spanish or non-Spanish? See discussion.
For example, how do we code Miyako Mitsubishi with race listed as Japanese who was born in Peru or Sylvia Shapiro with race listed as White who was born in Argentina?
For both cases, code the Spanish Surname or Origin field to 0 [Non-Spanish/Non-Hispanic]. Persons with non-Spanish surnames would not be coded as being Spanish solely because they are born in a Spanish country. Do not code Spanish ethnicity based only on birthplace. Place of birth is a separate data item and it can be used in data analysis to identify this particular group of people.
Histology (Pre-2007): What code is used to represent the histology "adenocarcinoma with a mucinous focus"? See discussion.
Could 8480/3 [mucinous adenocarcinoma] be used to code histology?
For tumors diagnosed prior to 2007:
Code the Histology field to 8140/3 [adenocarcinoma, NOS]. "Focus" does not indicate the majority of tumor per rule C2 on page 2 of the Coding Complex Morph Dx's. The tumor must be at least 50% mucinous, mucin producing, or signet ring to be coded to the specific histology.
We code to the more specific term if there are no qualifying or modifying terms such as: focally, focus, predominantly. If any qualifying words are used, the C1 rule applies, which is to code to the majority of tumor.
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.
EOD-Size of Primary Tumor: Should the code 001 in tumor size be used for tumors described as having "focal" involvement? See discussion.
Is tumor size coded to 001 for the following examples:
Example 1: Focal adenoca in left lobe on prostatectomy.
Example 2: Multifocal ductal carcinoma of breast on mastectomy.
Example 1 and 2: There is insufficient information in the examples to determine whether EOD-Size of Primary Tumor should be coded to 001.
The instructions are that code 001 is used for a microscopic focus or foci of tumor only. That means that the tumor is small enough that it could not be seen by the naked eye, nor would it be palpable. Be careful with the term "focal" because it is most often used to describe tumor cells grouped or concentrated in one area as in example 1. There is no implication that this focus was microscopic only. Was it mentioned in the gross or macroscopic portion of the pathology report? If so, it is not coded to 001. Was it palpable? If so, it is not coded to 001.
Example 2 cites a multifocal breast cancer. Again, did the pathologist visualize the cancer (was it reported on the gross or macroscopic portion of the pathology?) If so, do not use code 001. Was the lesion palpable? If so, do not use code 001.
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