EOD-Extension--Bladder: Both papillary transitional cell ca in situ and sessile (flat) transitional cell ca in situ are diagnosed simultaneously in the bladder. We code the higher histology (8130/2). For extension, do we use the code that corresponds to the histology (01), or to the higher extension code (06)?
For cases diagnosed between 1998-2003:
Code the EOD-Extension field to 06 [sessile (flat) (solid) carcinoma in situ], the higher extension code.
Grade, Differentiation--Bone Marrow: Can we use the AJCC Cancer Staging Manual, which lists myeloma as a B cell neoplasm under non-Hodgkin lymphomas, to code Grade, Differentiation field for myeloma to B-cell (code 6)?
For cases diagnosed prior to 1/1/2010:
No. Myeloma is a malignancy of plasma cells. Plasma cells are the daughters of B cells. So technically it would be correct to call them B cell, but that is not common usage.
Cell marker (phenotype) should be coded in the Grade, Differentiation field for only leukemias and lymphomas, as classified in the ICD-O-3. In the ICD-O-3, myeloma is listed under Plasma Cell Tumors, not Lymphomas. When a cell marker is coded for a leukemia/lymphoma it should be coded only from pathology and/or cytology reports.
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.
Histology (Pre-2007): What code is used to represent the histology "adenocarcinoma, undifferentiated, with sarcomatoid features"? See discussion.
Is the case more accurately coded with histology of adenosarcoma [8933/34] or adenocarcinoma, undifferentiated [8140/34]? Should "sarcomatoid" be interpreted as sarcoma?
For tumors diagnosed prior to 2007:
Code the Histology field to 8140/34 [adenocarcinoma, undifferentiated]. Sarcomatoid means sarcoma-like and should not be used in coding histology.
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.
Grade, Differentiation--All Sites: What code is used to represent this field when there are invasive and in situ components in a tumor, but only the in situ component is graded (e.g., Invasive ductal carcinoma with high grade ductal carcinoma in situ)?
Code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable]. The grade is taken from the invasive component only.
Grade, Differentiation--All Sites: Should we take the grade from a TNM staging form over a grade stated in a pathology report when the grade mentioned on the TNM staging form is a higher grade (e.g., Pathology report diagnosis is moderately differentiated adenocarcinoma, Gleason's 3+3=6, but the physician checked "poorly differentiated" on the TNM form)?
Code the Grade, Differentiation field to 2 [moderatley differentiated]. Code from the pathology report over the TNM staging form. If you do not have access to the path report, use the grade from the TNM form.
Scope of Regional Lymph Node Surgery/EOD-Number of Regional Nodes Examined: What codes is used to represent these fields when the surgeon states that a "lymph node dissection" was done, but no nodes are identified in the pathology report?
For cases diagnosed 1/1/2003 and after: Code the Scope of Regional Lymph Node Surgery field to 3 [Number of regional lymph nodes removed unknown or not stated; regional lymph nodes removed, NOS] and code the EOD-Number of Regional Nodes Examined field to 00 [No nodes examined].
The surgery fields reflect the procedures the physician performed. The EOD fields reflect the results of those procedures.
Terminology/EOD-Clinical Extension--Prostate: Is "firm" a term that implies clinically apparent prostate disease? See discussion.
PE: Prostate firm on DRE
IMP: Rule out prostate cancer
For cases diagnosed between 1998-2003:
Code the EOD-Clinical Extension field to clinically inapparent. The clinically apparent term list classifies "firm" as "maybe" being involved. If a maybe term such as "firm" is the only description available, code as clinically inapparent.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Prostate: Radical prostatectomy reveals two distinct tumors. One is "adenocarcinoma with ductal differentiation" and the other is "adenocarcinoma with acinar differentiation." What code is used to represent the histology and how many primaries does the patient have?
For tumors diagnosed 2001-2006:
This is one primary. Code the Histology field to 8255/3 [adenocarcinoma with mixed subtypes] based on rule A of the Coding Complex Morphologic Diagnoses. This is code was added in the ICD-O-3.
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-Extension--Pancreas: How do you code extension when a mass is described on exploratory laparotomy as compressing the duodenum, arising in the head of the pancreas, "extending around" the superior mesenteric vein and artery, and "encasing" the portahepatis?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 40 [extension to peripancreatic tissue, NOS]. Neither of the terms "extending around" nor "encasing" are interpreted as involvement with tumor by SEER.
Terminology/Terms of involvement: When the terms "lytic" or "lysis" are used in an imaging study, are they to be interpreted as synonymous with metastasis, or can these terms be used to describe a non-malignant condition?
Although the term "lytic lesion" is often used to describe bone lesions and "tumor lysis" develops in response to systemic therapy, the words are not a part of the SEER list of terms used to describe involvement. Do not code distant metastasis based only on these words.
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