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Primary Site/Histology--Lymphoma: How are these fields coded when the final diagnosis per the pathology report is, "Soft tissue and skeletal muscle, left thigh--Large B cell lymphoma with polyclonal and mature t-cells, involving the soft tissue"?
For cases diagnosed prior to 1/1/2010:Site: C492 [Soft tissue thigh]
Histology: 9680/36 [T-cell rich large B-cell lymphoma]
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 is the difference between code 8244/3 composite carcinoid (combined carcinoid and adenocarcinoma) and 8245/3 adenocarcinoid tumor?
For tumors diagnosed prior to 2007:
Assign code 8244/3 [composite carcinoid] when there is a combination of adenocarcinoma and carcinoid tumor.
Assign code 8245/3 [adenocarcinoid] when the diagnosis is exactly "adenocarcinoid."
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 (Pre-2007): What code should be assigned to acinar adenocarcinoma and ductal adenocarcinoma?
For tumors diagnosed prior to 2007:
Assign code 8255 [Adenocarcinoma with mixed subtypes]. According to histology rule #4 for a single tumor on page 86 of the 2004 SEER manual, use a combination code if one exists.
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.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: Would the simultaneously occurring histologies of "high grade ductal carcinoma in situ with micro invasion" and "keratinizing squamous cell carcinoma" be coded as two primaries or as a single primary when the pathologist is not clear whether two separate tumor masses exist?
For tumors diagnosed prior to 2007:
Code as two primaries, assuming the tumors are separate and the margins are clear/negative. Code 8071/3 [Invasive squamous cell ca, keratinizing] and 8500/3 [Ductal carcinoma, "microinvasive"].
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.
Reportability--Skin: Effective 2021, a cutaneous leiomyosarcoma is a related term for smooth muscle tumor, NOS (8897/1) in ICD-O-3.2. Currently, we have been capturing these as a C44_ (leiomyosarcoma, 8890/3) but the 2019 SEER inquiry states that atypical intradermal smooth muscle neoplasm (AISMN) was previously termed cutaneous leiomyosarcoma. This is not documented on the 2018 ICD-O-3 updates. Should this 2019 case be 8897/1 or 8890/3?
Cutaneous leiomyosarcoma is reportable for 2019. Code histology to leiomyosarcoma 8890/3.
As of cases diagnosed 1/1/2021, it is no longer reportable based on assignment to 8897/1 in ICD-O-3.2.
Multiple Primaries (Pre-2007)--Breast: Synchronous invasive right breast tumors. Ductal carcinoma, NOS in UIQ and Ductal carcinoma, tubular type in LOQ. Are these two primaries or a single primary coded to 8523/3?
For tumors diagnosed prior to 2007:
Code as two primaries, one 8500/3 [Infiltrating duct carcinoma] and one 8211/3 [Tubular carcinoma].
Apply the multiple primary rules first. These are synchronous right breast tumors with different histologies. Therefore, they are separate primaries according to rule 5.a on page 12 of the SEER Program Code Manual. ICD-O-3 histology code 8523/3 is NOT to be used to combine histologies from separate primaries; it is used for mixed histologies in a single primary.
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--Small Intestine: How do we interpret a pathology description of "extending through serosa and forming masses in the periserosal tissue" for a jejunum primary?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 55 [Invasion of/through serosa and adjacent connective tissue]. The description states the tumor extended through the serosa into periserosal tissue. The periserosal tissue in this case refers to adjacent connective tissue lying exterior to the intestinal wall and not the (sub)serosal tissue that lies exterior to the muscularis but inferior to the serosa. Analyze each case individually since pathologists are not consistent when using the above terminology.
Reportability/MP/H Rules/Histology: Is malignant perivascular epithelioid cell tumor (PEComa) reportable, and if so, what is the histology code?
Malignant perivascular epithelioid cell tumor (PEComa) is reportable because it is malignant. Assign 8005/3 to malignant PEComa.
We consulted an ICD-O-3 expert who explained that some PEComas such as angiomyolipoma and lymphangiomyomatosis have specific ICD-O codes and their malignant counterparts may be coded to 8860/3 and 9174/3 respectively. There are no separate ICD-O codes for other specific PEComas, e.g., clear cell “sugar” tumor of lung, clear cell myomelanocytic tumor of the falciform ligament and some “unusual” clear cell tumors occurring in other organs—or for PEComa, NOS. These PEComas may therefore be coded to 8005 as clear cell tumors NOS; in other words as clear cell tumors that are not clear cell variants of carcinomas, sarcomas, or other specific tumor type.
Please note, PEComa is non-specific as to behavior. Unless the pathologist states that it is malignant, (as was the case for this question), the default code is 8005/1 (non-reportable).
Surgery of Primary Site--Breast: Should code 51 (Modified radical mastectomy without removal of uninvolved contralateral breast) be used when a patient has excisional biopsy (22) and axillary dissection followed by a simple mastectomy without removal of uninvolved contralateral breast (41) as part of the first course of treatment?
Assign code 51 or 52 if a patient has an excisional biopsy and axillary dissection followed by a simple mastectomy during the first course of therapy. Code the cumulative result of the surgeries, which is a modified radical mastectomy in this case.
SEER collects only one surgery code per case. Code the most invasive, extensive or definitive surgery in Surgery of Primary Site.
First Course Therapy: Are radio immune labeled antibodies, such as Bexxar [Tositum--I-131] coded as immunotherapy, radiotherapy, or experimental therapy?
Agents such as Bexxar or Zevalin are radioisotopes and coded as radiation. These agents destroy cancer cells with radiation.