Behavior--Brain and CNS: Can hemangioblastomas occurring in the CNS be coded as /3 (malignant) based on a radiologic or clinical diagnosis by the physician? See Discussion.
Hemangioblastomas are borderline (/1) according to ICD-O. The standard matrix rule in ICD-O directs registrars to change the behavior code to malignant when a malignant (/3) behavior is stated by a physician for a morphology code that appears in ICD-O with a non-malignant behavior code. The "malignant" hemangioblastomas we see are not pathologically confirmed; they are radiological or clinical diagnoses confirmed when renal cell carcinoma is a disease process listed in the malignant differential diagnoses.
The behavior code for hemangioblastoma can be coded to /3 when a pathologist indicates that the behavior is malignant. The behavior code should be based on a pathologist's opinion. It is usually not possible for a radiologist or patient care physician to make this determination clinically.
The histologic appearance of hemangioblastoma may resemble metastatic renal cell carcinoma; therefore, one will often see renal cell carcinoma listed as a possible diagnosis. This does not indicate that the hemangioblastoma is malignant. Do not code the behavior as /3 based on a differential diagnosis of renal cell carcinoma.
Behavior--Breast: How is behavior coded when a biopsy shows in situ carcinoma with a focus suspicious for invasion and a subsequent excision/resection shows only in situ carcinoma?
Code this case as in situ. The specimen from the excision/resection is the more reliable source for determining behavior, compared to a biopsy, especially in this case where the behavior is ambiguous on the biopsy.
Behavior--Breast: How is this field coded for a case in which the final diagnosis reports DCIS, but the CAP protocol or microscopic findings show microinvasion? See Discussion.
1. Path report for breast cancer has final diagnosis as 'DCIS' but the CAP protocol in the body of the report says 'microinvasion seen, T1mic.'
2. Path report says 'DCIS' in the final diagnosis and microinvasion is identified in the microscopic portion of the report, but it is not in CAP protocol format and not stated in the final diagnosis.
Code both scenarios /3 [malignant (invasive)]. Information regarding behavior is not limited to the final diagnosis or the CAP protocol. See page 84 in the 2007 SEER manual:
Code the behavior as malignant /3 if any portion of the primary tumor is invasive no matter how limited; i.e. microinvasion.
Behavior--Head & Neck: Should the SEER IF_Morph_3 edit be modified because it does not allow a behavior code 2 with histology 8941 [carcinoma in a pleomorphic adenoma] for a parotid primary?
Code the behavior as 2 and over-ride the edit. The edit is there to flag unusual combinations. Once you have verified that the behavior is coded correctly, over-ride the edit.
The surgeon stage of T2 is based on size of tumor, the TIS is based on behavior. Code according to pathologically confirmed TIS.
Behavior--Lung: Can an in situ behavior code be used for a bronchioalveolar carcinoma of the lung when the pathologist appears to use the term bronchioalveolar to describe an in situ pattern of growth exhibited by an adenocarcinoma? Is the use of the term "pattern" in this situation indicative of in situ tumor? See Discussion.
In ICD-O-3, bronchioloalveolar adenocarcinoma is described only by behavior code 3 (invasive). Would the behavior be coded as in situ for the following cases?
Example 1: Left lower lobe, partial resection shows bronchioloalveolar carcinoma with focal areas of fibrosis (see comment). Comment: Although the possibility that these areas represent stromal invasion can not be excluded, we favor the interpretation that these areas do not represent true invasion. Synoptic summary: Minimal pathologic stage: Local Extent.
Example 2: Lung tumor described as adenocarcinoma, predominantly bronchoalveolar pattern. For most sites, the term pattern is used only for in situ cancer and is not a specific term used for invasive tumors. Is the use of the term "pattern" in this situation indicative of in situ tumor?
Code the behavior indicated in the pathology report. If the pathologist states the bronchioloalveolar carcinoma is in situ, apply the ICD-O-3 matrix rule and assign 8250/2. Otherwise, code 8250/3. Do not use the term "pattern" to infer in situ behavior.
Code behavior /3 for both examples based on information provided.
Behavior--Lung: How is behavior to be coded for a diagnosis of adenocarcinoma of a lung tumor that is further classified per the CAP protocol as, "non-mucinous bronchiolo-alveolar carcinoma (adenocarcinoma in situ)" while the pathologist also classifies the tumor as pT1b, pN0? See Discussion.
Is the following case coded with an invasive or in situ behavior when a RUL lobectomy specimen reveals adenocarcinoma and the Histologic Type per the CAP protocol layout is non-mucinous bronchiolo-alveolar carcinoma (adenocarcinoma in situ)? The stage per the pathologist is pT1b, pN0. Per the COMMENT section in the pathology report, "The terminology adenocarcinoma in situ is based on a recent publication in the Journal of Thoracic Oncology (Volume 6, #2, February 2011). Based on this criterion, the behavior represents adenocarcinoma in situ with no evident invasive component."
Code the behavior as in situ. The pathologist has the final say on the behavior of the tumor. This pathologist is indicating that in his opinion based on a recent publication, this tumor is in situ.
Cell indicator--Lymphoma: If the primary site for a lymphoma is stated to be the lymph nodes but there is no biopsy of a lymph node, can the immunophenotype designation for a lymphoma be coded based on a bone marrow or liver biopsy indicating "diffuse large B-cell lymphoma"?
For cases diagnosed prior to 1/1/2010:
The cell indicator or immunophenotype designation for lymphomas may be coded from pathology reports on tissue from bone marrow or liver when there is no tissue from the primary site. Code information on cell type from any available source.
See the Appendix C of the 2007 SEER manual, Coding Guidelines for Lymphomas, pages C-1055 to C-1056 for more information about coding this field for lymphomas.
For cases diagnosed 1/1/10 and later, 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.
Chemotherapy--Breast: In the absence of more specific information, is the insertion of a port-a-cath one month after mastectomy enough documentation to code chemotherapy to 88 [Recommended]?
Assign chemotherapy code 88 [Chemotherapy was recommended, but it is unknown if it was administered]. Be sure to confirm whether or not treatment was administered and update this code accordingly.
Chemotherapy--Breast: Is chemotherapy administered for inflammatory breast cancer also coded as therapy for an in situ tumor in the contralateral breast?
Yes. Because chemotherapy would likely affect both primaries, code it as treatment for both the in situ and the inflammatory breast cancers.
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