Histology--Head & Neck: How do you code histology for a myofibroblastic sarcoma of the soft tissue of the head and neck?
Assign code 8825/3 [Myofibroblastoma, malignant]. According to the WHO Classification of Soft Tissue Tumors, "Low grade myofibroblastic sarcoma represents a distinct atypical myofibroblastic tumor often with fibromatosis-like features and predilection for the head and neck." Also called myofibrosarcoma.
Reportability/Histology--Hematopoietic: If a JAK2 positive myeloproliferative disorder is reportable, how should histology be coded?
Please discuss the significance of JAK2 point mutation.
Example: Bone marrow biopsy showed hypercellular marrow with increased megakaryocytes associated with JAK2 point mutation consistent with myeloproliferative syndrome. Path comment: While the morphologic changes would be compatible with a myeloproliferative syndrome, they are not specific for this as similar findings can be seen in reactive conditions. However, a molecular diagnostic test demonstrated a positive JAK2 point mutation which would support the diagnosis of myeloproliferative syndrome. In summary, the combined histologic and molecular diagnostic findings support a myeloproliferative syndrome. The differential diagnosis would be between polycythemia vera and essential thrombocythemia. Subsequent clinical diagnosis: polycythemia vera.
For cases diagnosed prior to 1/1/2010:Follow the instructions in the SEER manual on pages 1-4 to determine reportability.
Code the histology using all information available for the case. If the clinician reviews the case and states a particular histology based on his/her review, code that histology.
The clinician has access to all of the information available for this case. He/she uses his/her expertise to form a clinical diagnosis.
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.
MP/H Rules/Histology--Thyroid: How would the histology "micropapillary carcinoma" of the thyroid be coded for cases dx'd 2007 and after?
For cases diagnosed 2007 or later, assign code 8260/3 [Papillary adenocarcinoma] according to rule H14.
For thyroid cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult, usually less than 1 cm. in diameter.
CS Tumor Size--Lung: If a 5/11/07 CT showed a 6.5 cm LLL mass and a 7/24/07 CT showed 8.4 cm LLL mass, do we code the larger tumor size identified within four months of diagnosis or do we code the first size documented at the time of diagnosis?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code the larger tumor size.
Reason no surgery of primary site/First course treatment: If the Reason no Surgery of Primary Site field is coded as 7 (refused), must the other treatment options (radiation, chemo, hormone) also be coded as 7? See Discussion.
Coding instruction #5 in the SEER manual states: "Assign code 7 (refused) if the patient refused recommended surgery or made a blanket statement that he/she refused all treatment."
Refused [code 7] means this modality was specifically recommended by the physician and the patient refused. If two treatment alternatives were offered and surgery was refused, code Reason no surgery of primary site 1 [Surgery of the primary site was not performed because it was not part of the planned first-course treatment].
Refusal of surgery does not necessarily mean that all treatment was refused. Coding Surgery of Primary Site as "refused" does not affect the coding of Radiation, Chemotherapy, Hormone Therapy, etc.
MP/H Rules/Multiple primaries--Lung: Should a subsequent primary be abstracted using rule M8 for a patient diagnosed in January 2000 with adenocarcinoma of the right upper lung if the patient initially sought alternative therapies and presented in September 2007 for a right upper lobe lung mass with extension into the mediastinum, mediastinal lymph node mets and a pericardial effusion? See Discussion.
After more than seven years, the patient in this case decided to proceed with the originally suggested standard therapy. Is this a multiple primary case because the tumors are "diagnosed" more than 3 years apart? Or should we assume this is further progression of the 2000 case because it was originally only treated with alternative therapies? The clinician in this case indicates the patient is being referred for treatment to the right upper lung originally diagnosed in 2000.
For cases diagnosed 2007 or later:
Do not abstract a 2007 primary for this case. From the information provided, there is disease progression/extension and lymph node metastasis in 2007; but there are no new lung tumors in 2007. Therefore, the 2007 MP/H rules do not apply.
MP/H Rules/Histology--Lung: What is the correct histology code for a neuroendocrine neoplasm described as a carcinoid and also referred to as oncocytic? See Discussion.
Left mainstem bronchus mass excised: metaplastic endobronchial mucosa with submucosa containing an infiltrating poorly diff malignant tumor. Origin of tumor is not identified in overlying mucosa. IHC stains will be performed.
Addendum #1. IHC stains show well diff neuroendocrine neoplasm, favor carcinoid. Recommend sending this to expert in lung neoplastic pathologist.
For cases diagnosed 2007 or later, code as 8246 [Neuroendocrine carcinoma, NOS]. According to our pathologist consultant, the neuroendocrine description is more specific than the oncocytic description in this case.
CS Extension: How is CS Ext coded for the following?
Rretroperitoneal primary
Cystic mucinous tumor with intraepithelial carcinoma
There is no CS Extension code for intraepithelial ca in the retroperitoneal scheme.
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.According to the American College of Surgeons I & R system, assign code 10 [confined to site of origin] for intraepithelial carcinoma of the retroperitoneum.
Primary site/Histology: Does SEER accept the site/type combination of lymph nodes (C77.0-C77.9) with the histology of either 9823 (B-cell chronic lymphocytic leukemia/small cell lymphocytic lymphoma) or 9827 (Adult T-cell leukemia/lymphoma)? See Discussion.
There is a discrepancy between the SEER Site/Type table and the CS histology codes under Lymph Nodes.
For cases diagnosed prior to 1/1/2010:These are not "impossible" site/histology edits. You can override them. However, if the lymph nodes are involved and a lymphoma histology is available, the lymphoma histology should be coded rather than leukemia histology. For example, assign histology code 9670 (Malignant lymphoma, small B lymphocytic, NOS) instead of 9823 (B-cell chronic lymphocytic leukemia/small cell lymphocytic lymphoma) if the disease is identified in the lymph nodes.
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.
Multiplicity Counter: Should this field be coded to 99 for cases of familial adenomatous polyposis (FAP)? See Discussion.
The MP/H rules state to abstract these cases as a single primary. The Type of Multiple Tumors Reported as One Primary field is coded as a single primary with a value of 32 (FAP with carcinoma), but the Multiplicity Counter seems to be unknown.
Assign code 99 [Multiple tumors present, unknown how many] for cases of FAP when the number of tumors is not stated.
An official website of the United States government
Home