Reportability--Brain and CNS: Is a thalamic amyloidoma reportable if so what histology code is used?
Thalamic amyloidoma is not reportable. Amyloidoma (tumoral amyloidosis, amyloid tumor) is a tumor-like deposit of amyloid. It is not neoplastic. Amyloid is a protein derived substance deposited in various clinical settings.
Birthplace/Place of birth, country: For patients originally born in a country that is currently listed as "historic only", where the original birth country now has a one-to-many relationship with the current country, how should the reported original birthplace be coded? (Example: Yugoslavia)
Assign code for Europe, NOS (ZZE) for Yugoslavia, NOS, without further information.
MP/H Rules/Histology--Breast: What histology code and MP/H Rule applies to the Histologic Type of "invasive ductal carcinoma with metaplastic stroma" for a single breast tumor? See Discussion.
The patient had a partial mastectomy with final diagnosis of invasive ductal carcinoma with metaplastic stroma. Knowing that metaplastic breast carcinoma has a worse prognosis than other types of breast cancer, is metaplastic stroma a synonym for metaplastic carcinoma when used in this context?
Code to metaplastic carcinoma, 8575/3. According to our expert pathologist consultant, "The term 'metaplastic stroma' implies that at least a portion of the carcinoma has undergone a 'metaplastic' change from epithelial in appearance to 'stromal' in appearance. I assume this is what CAP means by 'Invasive mammary carcinoma with matrix production,' which the WHO equates to metaplastic carcinoma."
Primary Site--Stomach: How do I code the primary site when the operative report and pathology report state that the tumor site is incisura of the stomach?
Assign C163. Incisura, incisura angularis, gastric angular notch, angular incisure of stomach all refer to the sharp angular depression in the lesser curvature of the stomach at the junction of the body with the pyloric canal. See Gastric angular notch in #12 on page 76 in the SEER manual, http://seer.cancer.gov/manuals/2015/SPCSM_2015_maindoc.pdf. See also the SEER training website, #12 on the illustration corresponds to the angular notch, http://training.seer.cancer.gov/ugi/anatomy/stomach.html. We will correct the key for this illustration.
MP/H Rules/Histology--Testis: How should histology be coded for a testicular primary with a combination of teratoma, yolk sac tumor and embryonal carcinoma? See discussion.
Patient had a radical orchiectomy with the final diagnosis of "Mixed germ cell tumor with the following features -- histologic type: Mixed germ cell tumor (teratoma 50%, yolk sac tumor 25%, and embryonal 25%)."
Assign 9085/3. Code this combination of teratoma, yolk sac tumor, and embryonal tumor in the testis to mixed germ cell tumor (9085/3) based on the WHO Classification of Tumors of the Male Genital Organs.
MP/H Rules/Histology--Skin: What histology code and MP/H Rule apply to a skin primary with the final diagnosis, ? See Discussion.
The patient had an upper arm shave biopsy with final diagnosis of basaloid carcinoma with squamous and neuroendocrine differentiation. The pathologist also comments: Further resection was negative for residual malignancy.
Would SINQ 20150033 apply, thus resulting in final histology of carcinoma with neuroendocrine carcinoma (8574/3)?
Assign 8574/3 according to Other Sites rule H17 for basaloid carcinoma with squamous and neuroendocrine differentiation.
There is no combination code that includes basal cell, squamous, and neuroendocrine. We can combine basal cell with squamous, 8094/3, or carcinoma with neuoendocrine differentiation, 8574/3. Rule H17 directs us to assign the higher code, 8574/3.
MP/H Rules/Histology--Breast: How should histology be coded for a breast primary with resection final diagnosis of "Ductal carcinoma with neuroendocrine features?" See Discussion.
Should the histology for "Ductal carcinoma with neuroendocrine features" be coded to 8500 (Ductal carcinoma, NOS) or 8574 (Adenocarcinoma with neuroendocrine differentiation)?
Code the histology to 8574/3 for Ductal carcinoma with neuroendocrine features.
Ductal carcinoma is also called "invasive breast carcinoma of no special type." WHO classifies Invasive breast carcinoma with neuroendocrine differentiation as 8574/3.
SEER Summary Stage 2000--Melanoma: Can Clark's level classification still used to Summary Stage melanoma? It was previously used by AJCC TNM, but was not included in the 7th edition. I see it is still listed in the CAP protocols for melanoma.
Clark's level can be used to assign in situ, localized or regional summary stage.
If there is a discrepancy between the Clark’s level and the pathologic description of extent, use the higher Summary Stage code.
Mets at diagnosis fields--Heme & Lymphoid Neoplasms (Lymphoma): How are Mets at Diagnosis -- Bone, Brain, Liver, Lung, Lymph Node, and Other -- to be coded for lymphomas in 2016? Are they always 0 if the TNM Stage is I, II, or III? How is bone marrow involvement coded -- in which Mets at Diagnosis field?
Note: Answer verified Sept. 2019, still valid for current cases.
Code all mets at diagnosis fields to 0 when the Stage is I, II, or III.
When the lymphoma is Stage IV, one of the mets at dx fields (other than Mets at Dx-Distant lymph nodes) needs to be coded to 1. Stage IV indicates that there is multiple extralymphatic organ involvement, diffuse involvement of an organ; liver, brain, lung or bone involvement, or bone marrow involvement.
For bone, brain, liver, and lung, code these as 1 when these sites are involved and they are not the primary site. This is the same instruction for solid tumor neoplasms.
For mets at dx-distant lymph nodes, always code to 0. For lymphomas, lymph node involvement is included in stage and not based on whether they are regional or distant.
For mets at dx-other, code to 1 for bone marrow involvement or if there is multi extralymphatic organ involvement.
Radiation Therapy--Breast: Are iodine 125 (I-125) seed implants for breast cancer coded as brachytherapy or as a localization technique similar to wire localization? See Discussion.
We are seeing many I-125 seed implants for breast cancer. Many of my associates are coding them as brachytherapy. I think they are the newest of the localization technique like wire localization but with greater accuracy. Most are done the same day as the surgery so brachytherapy does not make sense. Which is correct?
I-125 seeds could be used for brachytherapy for breast cancer or as a localization technique for nonpalpable breast tumors. If the seeds were in place a short time and removed as part of a breast surgical procedure, they were likely used for tumor localization. Radioactive seed localization (RSL) is thought to be more precise than the wire implantation technique for localizing lesions.
An official website of the United States government
Home