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20061014 | Surgery of Primary Site--Lung: Is this field coded to 30 [Resection of lobe or lobectomy] or 33 [Lobectomy with mediastinal lymph node dissection] when a lobectomy specimen includes 2 AP window lymph nodes? See Discussion. | LUL lobectomy: 1.7cm apical tumor, DX=mod well diff subpleural SCC, with involvement of pleural surface. 3 peribronchial LN neg and 2 AP window LNs neg. Stage T2N0. 1. No lymph node dissection or sampling was stated to be done 2. The lobectomy specimen contained the LNs 3. Scope of regional LN surgery is coded Would the surgery to primary site code 30 or 33? |
Code surgery of primary site to 30 [Resection of lobe or lobectomy]. According to the information provided, there was no lymph node dissection in this case. The 2 AP window nodes were obtained as part of the lobectomy specimen. | 2006 |
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20061006 | Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Testis: If an orchiectomy specimen contains non-seminomatous mixed germ cell tumor and a separate satellite of seminoma, how many tumors should be abstracted and how should the histology field(s) be coded? | Pathology: R Orchiectomy: 2.1 cm non-seminomatous mixed germ cell tumor (50% teratoma primarily mature, 50% embryonal CA and yolk sac tumor). Located 3cm from the main tumor is a 2mm satellite pure seminoma. | For tumors diagnosed prior to 2007:
This is a single primary because the first three digits of the ICD-O-3 histology codes are the same, according to Rule 3a on page 11 of the 2004 SEER manual. Code the histology 9065 [Germ cell tumor, nonseminomatous]. Code 9065 is preferred over the less-specific code of 9061 [Seminoma, NOS].
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. |
2006 |
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20061060 | CS Site Specific Factor--Prostate: How are SSF 5 (Gleasons Primary and Secondary Pattern Value) and SSF 6 (Gleasons Score) coded when there is a higher Gleason's pattern in less than 5% of the tumor? See Discussion. | Radical prostatectomy pathology states prostate adenocarcinoma "combined Gleasons score 3+3=6, with a small portion of Gleasons pattern 4 component comprising less than 5% of tumor volume." The WHO Classification of Tumors of the Urinary System and Male Genital Organs refers to "tertiary" Gleasons patterns in addition to the primary and secondary patterns. On prostatectomy, when this tertiary pattern is 4 or 5, WHO recommends that it should be reported in addition to the Gleasons score even when it is less than 5% of the tumor. |
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. Record Gleason's pattern and score from the largest specimen, even if this is a lower number. Ignore the tertiary pattern for now. This may change when the AJCC 7th Edition is published, as there is much discussion regarding the tertiary patterns and when they should be utilized. If there is a change in AJCC, at that time there will be a change to CS. |
2006 |
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20061131 | CS Lymph Node Examined--Lung: How is this field coded when a mediastinoscopy and lobectomy are performed and the pathology report indicates multiple lymph node fragments were removed as biopsy specimens and the lobectomy specimen revealed 3 interlobar lymph nodes? | 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 CS Lymph Node Examined field to 98 [number unknown] because the biopsy information is not clear and as a result you do not know how many lymph nodes were examined. |
2006 | |
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20061106 | Reportability--Hematopoietic, NOS: Is a "Myelodysplasia, refractory macrocytic anemia with multilineage dysplasia" reportable? | For cases diagnosed prior to 1/1/2010:Yes, myelodysplasia, refractory macrocytic anemia with multilineage dysplasia is reportable. This is a type of refractory anemia. Refractory anemia is reportable. 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. |
2006 | |
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20061124 | Reportability: Is a tumor reported as "neoplasm" or "neoplasia" per the pathology report, which is subsequently clinically referred to as "carcinoma" reportable? See Discussion. |
Example 1: Lung-Wedge resection and subsequent left lower lobe lobectomy showed papillary epithelial neoplasia. Tumor board and subsequent reports state "nonsmall cell carcinoma of lung." Example 2: Kidney-Partial nephrectomy showed epithelial neoplasm, clear cells with low grade cytology. Subsequent urology clinic notes state that path revealed clear cell renal carcinoma. 2004 SEER manual states that "cases clinically diagnosed are reportable. If the physician treats a patient for cancer in spite of the negative biopsy, accession the case." Do we also accession the case if primary site has been resected? Would diagnostic confirmation be coded 8 (clinical diagnosis only)? |
Accession the case and code Diagnostic Confirmation as 8 [clinical diagnosis only]. Accession a case with negative pathology when the clinician is aware of the negative pathology and continues to refer to the case as malignant. |
2006 |
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20061080 | Histology (Pre-2007): Is histology for an anorectal biopsy of "Cloacogenic carcinoma (squamous cell carcinoma with basaloid features)" coded to 8124/3 [Cloacogenic carcinoma] or 8083/3 [Basaloid squamous cell carcinoma]? | For tumors diagnosed prior to 2007:
Code histology to 8124/3 [Cloacogenic carcinoma]. These are squamous cell carcinomas of basaloid type that are found in the cloacogenic (transitional) zone of the anal canal.
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. |
2006 | |
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20061109 | CS Tumor Size--Lung/Breast: Explain why the SEER instructions differ from the CS Manual regarding priority order of sources to code tumor size? See Discussion. | Regarding the 2004 SEER Manual, Appendix C, Site Specific Coding Modules, Lung and Breast. The priority of sources for coding tumor size is Pathology, Operative Report, PE, imaging for breast and pathology, operative, endoscopic, and imaging for lung. This differs from the CS Manual instructions. | 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.For cases diagnosed in 2007 and forward, follow the instructions in the 2007 SEER manual and the CS manual. |
2006 |
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20061053 | Diagnostic Confirmation: How is this field coded for a case with a cytology that is suspicious for ductal carcinoma and the clinical diagnosis is carcinoma? See Discussion. | SINQ 20031152 states that histology for this type of case is to be coded per the clinical diagnosis of "carcinoma." Does it follow then that Diagnostic Confirmation is to be coded 8 (clinical diagnosis only)? Would we code Diagnostic Confirmation differently if the clinician stated that the diagnosis of malignancy was confirmed by the suspicious cytology? | Code diagnostic confirmation as 8 [clincial diagnosis] when there is a suspicious cytology and a physician's clinical diagnosis. Do not accession cases with only suspicious cytology. Code diagnostic confirmation as 8 when the clinician's diagnosis of malignancy is confirmed by the suspicious cytology. It is still a clinical diagnosis made by the physician using the information available for the case. |
2006 |
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20061037 | Multiple Primaries/Histology--Lymphoma: If a gastric biopsy demonstrates large B cell lymphoma arising in a low grade MALT lymphoma, how many tumors should be abstracted and how should the histology field(s) be coded? See Discussion. | Final path for gastric biopsy on 12/2005 is "consistent with malignant lymphoma" and Micro says "morphologic findings consistent with MALT lymphoma and an increased proportion of large atypical cells is concerning for large cell transformation. However, since the large cells are present only focally, a definitive diagnosis of large cell lymphoma cannot be rendered" A second gastric biopsy a week later said: Final Path: Diffuse large B cell lymphoma arising in low grade MALT lymphoma. Micro says: "Compared to patient's previous biopsy...the current specimen contains a higher percentage of large atypical cells which stain positively for CD79a, a B cell marker. The morphologic and immunohistochemical findings are consistent with a large B cell lymphoma arising in a low grade MALT lymphoma." These are different primaries according to the table of single versus subsequent primaries of lymphatic and hematopoietic diseases. |
For cases diagnosed prior to 1/1/2010: This is one primary. Code as 9699 [Marginal zone B-cell lymphoma, NOS]. The first biopsy was not conclusive. The biopsy one week later was more definitive. The reports are describing a difference between specimens, not a difference in disease. According to the WHO classification, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is an extranodal lymphoma with B-cells, cells resembling monocytoid cells, small lymphocytes and scattered immunoblast and centroblast-like cells. 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. |
2006 |
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