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20061113 | Histology (Pre-2007)--Melanoma: How is histology coded for a final pathology diagnosis of "malignant melanoma, NOS" that is clinically described as a nevus? | For tumors diagnosed prior to 2007:
Code 8720 [malignant melanoma]. Assign the histology code based on the histology stated in the final diagnosis on the pathology report. The pathology report must say melanoma arising in junctional nevus to use the code 8740/3 [Malignant melanoma in junctional nevus].
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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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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20061081 | Collaborative Staging--Lung: Given that the AJCC lung TNM is not applicable for a high grade sarcoma of this site, how do we code Collaborative Stage for this site/histo combination when the pathologist indicates a TNM stage of T2bN0M0=stage III, using AJCC Soft Tissue Sarcoma schema? | 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. Use the lung schema to code CS for sarcoma of the lung. Complete the CS information as best you can from the medical record WITHOUT using the TNM Soft Tissue Sarcoma staging form. Visceral sarcomas are specifically excluded from soft tissue sarcoma TNM staging and sarcomas are excluded from the TNM staging for lung. Sarcoma is listed on the Histology Exclusion Table for lung. When a case is coded in Collaborative Staging and the histology is on the exclusion list, SEER Summary Stage 1977 and 2000 can be assigned. For these cases, TNM will not be calculated and displayed results will be "T NA N NA M NA and Stage Group NA". |
2006 | |
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20061048 | CS Extension--Pancreas, Head: When a tumor is described as having "vascular encasement of the celiac artery", is extension coded to 68 [tumor is inseparable from the celiac axis]? | 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 vascular encasement of the celiac artery to CS extension code 68 [tumor is inseparable from the celiac axis].
This celiac axis is a small (1cm) area of branching arteries. The celiac artery branches into hepatic, gastric, and splenic at the axis. Dissecting tumor out from around the celiac axis is very tricky and usually encasement by tumor is a sign of inoperability. |
2006 | |
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20061075 | Multiple Primaries--Lymphoma: Is a diagnosis of mycosis fungoides followed a year later with a biopsy proven diagnosis of anaplastic large T-cell lymphoma stated to represent a transformation of the previous mycosis fungoides reportable as one or two primaries? | For cases diagnosed prior to 1/1/2010: This is one primary. Code the histology according to the original diagnosis, mycosis fungoides. The physician states that this one disease process started as mycosis fungoides and progressed into lymphoma. A physician's statement has priority over other sources in determining the number of hematopoietic primaries. In October 2006, a committee will begin working on multple primaries among hematopoietic diseases. The committee will provide further guidance on dealing with disease transformation and other issues. 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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20061134 | Reportability: Is an AIN III that arises in perianal skin, skin tags or condyloma acuminatum reportable or must an AIN III arise in the anus or anal canal in order to be reportable? | AIN III arising in perianal skin [C445] is not reportable.
AIN III [8077/2] of the anus or anal canal is reportable. |
2006 | |
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20061108 | Histology/Polyp--Colon: Which histology code is used when a colon biopsy states adenocarcinoma arising in a polyp, but the resection path states only adenocarcinoma, and does not mention arising in a polyp. See Discussion. | This scenario occurs frequently and our QC staff is divided on which code to use. 03-24-06 Rectal Polyp: Adenocarcinoma, moderately differentiated. 6-29-06 Rectum: Adenoca, MD, invades into the submucosa. No malignancy (0/15) LNs. |
Use the polyp information from the biopsy and code adenocarcinoma arising in a polyp (8210, 8261 or 8263 as appropriate). | 2006 |
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20061052 | Diagnostic Confirmation--Leukemia: How is this field coded when the clinician confirms that the diagnosis of CML is based on a combination of the clinical picture and positive cytogenetic studies? | Assign code 1 [Positive histology]. For leukemia only, assign code 1 for positive hematologic findings including peripheral blood smears, CBCs and WBCs. Cytogenetics studies would have been done on blood. Therefore, histology provided diagnostic confirmation as it would with smear, bone marrow, or other special study of blood cells. |
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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20061097 | Reportability--Lymphoma: Is a lymphoma diagnosed on a bone marrow biopsy reportable if the cytogenetics evaluation performed does not confirm the malignancy? See Discussion. |
Bone marrow Bx: Marginal zone lymphoma/leukemia. The morphology of the lymphoma/leukemia cells and the immunophenotypic characteristics identified by flow cytometry are consistent with marginal zone lymphoma/leukemia. Addendum Report: Cytogenetic evaluation revealed a 46,XY male karyotype. This is the normal male chromosome karyotype. Based on the limits of this methodology, no evidence of hematologic malignancy was observed in this specimen. |
For cases diagnosed prior to 1/1/2010: Yes, this case is reportable. The cytogenetic evaluation cited in the addendum report does not disprove the bone marrow biopsy diagnosis. 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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