Histology--Hematopoietic, NOS: When the histology is described in both WHO and FAB terms, which terminology has priority to code this field? See Discussion.
Example: Bone marrow biopsy was reported as: "Markedly hypercellular marrow aspirate with myelodysplastic alterations morphologically consistent with refractory anemia (FAB) or refractory cytopenia with multilineage dysplasia (WHO)."
For cases diagnosed prior to 1/1/2010:Give preference to the WHO terminology when both are used in the final pathology diagnosis. The WHO classification of tumors is the current standard and is recommended by the College of American Pathologists.
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.
Primary Site--Head & Neck: How is this field coded for a tongue primary described as "located on the lateral" or "left oral" tongue? See Discussion.
Case 1. Patient with squamous cell carcinoma, left oral tongue.
Case 2. Squamous cell carcinoma, left lateral tongue.
Case 3. Patient status post biopsy of lesion on tongue. Exam: healing left lateral tongue incision with sutures in place in underside of tongue.
Code Primary Site for cases 1 and 2 above to C023 [Anterior 2/3 of tongue, NOS]. Code lateral tongue without mention of dorsal or ventral surface to C023 [Anterior 2/3 of tongue, NOS].
Code Primary Site for case 3 to C022 [Ventral surface of tongue]. The underside of the tongue is specified as the site of the biopsy in case 3.
CS Extension--Bladder: How should this field be coded when the pathology states "papillary transitional cell carcinoma with no invasion into the submucosa or deep muscularis" but there is "focal extension of tumor into bladder diverticula"?
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 Extension field to 01 [Papillary transitional cell carcinoma stated to be noninvasive]. Extension into bladder diverticula does not change the code. Diverticula are pouches in the mucosa (mucous membrane).
Histology (Pre-2007)--Lung: What is the correct histology code for this case of squamous cell carcinoma with several different variants? See Discussion.
The path report from a left pneumonectomy says: This squamous cell carcinoma had several different variants present including typical non-keratinizing squamous cell, spindled cell squamous cell, clear cell squamous cell and a small cell variant of squamous cell.
I cannot find a combination code that fits; the majority of the tumor is not stated; so do you code the highest specific type mentioned - 8084 - Squamous cell, clear cell type?
For tumors diagnosed prior to 2007:
Assign histology code 8070 [squamous cell carcinoma, NOS]. Squamous cell carcinoma, NOS includes types of squamous cell carcinoma without a specific code. This is a combination squamous tumor that does not have a unique code.
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.
Ambiguous Terminology/Reportability: Are the terms "bordering on" and "may represent" diagnostic of cancer? See Discussion.
Pathology report states "...florid micropapillary hyperplasia, focally atypical with features bordering on low grade micropapillary ductal carcinoma in situ."
The terms "bordering on" and "may represent" are not diagnostic of cancer. These terms are not on the list of ambiguous terms that constitute a diagnosis of cancer. The diagnosis in the example above is not reportable to SEER.
CS Tumor Size--Ovary: The size of a cyst is not coded in this field. However, can the size of a "cystic mass" be coded in this field? See Discussion.
The specimen consists of a cystic mass which weighs 1520 grams and measures 23 x 17 x 10 cm.
If the tumor is described as a "cystic mass" and only the size of the entire mass is given, code the size of the entire mass, because the cysts are part of the tumor itself.
Please note: Ovarian cancer stage is not based on tumor size.
Immunotherapy/Chemotherapy: Are monoclonal antibodies, such as Avastin and Erbitux, coded as immunotherapy or chemotherapy? See Discussion.
In review of the "FDA-approved oncology agents not listed in SEER Book 8" provided in 5/02, it appears "monoclonal antibodies" are coded as immunotherapy.
Code Avastin and Erbitux as chemotherapy because both of these drugs are growth inhibitors. Code growth inhibitors (cytostatic agents) as chemotherapy. Do not assume that monoclonal antibodies are coded as immunotherapy.
Ambiguous Terminology/Reportability: Is the phrase "indicative of cancer" SEER reportable?
No. The phrase "indicative of cancer" alone is not a definitive cancer diagnosis. The word "indicative" is not on the list of ambiguous terms that is equivalent to a diagnosis of cancer.
Histology (Pre-2007)--Lung: Should "moderately differentiated adenocarcinoma of scar type, intermixed with bronchiolo-alveolar carcinoma" be coded to 8250 [bronchiolo-alveolar adenocarcinoma, NOS] or 8255 [adenocarcinoma of mixed subtypes]?
For tumors diagnosed prior to 2007:
Code Histology to 8255 [Adenocarcinoma with mixed subtypes]. This is a single tumor containing both a scar carcinoma and a bronchiolo-alveolar carcinoma--use 8255. The synonym for 8255 is adenocarcinoma combined with other types of carcinoma (not just subtypes).
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.
Primary site/Histology (Pre-2007)/Behavior: What is the correct site and histology/behavior for the following diagnosis: "mucinous cystadenoma of the appendix with perforation and pseudomyxoma peritonei." This was diagnosed at e-lap for a separate adenocarcinoma of the ascending colon.
For tumors diagnosed prior to 2007:
The appropriate code for mucinous cystadenoma of the appendix with perforation and pseudomyxoma peritonei is C18.1 8470/0. It is not reportable to SEER. According to our pathologist consultant, mucinous cystadenoma is a legitimate term for such appendiceal tumors. They may implant all over the peritoneum as pseudomyxoma peritonei, especially in the face of perforation, without being histologically malignant.
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.
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