| Report | Question ID | Question | Discussion | Answer | Year |
|---|---|---|---|---|---|
|
|
20091087 | Reportability--Appendix: Is a metastatic low-grade appendiceal mucinous neoplasm reportable if the pathologist states that it is a borderline tumor of the appendix? See Discussion. | Low-grade appendiceal mucinous neoplasm; Lt ovary, cul-de-sac, omentum, and small bowel: Metastatic low-grade appendiceal mucinous neoplasm. Per pathologist this is a borderline tumor of the appendix. | Borderline tumors (other than brain and CNS) are not reportable to SEER. In the case of borderline tumors, the term "metastatic" does not automatically make them reportable. When the "metastatic deposits" are also borderline, the case is not reportable. For this case in particular, the "metastases" are actually (benign) implants and not malignant or invasive mets. | 2009 |
|
|
20091100 | MP/H Rules/Histology--Melanoma: How is histology coded for a "melanoma in situ, lentiginous type," arising in the skin of the lower leg? See Discussion. |
In researching this, acral lentiginous melanoma is observed on the palms, soles and under the nails. To code to 8744, do we specifically have to see the word "acral" lentiginous melanoma? |
For cases diagnosed 2007 to 2020 Assign 8742/2 [lentigo maligna] to "melanoma in situ, lentiginous type." Acral lentiginous melanoma is not the same as melanoma, lentiginous type. "Acral lentiginous melanoma," 8744, should be used only if the report states acral lentiginous melanoma or malignant melanoma, acral lentiginous type. Acral lentiginous melanoma most often occurs on the soles of the feet or the palms of the hands. |
2009 |
|
|
20091021 | Behavior/Reportability--All sites: Would a GIST tumor stated to be "high risk for malignant behavior" be a reportable GIST? See Discussion. |
According to our pathologist and oncologist, the terms "malignant" and "benign" do not apply to GIST. Rather, the term "high risk for malignant behavior" is used. This is based on tumor size: greater than 5 cm and mitotic activity: greater than 5 mitoses/50 hpf. |
Do not report the case to SEER if it does not satisfy the criteria for reportability. According to the current reportability criteria, malignant GIST (8936/3) is reportable to SEER. GIST coded to 8936/0 or 8936/1 is not reportable. If your pathologist will not indicate "malignant" or "benign," code 8936/1 applies according to ICD-O-3 and, therefore, these are not reportable to SEER. |
2009 |
|
|
20091055 | Date therapy initiated/Systemic/Surgery Sequence--Breast: How are these fields coded when a patient has chemotherapy after a sentinel lymph node biopsy and has a lumpectomy after completing chemotherapy? See Discussion. | On 4-10-08 a patient underwent sentinel lymph node biopsies. This was followed by chemotherapy which started on 4-15-08. The patient subsequently underwent a lumpectomy on 11-10-2008. | For this case, code Date Therapy Initiated to the date of the sentinel lymph node biopsy [04102008]. Assign code 3 [Systemic therapy after surgery] in Systemic/Surgery Sequence. |
2009 |
|
|
20091031 | MP/H Rules/Histology--Thyroid: How is histology coded for a thyroid tumor described as "predominantly papillary carcinoma, tall cell variant, follicular type"? | For cases diagnosed 2007 or later, assign code 8340 [Papillary carcinoma, follicular variant] according to rule H15 for Other Sites. "Predominantly" and "type" indicate specific histologies. "Variant" does not. See rule H13. The histology in this case is papillary and follicular. Tall cell variant is ignored. |
2009 | |
|
|
20091127 | MP/H Rules/Multiple primaries--Brain and CNS: How many primaries are to be accessioned for a patient with Neurofibromatosis 2 (NF2) who presents with meningiomas on the left and right side of the brain and multiple meningiomas of the spinal cord? See Discussion. |
We have a patient with NF2 who also has meningiomas diagnosed on the left and right side of the brain as well as multiple meningiomas of the spinal cord. Are the meningiomas all one primary (separate from the NF2): C70.9 and 9530/1? |
For cases diagnosed 2007 or later, this is four primaries. Report NF2 because it occurs with reportable neoplasms. Note: Report NF only once per patient. Per MP/H Benign CNS Rule M4, the meningiomas of the meninges/brain (C70.0) and meninges/CNS (C70.1) are multiple primaries. Code the meningiomas of the spine to the histology to 9530/1 [Multiple meningiomas] (Rule H6) because there are multiple tumors in the spine. Per Rule M5, the meningiomas of the right and left side of the brain are multiple primaries. Code of each to the histology 9530/0 [Meningioma, NOS] per Rule H2 because they are separate primaries (assuming there is one tumor on each side of the brain). |
2009 |
|
|
20091131 | Multiplicity Counter/Type of Multiple Tumors--Breast: How are these fields coded when a patient underwent a lumpectomy demonstrating two measured foci of invasive ductal carcinoma (1.5 cm and 3 mm) and "focally seen" in situ ductal carcinoma (DCIS) followed by a re-excision that is positive for 1.5 mm focus of residual invasive carcinoma? See Discussion. | Lumpectomy path shows two foci of invasive ductal carcinoma, 1.5 cm & 3 mm sizes, and CAP summary lists "DCIS: focally seen", no further description. The re-excision pathology specimen finds a 1.5 mm focus of residual invasive carcinoma, very close to the new inferior margin (so registrar assumed this was probably not part of the previously excised mass), and no mention of any more in situ.
Can we assume the DCIS was associated with/part of the invasive tumors because it was not measured or described separately? If we say there are 3 tumors (for the measured invasive foci), should Type of Multiple Tumors be coded 30 [In situ and invasive] or 40 [Multiple invasive]?
|
Code 03 [3 tumors] in the multiplicity counter. Do not count the "focally seen" DCIS because it was not measured. Code 30 [In situ and invasive] in Type of Multiple Tumors Reported as One Primary. The single primary reported for this case is a combination of in situ and invasive tumors. |
2009 |
|
|
20091084 | Primary site--Colon: How do you determine the correct subsite when there is conflicting information in different reports? Are there priority rules for coding subsite for sites other than Head and Neck? See Discussion. | The path report for a hemicolectomy says, " Specimen: left colon..." and the microscopic says, "...received in formalin designated left colon..." The Operative procedure report says, "Postoperative diagnosis - splenic flexure tumor." The text of this report says, "Mobilizing the splenic flexure mass was incredibly difficult..." and then goes on to describe exactly how and where it was resected. The discharge summary says adenosquamous carcinoma of the splenic flexure. SINQ20051010 says to use the pathology report first, but this was written before the new MP/H rules. | Use the operative report information to code primary site in this case. It is more accurate. The operative report is usually a better source of location information compared to the pathology report. The pathologist can only reiterate the location as it was reported to him/her. The 2007 SEER manual states "Unless otherwise instructed, use all available information to code the site," page 69. |
2009 |
|
|
20091065 | Primary Site/CS Extension--Lymphoma: How are these fields coded for a non-Hodgkins lymphoma case with scans that show non-specific parenchymal lung nodules and a large mediastinal mass? See Discussion. |
Patient presented with large bulky mediastinal mass. CT showed no pleural effusion. Findings also show non-specific parenchymal lung nodules. Biopsy of mediastinal mass showed malignant B-cell lymphoma of follicle center cell origin. Abdomen /Pelvis CT showed borderline lymph nodes in bifurcation. Clinical diagnosis was probable stage 3 if not 4 lymphoma. Per lymphoma guidelines, if extra-nodal primary site is assigned to the extranodal site if an extra-nodal site and its regional lymph nodes are involved. Would the parenchymal lung nodules be indicative of pulmonary involvement? If so, would primary site be lung? Or, would the parenchymal nodules be stage 4 disease and primary site be assigned to lymph nodes? |
For cases diagnosed prior to 1/1/2010, 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 Primary Site to C779 [Lymph node, NOS]. In this case, there is no statement that lymphoma involves the lung. "Nonspecific parenchymal lung nodules" are not indicative of lymphoma involvement. Consequently, this cannot be assumed to be an extra-nodal lymphoma. Additionally, it is not clear whether or not the "borderline" pelvic lymph nodes are involved. If the physician cannot provide more information, follow instruction 4.e in the SEER manual on page 72. 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. |
2009 |
|
|
20091061 | Multiplicity Counter--Head & Neck: How is this field coded when a patient has carcinoma in the same location as a previous primary but it is unknown if there was a disease-free interval? See Discussion. | Patient was diagnosed with squamous cell carcinoma, single tumor of the right true vocal cord in May 2008. Tumor was treated with radiation therapy and chemotherapy. Excision of right vocal cord mass in February 2009 shows squamous cell carcinoma. | Assign code 01 [one tumor only] for the example provided (see discussion). Given the information provided, there is no reason to suspect that the February 2009 diagnosis represents new tumor; therefore, it does not affect the multiplicity counter. It appears that this was the treatment plan for the original diagnosis in May 2008: radiation and chemo followed by excision of the mass. | 2009 |
Home
