CS Extension--Pancreas: How do you code this field for a head of pancreas primary with involvement of portal and splenic veins? See Discussion.
The splenic artery/vein is only mentioned in the body and tail scheme; no mention is made of this site in the pancreatic head scheme.
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.Assign CS extension code 54 [major blood vessels]. The portal vein is listed under code 54 for head of pancreas. The splenic vein branches from the portal vein.
Reportability/Histology--Brain and CNS: Is an "inflammatory myofibroblastic tumor" reportable for Brain and CNS sites? See Discussion.
Histology code 8825/1 (Inflammatory Myofibroblastic Tumor) is not listed in the ICD-0-3 Primary Brain and CNS Site/Histology listing for reportable Brain/CNS tumors.
If the inflammatory myofibroblastic tumor is primary in one of the sites specified below and diagnosed 1/1/2004 or later, it is reportable.
Reportable brain and CNS tumors are any benign and borderline primary intracranial and CNS tumors with a behavior code of /0 or /1 in ICD-O-3 diagnosed 1/1/2004 and later, of the following sites:
Cerebral meninges C700
Spinal meninges C701
Meninges, NOS C709
Cerebrum C710
Frontal lobe C711
Temporal lobe C712
Parietal lobe C713
Occipital lobe C714
Ventricle, NOS C715
Cerebellum, NOS C716
Brain stem C717
Overlapping lesion of brain C718
Brain, NOS C719
Spinal cord C720
Cauda equine C721
Olfactory nerve C722
Optic nerve C723
Acoustic nerve C724
Cranial nerve, NOS C725
Overlapping lesion of brain and central nervous system C728
Surgery of Primary Site/Scope Regional LN Surgery--Breast: How should these fields be coded when a sentinel lymph node dissection removes one-to-three axillary lymph nodes and a total/simple mastectomy is done?
Assign code 41 [Total (simple) mastectomy, NOS WITHOUT removal of uninvolved contralateral breast] for Surgery of Primary Site. Assign code 2 [Sentinel lymph node biopsy] for Scope of Regional Lymph Node surgery. Code 41 applies to a total/simple mastectomy with any number of sentinel lymph nodes removed -- as long as all of the nodes removed are designated as sentinel nodes.
MP/H Rules/Histology--Breast: How is histology to be coded for a breast primary described as "tubular carcinoma (well differentiated invasive ductal carcinoma)"? See Discussion.
How are terms that are modified by parentheses to be interpreted? Do terms in parentheses modify the stated diagnosis and thus have priority over the stated diagnosis? Or would rule H17 apply and histology would be coded as duct and other carcinoma? For this case, the wording of the diagnosis and use of parentheses seem to indicate that tubular is a type of ductal carcinoma. Tubular is not listed as a specific duct carcinoma in the MP/H rules histology tables for breast.
For cases diagnosed 2007 or later, code the histology as tubular carcinoma [8211/3]. This is not a case of tubular AND infiltrating duct. The histology is stated to be tubular. Tubular is not a specific type of duct carcinoma.
Date of Multiple Tumors--Breast: How is this field coded when a second breast tumor is found at mastectomy two months after the original breast cancer was diagnosed, but during initial workup and treatment? See Discussion.
Breast cancer was diagnosed on core biopsy on 02-27-07. It was not known that the breast was harboring 2 tumors until mastectomy was done on 4-01-07. Both tumors are counted as one primary.
Code "Date of Multiple Tumors" field to the date of the mastectomy. That is the date that multiple tumors were discovered.
Multiple Primaries--Urinary: How many primaries should be coded for an 8/9/07 invasive transitional cell carcinoma of right ureter; 7/9/08 non-invasive urothelial carcinoma of bladder; 11/18/08 non-invasive urothelial carcinoma of left ureter; 6/20/09 invasive urothelial carcinoma of left ureter?
One primary. This is a good example of how the field effect occurs in the urinary system. From 2007 to 2008, Rule M8 says bladder and ureter tumors are not new primaries and would be documented as recurrences. Because other urinary sites are involved by 11/08 and by 06/09, do not make second primary of left ureter (Rule M4 does not apply).
Histology--Hematopoietic: How is histology coded for a "chronic lymphocytic leukemia with plasmacytic differentiation"?
For cases diagnosed prior to 1/1/2010:Assign histology code 9823/3 [Chronic lymphocytic leukemia]. Plasmacytic differentiation does not indicate a plasma cell or plasmacytic leukemia.
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.
MP/H Rules--Bladder: Should an invasive urothelial carcinoma of the bladder diagnosed in 2004 followed by an in situ urothelial carcinoma of the ureter diagnosed in 2008 be reported as multiple primaries per the three-year guideline in Rule M7 or a single primary per the subsite guideline in Rule M8? See Discussion.
Rule M7 states, "Tumors diagnosed more than three (3) years apart are multiple primaries." Should this rule be modified to say, "Bladder tumors diagnosed more than three (3) years apart are multiple primaries"? Does Rule M7 apply to only bladder tumors or does this rule apply to tumors in any of the urinary sites similarly to Rule M8 which states, "Urothelial tumors in two or more of the following sites are a single primary: Renal pelvis (C659) Ureter (C669) Bladder (C670-C679) Urethra/prostatic urethra (C680)"?
For cases diagnosed 2007 or later, Rule M7 pertains to renal pelvis, ureter, bladder and other urinary sites as defined by the topography codes listed in the header of these rules.
An invasive urothelial bladder tumor followed more than three years later by an in situ TCC of the ureter are reported separate primaries. Rule M8 applies when the tumors in these sites are diagnosed within three years of each other.
Multiplicity Counter--Lung: How is this field coded when there is no evidence of the primary tumor? See Discussion.
Patient presented with large mediastinal mass. CT showed no intraparenchymal lung tumor. Biopsy of mediastinal mass revealed adenocarcinoma consistent with lung primary.
Multiple Primaries--Breast: How many primaries should be reported when a lobular carcinoma with positive margins is followed 8 years later by a lobular carcinoma near the previous lumpectomy site? See Discussion.
Left breast invasive lobular ca diagnosed 3/00 and treated with a lumpectomy, but with multiple positive margins; she received no post operative radiation or other medical treatment (unknown why). 10/08 core biopsy of "an area of distortion" near the scar site is positive for invasive lobular ca. The radiologist states "compatible with recurrence at her previous lumpectomy site" on an x-ray report.
One thought is that this should not be a new primary because the patient was never disease free (multiple positive margins) and the patient received incomplete treatment. Or should this be a new primary because the tumors are diagnosed more that 5 years apart?
Abstract the 10/08 diagnosis as a new primary, per Breast rule M5. In spite of the positive margins and apparently incomplete treatment in 3/00, there is no mention of the presence of disease between 3/00 and 10/08 according to the information provided.
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