MP/H Rules/Multiple primaries--Brain: Does a patient diagnosed with anaplastic astrocytoma of the left temporal lobe in 2000 followed by a diagnosis of oligoastrocytoma of the right frontal lobe in 2007 have a single primary per rule M7 or multiple primaries per rule M8? See Discussion.
MP/H rule M7 states that tumors with ICD-O-3 histologies on the same branch in chart 1 are a single primary. Chart 1 shows that both of the histologies for our sample case are located on the glial branch. However, the glial tumor branch has three secondary branches. Does rule M7 apply to secondary branches? Anaplastic astrocytoma [9402] is classified under the secondary branch for astrocytic tumors. Oligoastrocytoma [9382] is classified under the secondary branch for mixed glioma. Does rule M7 or does rule M8 apply for this case? Does this case represent one or two primaries?
For cases diagnosed 2007 or later, Rule M8 applies. There are two primaries.
Anaplastic astrocytoma and oligoastrocytoma (mixed glioma) are on separate branches in Chart 1. They are both gliomas, but one is a mixed glioma and the other is an astrocytic tumor.
Surgery of Primary Site--Corpus uteri: How are the surgery fields to be coded when patient undergoes hysterectomy and omentectomy for endometrial primary? See Discussion.
The example for instruction 6 in the 2007 SEER manual on page 179 (for surgery of primary site) states "code an en bloc removal when the patient has a hysterectomy and an omentectomy." There is no Site-Specific Surgery code for corpus uteri that combines hysterectomy with omentectomy. Is the information about removal of the omentum lost or is it documented under Surgical Procedure of Other Site?
Use the most appropriate code in the "Surgery of Primary Site field." Do not code the omentectomy in "Surgical Procedure of Other Site" when it is performed with a hysterectomy for an endometrial primary.
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.
CS Lymph Nodes--Ovary: Are positive lymph nodes removed from "colon tissue" during a modified posterior pelvic debulking regional or distant? If regional, what is the appropriate CS LN code?
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.Pericolonic lymph nodes are "regional" lymph nodes for an ovarian primary. If you do not have enough information to assign codes 12-30, assign code 50 [Regional lymph nodes, NOS].
MP/H Rules/Histology--Ovary: How is histology coded for "serous carcinoma, papillary invasive pattern"?
For cases diagnosed 2007 or later, code the histology 8441/3 [Serous carcinoma, NOS]. Use the Other Sites rules. Start with rule H8 and stop at rule H11. "Pattern" is not one of the terms used to identify a specific type (See H16), so papillary is ignored.
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.
CS Site Specific Factor--Head & Neck: Can SSF 1-6 be coded using clinical information only, or does the source of information for lymph nodes need to be pathological?
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.CS Site Specific Factors 1 through 6 for head and neck sites may be coded using either clinical or pathologic information.
Grade--Breast: How is this field coded for an "invasive ductal carcinoma, well differentiated, low nuclear grade"?
Assign code 1 [Grade 1, well differentiated]. Use the table in the 2007 SEER Manual on page C-607. Both "low grade" and "well differentiated" are coded 1 in the grade field.
CS Tumor Size/CS Site Specific Factor--Breast: When tumor size is unknown, but it is known that both in situ and invasive components are present, how should CS Tumor Size and SSF6 be coded? See Discussion.
We coded CS Tumor Size 990 and SSF 6 to 060 for a case in which no tumor size was mentioned and the breast core biopsy identified microinvasive infiltrating lobular carcinoma and lobular carcinoma insitu. The lumpectomy identified no residual tumor. SEER edit 218 states we must have CS Tumor Size as 999 if the CS SSF 6 is 060. Yet the tumor size code of 990 (Microinvasion; microscopic focus or foci only, no size given; described as less than 1 mm) would more accurately reflect this case. Even in a situation where there was microinvasion described as less than 1mm, the edit will not allow one to code CS Tumor Size to 990 with the CS SSF 6 as 060. Should these types of cases have CS Tumor Size coded 999 or should the edit be adjusted to allow for this combination?
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 CS tumor size 990 [Microinvasion; microscopic focus or foci only, no size given; described as less than 1 mm] and CS SSF6 050 [Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated AND proportions of in situ and invasive not known].
This combination of codes captures the information available for this case.
CS Tumor Size--Breast: How is this field coded for DCIS that is present in scattered small foci over five of eight slides, and the greatest aggregate dimension measures 0.5 cm? See Discussion.
Breast biopsy was prompted by abnormality seen on mammography. Would this be an example of when to code 996 (mammographic/xerographic diagnosis only, no size given; clinically not palpable) applies for the CS Tumor Size field?
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 code 005 [0.5 cm] in this case. According to the General Instructions for CS tumor size, it is acceptable to code an aggregate size stated by the pathologist (see instruction 4.i).
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