Grade, Differentiation--Bladder: How is this field coded for a five grade system? See Description.
Example: Invasive, high grade transitional cell carcinoma (Grade 4-5/5)
For this example, code grade as 4 based on the term "High grade." If "high grade" was not stated, the grade would be coded as 9, not determined. There is no SEER translation between the ICD-O grades and a five grade system for bladder. None of the pathololgist experts we querried knew of a five grade system for bladder.
EOD-Pathology Extension--Prostate: Is extracapsular extension implied by the phrase, "involvement of periurethral or urethral margins"? See Description.
The prostatectomy final pathology diagnosis states that the tumor involves the periurethral margin. The microscopic describes involvement of the urethral margin.
For cases diagnosed 1998-2003: Code the EOD-Extension field in the 20-34 range, which implies no extension beyond the prostate. Disregard involvement of periurethral margin or urethral margin, NOS, unless the pathologist or surgeon specifically mentions "extraprostatic urethra" involvement.
CS Site Specific Factor--Prostate: Does perineural invasion affect the coding of SSF3, pathologic extension? See Description.
"Adenoca scattered over a 2.5 cm region bilaterally toward the apex. Perineural invasion is identified, including within the right apex." Does this mean that there is extension into the apex?
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.For cases diagnosed 2004 and forward:
Presence or absence of perineural invasion does not affect pathologic extension. Most likely perineural invasion is still localized. It means that there is tumor found along the track of the nerves in the prostate. Where the nerves enter the prostate, the capsule is thinner than in other areas; thus pathologists make note of the potential for extracapsular extension.
The CAP Cancer Protocol for Prostate states that perineural invasion "has been associated with a high risk of extraprostatic extension...although the exact prognostic significance remains to be determined."
Based on the available information, code the case example to 023 [Involves both lobes].
Primary Site: Should we code C80.9 [unknown primary] or code C34.9 [Lung] according to the terminology, "most likely site of origin is lung"? See Description.
We have a case of metastatic keratinizing squamous cell ca. The work-up shows small densities in the lung that may represent inflammatory or chronic changes. No other imaging that shows origin. Physical exam states 2 months of left axillary mass. H/O SCCA of the skin involving chest wall.
Path reads: Metastatic w/d keratinizing SCCA. This lesion almost undoubtedly represents mets. The most likely site of origin is lung followed by esophageal primary or head & neck. The final discharge states, "Metastatic SCCA to Left Axilla".
Code the primary site according to the physicians' opinion, especially the treatment decision. If the physician treats the patient for a lung primary, code primary site as lung. If the primary site cannot be determined, code C80.9.
According to the pathologist, the most likely primary site for the example above is lung. The final discharge diagnosis does not reflect the pathologist's opinion, and does not contradict it either. If there is no conflicting medical opinion, code primary site to C34.9 [lung].
Multiple Primaries (Pre-2007)--Trachea/Lung: Would synchronous lesions, of the same histology, diagnosed in the right upper lobe of the lung and trachea be a single primary when the physician feels they are two separate primaries?
For tumors diagnosed prior to 2007:
According to SEER rules, abstract as one primary because although these sites have separate topography codes in ICD-O-3, they were coded to the same three-digit topography code in the first edition of ICD-O (SEER Program Code Manual, 3rd Edition, page 8, Exception B). Simultaneous lesions of the same histology in trachea and lung are one primary. Code the primary site to C399 [Ill-defined sites within respiratory system].
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.
Reportability/History (Pre-2007)/Behavior Code--Ovary: Should the matrix principal in Rule F be applied to code a 2002 right ovary case to 8462/3 [Papillary serous borderline ovarian tumor] when peritoneal washings reveal the same histology?
For tumors diagnosed prior to 2007:
Do not apply the matrix principle in this case. This ovarian tumor is not reportable (behavior /1 per ICD-O-3). The peritoneal washings reveal the same histology (/1), rather than malignant cells. Based on the information provided, there is no evidence to support changing the behavior 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.
Histology (Pre-2007)--Kidney, renal pelvis: What codes are used to represent the histologies of 1) "renal papillary (chromophil) carcinoma" and 2) "chromophil renal cell carcinoma?"
For tumors diagnosed prior to 2007:
Code "chromophil" to 8260 [papillary renal cell]. According to our pathologist consultant, in the case of chromophil, most authors regard this as more or less synonymous with papillary renal cell [8260]. "More or less" because papillary is an old term descriptive of the microscopic structure, while chromophil is newer and based on the cytology; because most of the latter are papillary the current usage assumes them to be equivalent.
1) The diagnosis "renal papillary (chromophil) carcinoma" tells us that the pathologist who wrote it was seeing both pattern and cytologic features, and is regarding papillary equivalent to chromophil; thus, code to 8260.
2) Code "chromophil renal cell carcinoma" to 8260.
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.
Histology (Pre-2007)--Lung: What code is used to represent the histology "mucin-producing bronchoalveolar carcinoma?" Is mucin-producing synonymous with mucinous?
For tumors diagnosed prior to 2007:
Code histology as 8253 [Bronchiolo-alveolar carcinoma, mucinous]. Mucin-producing bronchoalveolar carcinoma is best classified in ICD-O-3 as Bronchiolo-alveolar carcinoma, mucinous.
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.
Scope of Regional Lymph Node Surgery 2003+/Number of Regional Lymph Nodes Examined--Hematopoietic/Brain/Lymph Nodes/Ill-defined/Unknown: Are codes 9 [Unknown; not stated] and 99 [Unknown; not stated] used respectively for these data items for the mentioned primary sites?
For cases diagnosed Jan 2003 and later:
The Number of Regional Lymph Nodes Examined field is blank for 2003+ cases.
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