Cell indicator--Lymphoma: If the primary site for a lymphoma is stated to be the lymph nodes but there is no biopsy of a lymph node, can the immunophenotype designation for a lymphoma be coded based on a bone marrow or liver biopsy indicating "diffuse large B-cell lymphoma"?
For cases diagnosed prior to 1/1/2010:
The cell indicator or immunophenotype designation for lymphomas may be coded from pathology reports on tissue from bone marrow or liver when there is no tissue from the primary site. Code information on cell type from any available source.
See the Appendix C of the 2007 SEER manual, Coding Guidelines for Lymphomas, pages C-1055 to C-1056 for more information about coding this field for lymphomas.
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.
Multiplicity Counter: Are in situ tumors diagnosed more than 60 days after invasive tumors of the same site and histology included in the Multiplicity Counter?
If an in situ tumor following an invasive tumor is a single primary according to the multiple primary rules for that particular site, include the in situ and the invasive tumors in the multiplicity counter.
Systemic/Surgery Sequence--Breast: How is this field coded for a breast cancer patient treated with a lumpectomy followed by chemotherapy and then a mastectomy?
Assign code 2 [Systemic therapy before surgery]. The code in Systemic Treatment/Surgery Sequence is related to the surgery coded in Surgery of Primary Site. For SEER, the mastectomy will be coded in the surgery field. The chemotherapy occurred before the mastectomy.
Primary Site: Is an "angiosarcoma" stated as arising in the skin of the breast and treated with a mastectomy, coded to the primary site of skin or breast?
Code the primary site as skin of breast when skin of breast is documented as the site of origin.
According to the WHO classification of soft tissue tumors, the majority of angiosarcomas "develop as cutaneous tumors...less than one quarter present as a deep soft tissue mass."
EOD-Pathologic Extension--Prostate: When coding a prostate case with a date of diagnosis prior to 1995, is the EOD-Pathologic Extension-Prostate field left blank?
For tumors diagnosed prior to 1995, leave EOD-Pathologic Extension--Prostate field blank.
Code all EOD fields according to the EOD coding scheme in effect for that year of diagnosis.
CS Site Specific Factor--Lymphoma: Can the registrar calculate the International Prognostic Index (IPI) score from information found in the H&P or on the back of a TNM form for the SSF 3 field if the physician does not document it in the medical record?
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.Record the IPI score in SSF3 when the score is documented in the medical record. If the score is not stated, do not calculate it.
Histology (Pre-2007)--Breast: How is "invasive lobular carcinoma with signet ring cell features (95%) and ductal features (5%)" coded for a single tumor diagnosed prior to 2007?
For cases diagnosed 1/1/04-12/31/06, code histology to 8524 [Lobular mixed with other types of carcinoma]. Assuming there is no mention of in situ, Histology Coding Rule 3 applies: Use a mixed histology code if one exists
For cases diagnosed 2007-2014, 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.
MP/H Rules--Ovary: Rule M7 states bilateral epithelial tumors (8000-8799) are reportable as a single primary. Are bilateral germ cell tumors of the ovary (e.g., dysgerminoma (9060/3)) that occur simultaneously now reported as two primaries?
For cases diagnosed 2007 or later, rule M7 applies to ovarian epithelial tumors with ICD-O-3 histology codes between 8000 and 8799. Rule M7 does not apply to dysgerminoma which is coded to 9060. Go on to the next rule, M8 and abstract as multiple primaries, left and right.
MP/H rules/Histology--Lung: How is histology coded for a path diagnosis of "pleomorphic carcinoma with adenocarcinoma, squamous, clear cell and spindle components"? Please see discussion.
Path diagnosis of lung tumor is pleomorphic carcinoma, with adenocarcinoma, squamous, clear cell, and spindle cell components. Path comment states: "While the majority of tumor displays usual adenocarcinoma-type features, elsewhere the tumor shows varying differentiation, including squamous, clear cell and spindle cell differentiation. Therefore the tumor is best categorized as pleomorphic carcinoma."
This tumor is best described by a non-specific histology. However, the MP/H rules guide the abstractor to identify a more specific histology. If we work through the lung rules, would we end up using rule H7 and code the histology with the numerically highest ICD-O-3 code?
For cases diagnosed 2007 or later, assign histology code 8022 [pleomorphic carcinoma] based on the pathologist's assessment and rule H3. He/she reviewed all of the histologic components and rendered a final diagnosis of pleomorphic carcinoma.
"Components" is not a term indicative of a more specific histology. See note under rule H5.
CS Tumor Size/CS Site Specific Factor--Breast: How do you code the CS Tumor size and SSF6 fields for a breast cancer described as "Paget disease with underlying intraductal carcinoma (4cm x 3.2cm)"?
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 Tumor Size: Assign code 040 for tumor size and code SSF6 as 050 [Invasive and in situ components present, size of entire tumor coded in CS TS]. The size of the invasive component is not stated AND proportions of in situ and invasive are not known.
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