Reportability/Date of Diagnosis--Ovary: Is a patient SEER reportable in 2001 or 2003 if she presented with a diagnosis of papillary serous tumor of low malignant potential [borderline tumor] per the 5/2001 surgery but at the time of the planned second look laparoscopic surgery is stated to have Stage 3A ovarian cancer? See Discussion.
A patient was seen in 5/2001 for large pelvic mass growing from right ovary. After TAH and USO and partial omemtectomy, path diagnosis was papillary serous tumor of low malignant potential (borderline tumor), unruptured. Right ovary and omental implant have identical histologic appearance, except the psammoma body formation and the ovary does not.
Patient does not return for lap as planned in 6-12 months.
In 1/03 she returns to hospital with abdominal pain and has debulking, hemicolectomy and Hartmann's procedure. 1/03 Path report "metastatic papillary serous adenoca." Chart now says "History of stage 3A ovarian cancer."
Yes, this case is reportable in 2003. Malignancy was confirmed in 2003. The diagnosis made in 2001 is not reportable for that year, and was not reviewed or revised according to the information provided.
Reportability--Appendix: Is an appendiceal carcinoid with one periappendiceal lymph node positive for metastatic carcinoid tumor reportable to SEER? See Discussion.
The patient had an appendectomy followed by a hemicolectomy. No residual carcinoid tumor was identified but there was one lymph node positive for metastatic carcinoid tumor.
Yes, this carcinoid is reportable to SEER. This carcinoid is malignant by virture of the lymph node metastasis. Code the behavior as /3.
MP/H/Histology--Pituitary: Would you code Crooke cell adenoma as 8272/0 pituitary adenoma?
Yes, code Crooke cell adenoma to 8272/0 pituitary adenoma. According to the WHO classification, it is a variant of adrenocorticotropic hormone (ACTH) producing adenoma (8272/0).
Surgery of Primary Site/Multiple primaries--Breast: Should the Surgery of Primary Site for the 2020 diagnosis be coded 51 (Modified radical mastectomy without removal of uninvolved contralateral breast) when a partial mastectomy and axillary lymph node dissection are performed for a 2011 right breast primary and a subsequent 2020 right breast primary is treated with a total mastectomy only? See Discussion.
The patient underwent a partial mastectomy and sentinel lymph node biopsy, followed by an axillary lymph node dissection for the first right breast primary in 2011. The separate 2020 right breast primary was treated with a total mastectomy and removal of one involved axillary lymph node. The operative report only refers to this as a non-sentinel lymph node, with no mention of other axillary findings.
Cumulatively, this patient has undergone a modified radical mastectomy since there were likely no remaining axillary lymph nodes. If the Surgery of Primary Site data item is cumulative, does the order of surgeries matter?
It is unclear whether this question should be directed to SINQ (for coding in a SEER registry) or to CAnswer Forum because both have addressed similar surgery related questions in the past and and there is no guidance regarding this specific situation.
Yes, assign surgery of primary site code 51 for the 2020 diagnosis in this case. Code the cumulative effect of all surgeries to the primary site. This means that for the 2020 primary, code the cumulative effect of the surgery done in 2011 plus the surgery performed in 2020. Use text fields on both abstracts to record the details.
Diagnostic confirmation: When a CT guided Fine Needle Aspiration is performed and the pathology report indicates smears and cell block were prepared, if the diagnosis is positive for cancer, can you code diagnostic confirmation as 2 (positive cytology) because of the cell block?
Yes, assign diagnostic confirmation code 2 for diagnosis based on smears and cell block from CT guided FNA. This reply pertains to solid tumors.
MP/H Rules/Multiple primaries--Melanoma: How many melanoma primaries should be abstracted if, during the workup for a metastatic melanoma of an unknown cutaneous site, an in situ melanoma is also discovered? See Discussion.
Patient has diagnosis of melanoma with spindle cell features found in a right lower lobectomy specimen. Chart notes indicate this is metastatic from a cutaneous primary of unknown site. Further work up includes a biopsy of the tip of the nose, which is diagnostic for in situ melanoma. Should this be abstracted as two separate primaries, one for an invasive melanoma of unknown primary site and the other for an in situ melanoma of the skin on the tip of the nose? Which MP/H Rule would apply?
Yes, abstract this as two separate primaries, an invasive melanoma of unknown primary site and an in situ melanoma of the skin on the tip of the nose. Rule M3 applies.
CS Site Specific Factor--Prostate: Please clarify how SEER registries should use code 040 for Site-Specific Factor 3 on prostate cases. See Discussion.
The 6/11/09 NAACCR Webinar on prostate cancer pointed out that SSF 3 code 040 refers the registrar to Note 4, which states "when the apical, distal urethral, bladder base, or bladder neck margins are involved and there is no extracapsular extension, use code 040." The webinar went on to say that code 040 ONLY applies to these specific margins, and that if other margins are involved (for example, the 'right lateral margin'), we should not use code 040. Is this consistent with SEER's interpretation of Note 4? Are we to ignore involvement of margins other than those specified in Note 4, and consequently code SSF 3 within the 000-032 range? Would this also apply to code 048 (extracapsular extension and margins involved)?
Yes, SEER agrees. Code SSF3, code 040 per page C-740 of 2007 SEER manual exactly as stated in Note 4. According to the Inquiry and Response System of the CoC, Note 4 lists specific margins that were once thought to have a prognostic impact. Code 040 in SSF3 should be used only when those margins are involved.
Behavior/Date of Diagnosis--Lung: If the term "Pancoast tumor, NOS" is malignant by definition, should the date of diagnosis be coded to the date of the clinical diagnosis when the clinical diagnosis is made prior to the histologic confirmation of the malignancy?
Yes, Pancoast tumor is by definition malignant. It is defined as a lung cancer in the uppermost segment of the lung that directly invades into the brachial plexus (nerve bundles) of the neck, causing pain. If a Pancoast tumor was identified on imaging prior to the biopsy, the date of diagnosis should be linked to the Pancoast tumor report.
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