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Report Produced: 08/27/2024 09:21 AM

Report Question ID Question Discussion Answer Year
20021055 EOD-Extension--Liver: Can we use CT scan descriptions such as "portal vein thrombosis" or "extensive infiltration of the liver" or "diffuse infiltration of the liver" to code extension for liver primaries? See discussion.

1. Would you code portal vein involvement for a CT scan description of "portal vein thrombosis"?

2. Would you code more than one lobe of the liver as involved for CT scan descriptions of "extensive infiltration of the liver" or "diffuse infiltration of the liver"?

For cases diagnosed 1998-2003:

1. No. Thrombosis can be caused by non-cancerous conditions.

2. Yes. Code the EOD-Extension field to 65 [Multiple (satellite) nodules in more than one lobe of the liver] when "extensive infiltration" or "diffuse infiltration" is stated.

 2002
20021150 SEER Guidelines Over Time: Should we apply the current guidelines to previously missed older cases now being reported to the central registry? See discussion.

1. We receive "straggler" cases for coding that were diagnosed when previous coding schemes and guidelines were applicable. When a specific guideline is in place for a given time period and is later changed in some way, we try to use the specific guideline that was in place at the time of diagnosis when coding the incoming case. However, it is not always possible to remember or to be able to access those old guidelines.

2. There are situations when coding old cases that have no applicable guideline for the older diagnosis years but current SEER documentation informs the coder how to handle the situation. For example, in the SEER Program Code Manual (3rd ed), 3 new guidelines were added for coding of differentiation. There were no guidelines in the previous SEER manual that specifically covered those situations. Should we use the current rules in coding differentiation on the older incoming case?

 Code all fields according to the instructions that were in effect at the time the case was diagnosed. If the old guidelines are unavailable or non-existent, code the case in the current scheme. The year the case was abstracted will indicate that the case was a late entry into the system and that could account for the differences in coding seen by a reviewer. 2002
20000482

EOD-Extension--Head & Neck (Larynx): When "fixed" is stated for a larynx primary does it specifically have to say that it is the vocal cord that is fixed? Are the terms "fixed" and "immobile" synonymous? Should these cases be coded to 40 rather than 35? See discussion.

1. The tumor is fixed, the arytenoid on left side is fixed and the right arytenoid is partially fixed. Palpation of the tumor reveals it to be fixed in the larynx. T3 N0 M0 Stage III.

2. Erythema and swelling of right false cord with bulging and immobility. Left cord moves normally. T3 N0 M0 Stage III.

For cases diagnosed 1998-2003:

Code the EOD-Extension field for both cases to 40 [Tumor limited to larynx WITH vocal cord fixation]. Code 35 [Impaired vocal cord mobility] implies that mobility is diminished in strength and/or quality but is not rigid. Impaired mobility is a T2 tumor. Because the second case is T3, the physician implies he/she is using the term "immobility" to describe complete fixation.

 2000
20021005 EOD-Extension--Lymphoma: What code is used to represent this field for an extranodal lymphoma that has more than one tumor in the primary site OR has intraluminal extension from the primary site to an adjacent organ? See discussion.

1. Small lymphocytic lymphoma with 2 tumors in the stomach.

2. Lymphoma involving the cecum and ileum.

3. Lymphoma of the fundus of stomach with extension into the esophagus.

For cases diagnosed 1998-2003:

Using the EOD scheme for lymphoma, code the Extension field to 11 [Localized involvement of a single extralymphatic organ or site; Stage IE] for all 3 of these cases.

For the stomach lymphoma: There are 2 areas of lymphoma, but it is still confined to one site.

For the other 2 lymphomas: Intraluminal (mucosal) spread of the lymphoma never equals extension. The same phrase that was added to code 21, "Direct extension to adjacent organs or tissues", will be added to code 11 in the Collaborative Stage System. Neither "mucosal spread to a contiguous organ" or "direct extension into a nearby organ" affect staging. Both are still coded to 11 as long as there are no other sites of lymphoma involvement.

EOD code 80 is poorly written. It does not mean diffuse invovement or multiple tumors in a single organ but rather "diffuse disease in two or more organs."

 2002
20021100 Primary Site: How do we code the primary site for a malignancy that occurs in parenchyma located in an ectopic site? See discussion.

1. Patient presented with a subcutaneous nodule in right axilla. Pathologic impression by initial and reviewing pathologists is that the lesion represents a breast adenocarcinoma arising in ectopic mammary parenchyma. Subsequent breast biopsies were negative.

2. Patient presented with right branchial cleft cyst. The pathologist states the cyst is a primary thyroid adenocarcinoma arising in an ectopic focus of thyroid tissue. The subsequent total thyroidectomy is negative.

Code the primary site to the location of the malignancy.

1. Code the Primary Site field to C76.1 [Axilla NOS].

2. Code the Primary Site field to C10.4 [Branchial cleft].

 2002
20021124

Multiple Primaries (Pre-2007)/Primary Site/EOD-Extension--Lung: Should lung cases be counted as more than one primary when nodules removed from separate lobes of the same lung have either the same histology or they are different immunophenotypes of the same main histologic classification (e.g., adenocarcinoma)? See discussion.

1. Path report: "Two nodules (RLL, RUL) of primary pulmonary demonstrate adenocarcinoma with different histologic appearances and different immunophenotypes consistent with synchronous lung adenocarcinomas." Per ICC interpretation, two lung primaries are favored.

2. Path report: "Two peripheral nodules (LLL, LUL) demonstrate similar P.D. non-small cell carcinoma with features of large cell undifferentiated carcinoma."

For tumors diagnosed prior to 2007:

According to current SEER rules, both examples represent one primary because both tumors are in one lung and of a single histologic type. Code the Primary Site field to C34.9 [Lung, NOS] for both examples and the EOD-Extension field to 77 [Separate tumor nodules in different lobe]. This will capture the fact that there are multiple tumors within the lung for each of these examples.

Differences in immunophenotypes confirm independent de novo cancers and rule out metastasis. Immunophenotype differences do not equate to different histologies. In the first example described, there are different histologic features; however, the main classification is adenocarcinoma.

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.

 2002
20091082 Behavior--Breast: How is this field coded for a case in which the final diagnosis reports DCIS, but the CAP protocol or microscopic findings show microinvasion? See Discussion.

1. Path report for breast cancer has final diagnosis as 'DCIS' but the CAP protocol in the body of the report says 'microinvasion seen, T1mic.'

2. Path report says 'DCIS' in the final diagnosis and microinvasion is identified in the microscopic portion of the report, but it is not in CAP protocol format and not stated in the final diagnosis.

Code both scenarios /3 [malignant (invasive)]. Information regarding behavior is not limited to the final diagnosis or the CAP protocol. See page 84 in the 2007 SEER manual:

Code the behavior as malignant /3 if any portion of the primary tumor is invasive no matter how limited; i.e. microinvasion.

 2009
20041069

Reportability--Brain and CNS: Is a meningioma invading the bone malignant and, therefore, SEER reportable if diagnosed prior to 2004? See Discussion.

1. Meningothelial meningioma with prominent nuclear pleomorphism, infiltration into dura, calvarium, temporalis skeletal muscle.

Microscopic: Multifocal infiltration by meningothelial tumor...extensive infiltration of trabecular spaces, extension through inner and outer calvarial layers by meningioma...mitotic activity in tumor noted but below the 4 per 10 high power field threshold for diagnosis of atypical meningioma.

2. Aggressive (invasive) transitional type meningioma, neuroimaging and histology imply extensive invasive meningioma involving bone and paraspinal soft tissues. Microscopy:...invaded bone...focal EMA positivity diagnostic of invasive transitional type meningioma... tumor invades bone.

The two cases above are benign meningiomas and not reportable prior to 2004. According to an expert consultant, meningiomas are in the lining cells for the inner table of the skull and as such have an affinity for bone that allows them to penetrate adjacent bone without being "malignant."

The WHO Nervous System Tumor Classification states malignant meningioma exibits histological features of frank malignancy far in excess of the abnormalities present in atypical meningioma (WHO grade II). Examples of the histologic features of malignant meningioma are obviously malignant cytology, or high mitotic index (20 or more mitoses per 10 high-power fields). They correspond to WHO grade III and are usually fatal.

 2004
20000849 Primary Site--Lymphoma: How should you code the primary site for a lymphoma that presents with involvement of an extranodal site and regional lymph nodes? See discussion.

1. Lymphoma involves the spleen and the splenic lymph nodes.

2. MALT Lymphoma involves the stomach and the gastric and iliac lymph nodes.

1. Code the Primary Site field to C42.2 [spleen].

2. Code the Primary Site field to C16._ [stomach].

When lymphoma presents in an extranodal site and in the regional lymph nodes for that extranodal site, code the Primary Site field to the extranodal site. The typical disease process is that lymphoma can spread from an extranodal organ to its regional lymph nodes. It cannot metastasize from the regional lymph node to the extranodal organ. The exception to this would be if the lymph nodes presented as one large mass that extended into the regional organ.

 2000
20000487 Primary Site--Kaposi Sarcoma: Would the following Kaposi primaries be examples of cases not coded to skin for primary site? See discussion.

1. KS developed initially as a lesion in the oral cavity and followed by the appearance of skin lesions.

2. KS found in a resected parotid gland with metastasis to the parotid gland lymph node. No skin lesions identified.

3. KS discovered in a biopsied 3 cm axillary lymph node. Clinically, the patient had hepatosplenomegaly, ascites, and extensive mesenteric lymph nodes. (No mention of skin.)

Code the Primary Site field as follows:

1. C44.9 [Skin, NOS] as the default value when lesions develop simultaneously in skin and non-skin areas.

2. C07.9 [Parotid gland]

3. C44.9 [Skin, NOS] as the default value when there is no mention of lesions in the skin or other primary site.

Edward Klatt states in Practical AIDS Pathology, "...Visceral Kaposi (involving one or more internal organ sites) is also present in three-fourths of cases, but may not be diagnosed prior to autopsy. Visceral involvement frequently includes the lung, lymph nodes and gastro-intestinal tract."

 2000