EOD-Lymph Nodes--Breast: Are lymph nodes described as being either "keratin positive" or "keratin positive for metastasis" to be coded as involved lymph nodes?
For cases diagnosed between 1998-2003:
Lymph nodes that are only "keratin positive" would not be coded as involved lymph nodes. The pathologist uses this expression to mean that the nodes stained positive for keratin that does not mean they are also involved with cancer.
However, if the pathologist uses these stains to make a definitive diagnosis of metastatic carcinoma (i.e., uses the expression "keratin positive for metastasis"), then code the nodes as involved.
Reportability/Diagnostic Confirmation: If a physician signs a case out as "precancerous melanosis of the face" (8741/2) and there is no microscopic confirmation of the disease, is thisĀ a reportable clinical diagnosis?
This case is reportable because the diagnosis of precancerous melanosis was stated by a recognized medical practitioner. Precancerous melanosis meets the reportable diagnosis criteria (See 2007 SEER Manual page 1).
Primary Site--Unknown & ill-defined site: Should the primary site be coded to C809 [Unknown primary site] or C761 [Thorax, NOS] if the patient died following a limited work-up that included on a cytology on pericardial fluid that was positive for poor differentiated adenocarcinoma?
Based on the information provided, code the primary site to C809 [Unknown primary site]. There is not enough information provided to suggest that the primary site is the thorax or any other location.
Histology--CLL/SLL: If a tissue diagnosis of "small lymphocytic lymphoma" is made six months after an initial blood diagnosis of "chronic lymphocytic leukemia" should the histology be updated from 9823/3 to 9670/3?
For cases diagnosed prior to 1/1/2010:Do not change the histology to small lymphocytic lymphoma (9670/3). The chronic lymphocytic leukemia has advanced/progressed and disseminated into other tissues from the blood during the last six months. If the patient presents with disease in the blood and/or bone marrow only, code to CLL. If a lymph node or other solid tissue is involved initially, code to SLL. For the case cited, the tissue involvement occurred six months after the initial diagnosis and the histology code is not changed to reflect the progression of disease.
For cases diagnosed 2010 forward, 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.
CS Lymph Nodes/CS Mets at Dx--Melanoma: How are these fields coded if a sentinel lymph node biopsy reveals no malignancy but there is an aggregate of melanoma cells in the lumen of a large vein immediately adjacent to the lymph nodes?
This question was answered by the CoC:
Do not count this as regional metastatic disease since there is no evidence it is an established tumor. Stage this as a N0.
MP/H Rules/Histology--Colon: The final diagnosis on a path report for a colon specimen says: Is a colon specimen final diagnosis of carcinoma in situ in a serrated adenoma coded to 8010/2, 8210/2 or 8213/2?
For cases diagnosed 2007 or later, code the histology as 8213/2 [carcinoma in situ in a serrated adenoma].
The steps used to arrive at this decision are:
: Apply ICD-O-3 rule F (Matrix principle) and assign the behavior code /2 when the behavior assigned by the pathologist differs from the usual behavior as given in the ICD-O-3.
: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text) and go to the Colon Histology rules.
: Start at the SINGLE TUMOR module, Rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at rule H4. Code the histology as 8213/2.
Note: The histology 8213 (adenocarcinoma in serrated adenoma) will be added to rule H4 in the next revision.
Histology: Are all well differentiated neuroendocrine carcinomas (carcinoid) tumors coded to 8240 or 8246? When do you use code 8246?
Code 8246 is correct when the mass/lesion is referred to as neuroendocrine "carcinoma" or NEC. Use code 8240 when the mass/lesion is referred to as a neuroendocrine "tumor" or NET G1. The difference is the word tumor versus carcinoma. Carcinoid is most often used interchangeably with neuroendocrine tumor and not with neuroendocrine carcinoma.
Surgery of Primary Site/Surgical Procedure of Other Site--Bladder: What codes are used to represent these fields for a deeply invasive bladder primary treated initially with a TURP (for suspected prostate extension that turns out to be pathologically negative) and a TURB that is subsequently treated with a cystoprostatectomy?
For cases diagnosed 1/1/2003 and after, code:
1. Surgery of Primary Site field to 60 [Radical cystectomy (male only)] because the cystoprostatectomy was the most extensive (definitive) surgery performed to the primary site.
2. Surgical Procedure of Other Site to 2 [Non-primary surgical procedure to other regional sites] based on the TURP.
Reportability/Histology--Skin: Is 'skin, left temporal scalp, low grade adnexal carcinoma, probable sweat gland origin' reportable as 8400/3, skin of temple?
Assign 8390/3 for adnexal carcinoma of skin. 8390/3 is reportable, including 8390/3 of skin.