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.
The PH rules for coding lymphomas (Module 7) refer to a lymph node region as defined by the ICD-O-3. Per the Appendix C, , the ICD-O-3 lymph node region for "pelvic" is C775. In this case, there is one lymph node region involved (bilaterally). Per Rule PH20, code the specific lymph node region when multiple lymph nodes within the same lymph node region (as defined by the ICD-O-3) are involved, C775. Per Note 1 under Rule PH20, use this rule when there is bilateral involvement of lymph nodes.
This same table in Appendix C also provides information on how left and right pelvic lymph nodes are categorized by AJCC for purposes of coding stage. If the left and right pelvic lymph nodes are positive for lymphoma, it is involvement of two regions. The case is coded as Stage II.
Keep in mind that the ICD-O-3 definition of regions is used to code the primary site, while the AJCC definition of regions is used to code stage.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
MP/H Rules/Multiple Primaries--Bladder: The new multiple primary rule M7 states that tumors diagnosed more than three years apart are multiple primaries. Does this apply to in situ bladder tumors that occur more than three years apart and to an in situ tumor that occurs three years after an invasive tumor?
For cases diagnosed 2007 or later, use the MP/H rules in order. Rule M6 comes before rule M7.
M6 states that bladder tumors with certain histologies are a single primary. It is a single primary regardless of timing if there is any combination of:
papillary carcinoma [8050]
transitional cell carcinoma [8120-8124]
papillary transitional cell carcinoma [8130-8131]
Rule M7 applies to bladder tumors with histologies other than those listed above. If you have such a case, rule M7 applies to in-situ tumors and to an in situ three years after an invasive.
Primary Site--Head & Neck (Middle ear): How do you code site for a skull based tumor consistent with a low grade papillary adenocarcinoma of "endolymphatic sac origin"?
Code Primary Site to C30.1 [Middle ear]. The endolymphatic sac is part of the inner ear labyrinth located with in the petrous portion of the temporal bone.
First course treatment--Heme & Lymphoid Neoplasms: Is the use of the corticosteroid, Clobetasol, cancer-directed treatment for mycosis fungoides or is it only used to treat the side effects of that disease?
Clobetasol is not cancer-directed treatment at this time.
Note: Question originally submitted in 2010. During 2014 review, this was checked and Clobetasol is still not cancer directed treatment for Mycosis Fungoides.
Primary Site--Lymphoma: How should this field be coded when a diffuse large B-cell lymphoma is found in the femur and in the soft tissue of the anterior chest wall but all CT scans are negative for lymphadenopathy?
For cases diagnosed prior to 1/1/2010:Code the Primary Site field to C809 [Unknown primary site]. The primary site of diffuse large B cell lymphoma can be either nodal or extranodal. The case described above is likely extranodal because there is no evidence of lymph node involvement. Because the extranodal site of origin is unknown, code the Primary Site to C809.
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.
Primary Site--Liver: What is the topography code for combined hepatocellular carcinoma/cholangiocarcinoma (M-8180/3) especially when there is no documentation that intrahepatic bile duct is the tumor site? Reports usually just indicate a liver mass(es) but since the intrahepatic ducts are within the liver, is the code C221 due to the cholangiocarcinoma component, thus making the case stageable?
If there is no further information about where the cancer originated, assign C220. Use ICD-O-3 as the source for coding topography. The topography code associated with combined hepatocellular and cholangiocarcinoma (8180/3) is C220 when there is no other information available, according to ICD-O-3.
MP/H Rules/Histology--Breast: Patient has single invasive left breast tumor diagnosed in 2008. Final pathology diagnosis is "Invasive solid papillary carcinoma". No mention of ductal in report. What is histology?
For cases diagnosed 2007 or later:
As of July 2010:
Code the histology 8503 [Infiltrating papillary adenocarcinoma].
This is solid papillary, not solid AND papillary carcinoma. Solid is an adjective modifying papillary, in other words, a subtype of papillary. We do not have a code for solid papillary, so we code to the NOS, papillary using rule H14.
EOD-Extension--Small Intestine: How do we interpret a pathology description of "extending through serosa and forming masses in the periserosal tissue" for a jejunum primary?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 55 [Invasion of/through serosa and adjacent connective tissue]. The description states the tumor extended through the serosa into periserosal tissue. The periserosal tissue in this case refers to adjacent connective tissue lying exterior to the intestinal wall and not the (sub)serosal tissue that lies exterior to the muscularis but inferior to the serosa. Analyze each case individually since pathologists are not consistent when using the above terminology.
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