Reportability--Liver: Is a 2023 cholangiocarcinoma case
with Liver Imaging Reporting And Data System (LI-RADS) M (LR-M) lesion on
imaging reportable?
Report LR-M unless there is information to the contrary.
The American College of Radiology defines LR-M as "probably or definitely
malignant, not necessarily hepatocellular carcinoma (HCC)."
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: Would the simultaneously occurring histologies of "high grade ductal carcinoma in situ with micro invasion" and "keratinizing squamous cell carcinoma" be coded as two primaries or as a single primary when the pathologist is not clear whether two separate tumor masses exist?
For tumors diagnosed prior to 2007:
Code as two primaries, assuming the tumors are separate and the margins are clear/negative. Code 8071/3 [Invasive squamous cell ca, keratinizing] and 8500/3 [Ductal carcinoma, "microinvasive"].
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.
Histology (Pre-2007)--Breast: Is a "noninvasive papillary carcinoma, solid type, of the breast" coded to 8503/2 [noninfiltrating intraductal papillary carcinoma] or 8230/2 [Intraductal carcinoma, solid type]?
For tumors diagnosed prior to 2007:
Code histology to 8503/2 [Noninfiltrating intraductal papillary adenocarcinoma]. "Solid" is one of four subtypes of intraductal papillary carcinoma. The other subtypes are cribriform, micropapillary and spindle cell. ICD-O-3 does not provide codes for each intraductal papillary subtype, so code to intraductal papillary carcinoma.
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.
EOD-Extension--Corpus uteri: How should EOD extension be coded when the pathology report shows adenocarcinoma arising in the endometrium with the statement "no invasive carcinoma identified?"
For cases diagnosed 1998-2003: Code endometrial cancer with no invasion to EOD extension code 11 [Confined to endometrium (stroma)]. "No invasion" most likely means no invasion of the myometrium.
Histology (Pre-2007)--Melanoma: How is histology coded if the final diagnosis is "melanoma" and only in the comment section of the pathology report is there an indication of "Type: Lentigo Maligna. Cell Type: Small Cell"?
For tumors diagnosed prior to 2007:
Code the histology as 8742 [lentigo maligna melanoma]. Code the specific histologic type, even if stated only in the comment section.
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.
CS Extension--Retinoblastoma: When the degree of extension differs between the retinas, how is extension coded for simultaneous bilateral retinoblastoma?
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.Assign the CS extension code that corresponds to the greatest level of extension seen in either eye, excluding information from enucleation.
Record extension based on enucleation in Site Specific Factor 1.
Record bilateral disease under laterality. For retinoblastomas, bilaterality is not a component or consideration for staging.
EOD-Extension--Head & Neck: How much information is needed for a head and neck primary in order to code extension to localized versus unknown? What code is used to represent this field when the only information for a buccal cavity primary is a positive aspiration of the buccal mass?
For cases diagnosed 1998-2003:
Code the EOD-Extension to 99 [Unknown] for this case until more information is received. The available information does not describe the primary site and there is a complete lack of staging information.
Head and neck cancers spread early and often to nodes. Do not code the EOD-Extension to localized when the information is as limited as it is for this example.
Multiple Primaries (Pre-2007)--Skin: In a patient with Muir Torre syndrome, should each of 12 sebaceous carcinomas diagnosed from 1994-2005 be a new primary or should this process be one primary diagnosed in 1994?
For tumors diagnosed prior to 2007:
Follow the rules in the 2004 manual for determining multiple primaries. When the sebaceous carcinomas are in different sites (topography code difference in the first two numeric digits after the C), they are separate primaries. When the sebaceous carcinomas are more than two months apart, they are separate primaries.
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.
CS Extension--Bladder: How should this field be coded when the pathology states "papillary transitional cell carcinoma with no invasion into the submucosa or deep muscularis" but there is "focal extension of tumor into bladder diverticula"?
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.
Code the CS Extension field to 01 [Papillary transitional cell carcinoma stated to be noninvasive]. Extension into bladder diverticula does not change the code. Diverticula are pouches in the mucosa (mucous membrane).
Histology--Heme & Lymphoid Neoplasms: How is this field coded for a patient with a negative bone marrow and multiple plasmacytomas in different bone sites (e.g., thoracic vertebrae and left femur)?
Code the primary site to C419 [Bone, NOS] and the histology to 9731/3 [solitary plasmacytoms].
The vertebral lesions are common for plasmacytomas, as are lesions of the femur. If the patient does not meet the criteria of plasma cell myeloma/multiple myeloma (which is 20% of the leukocyte differential count), do not code the histology to multiple myeloma.
Per Rule M2, abstract a single primary when there is a single histology.
Per Rule PH3, code the primary site to the where the plasmacytoma originated and code the histology of bone () when the diagnosis is multiple plasmacytomas of the bone.
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.
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