CS Lymph Nodes--Breast: Are small isolated tumor emboli occasionally found in lymph node capsular or pericapsular lymphatics sufficient to code as a lymph node metastasis?
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 "small isolated tumor emboli" in the pericapsular lymphatics detected by H&E that are less than 0.2 mm as 05 [Regional lymph node(s) with ITC's detected on routine H & E stains].
First-Course of Cancer-Directed Therapy Fields/Hematopoietic, NOS: How do you code treatment for a myelodysplastic syndrome when a patient is admitted to receive a "second transfusion 7 months after diagnosis"?
The first course of treatment for these hematopoietic primaries lasts until there is a treatment change. For the case you cite the second transfusion (7 months after diagnosis) would be first course treatment. Code the Other Cancer-Directed Therapy Field to 1 [Other cancer-directed therapy].
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)."
First Course Cancer-Directed Treatment--Bladder: How should Mitomycin-C instillation for bladder cancer be coded?
Code the instillation of Mitomycin-C into the bladder for a bladder primary in both the Chemotherapy and Surgery to Primary Site fields. Code the Chemotherapy field to 02 [Single-agent chemotherapy administered as first course therapy]. Mitomycin-C is listed in SEER book 8 as a chemotherapeutic drug, specifically an alkylating agent.
Also, code the Surgery of Primary Site field to 15 [intravesical therapy]. Code the surgical procedure as well as the type of drug (chemotherapy in this case).
MP/H Rules/Multiple primaries--Prostate: Is duct carcinoma of the prostate the same as an adeno/acinar carcinoma of the prostate? Specifically, does rule M3 apply when there is an adenocarcinoma of the prostate followed by a duct carcinoma of the prostate or a duct carcinoma followed by adenocarcinoma?
Rule M3 does not apply to adenocarcinoma followed by duct carcinoma of the prostate or vice versa. Rule M3 pertains to cases of adenocarcinoma and acinar carcinoma. These two terms, adenocarcinoma and acinar carcinoma, are equivalent for the purpose of applying the MP/H rules to prostate cases. See page 77 of the Other Sites Terms and Definitions, http://www.seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf
CS Lymph Nodes--Breast: What code should be used for the the following? There is no mention of LNS clinically; the patient has neoadjuvant therapy; and the LNS are matted pathologically.
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.Use the information from the pathologic evaluation to code CS Lymph nodes.
In the nodes evaluation field, assign code 6 [Regional lymph nodes removed for examination with pre-surgical systemic treatment or radiation and lymph node evaluation based on pathologic evidence]. See CS Lymph Nodes note 4.
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-Clinical Extension--Prostate: How is this field coded when biopsies of the prostatic apex are positive and the physician clinically stages the case as T1c?
For cases diagnosed 1998-2003:
Code clinical extension to 33 [arising in the prostatic apex] when a biopsy of the prostatic apex is positive for malignancy, with no further evidence of involvement. If biopsies of both the apex and another site within the prostate (for example right lobe) are positive and there is no mention that the malignancy arose in the apex, code extension to 34 [extending into the prostatic apex].
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.
Priorities/CS Tumor Size--Breast: What is the priority order used in coding tumor size for this site when there is a larger 2 cm lesion noted on the PET scan and smaller sizes described in the pathology report as two malignant masses one measuring 0.8 cm and the second measuring 1.0 cm per the GROSS?
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 CS Tumor Size as 1.0 cm. The pathology report is the highest priority source for coding tumor size. When multiple tumors are present, code the size of the largest tumor.
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