First Course Treatment/Neoadjuvant Therapy--Melanoma: How are the three Neoadjuvant Therapy data items (Neoadjuvant Therapy, Neoadjuvant Therapy--Clinical Response, Neoadjuvant Therapy--Treatment Effect) coded when a patient is diagnosed with melanoma in the lymph nodes with no primary skin site identified? The physician gives immunotherapy as neoadjuvant therapy with planned and carried out surgical resection of involved lymph nodes following completion of immunotherapy. There is no "planned definitive surgical resection of the primary site" as no primary site was found,
Assign code 0 to each of the three Neoadjuvant Therapy data items in this situation.
We will add an example to the coding instructions for these data items in the next release of the manual.
Reportability--Carcinoid: Is a diagnosis of carcinoid heart disease, based solely on clinical information and no pathology, reportable?
Carcinoid heart disease is not reportable but this diagnosis indicates that the patient likely has a carcinoid tumor which may be reportable. Obtain further information.
Surgery of Primary Site/Scope Regional LN Surgery--Breast: How should these fields be coded when a sentinel lymph node dissection removes one-to-three axillary lymph nodes and a total/simple mastectomy is done?
Assign code 41 [Total (simple) mastectomy, NOS WITHOUT removal of uninvolved contralateral breast] for Surgery of Primary Site. Assign code 2 [Sentinel lymph node biopsy] for Scope of Regional Lymph Node surgery. Code 41 applies to a total/simple mastectomy with any number of sentinel lymph nodes removed -- as long as all of the nodes removed are designated as sentinel nodes.
MP/H Rules/Histology--Lung: Per SINQ 20110115, why is micropapillary adenocarcinoma of the lung coded to 8260 [papillary adenocarcinoma] rather than 8050 [papillary carcinoma]?
The histology codes for lung tumors are based on the World Health Organization Classification of Lung Tumors. Chart 1 in the MP/H Lung Equivalent Terms, Definitions, Charts, Tables and Illustrations (2007 MP/H Rules Manual) illustrates the WHO Classification of Lung Tumors.
Using Chart 1, note that papillary adenocarcinoma [8260] is located under the Adenocarcinoma (NOS) branch. The histology in question was stated to be "micropapillary adenocarcinoma" and not "papillary carcinoma." Papillary carcinoma, NOS [8050] is not actually located on the chart. However, papillary squamous cell carcinoma is listed under the Squamous Cell Carcinoma, NOS branch, histology code 8052.
Next, look up papillary carcinoma [8050] in the Morphology - Numerical listing section of the ICD-O-3. Papillary carcinoma, NOS is a Squamous Cell Neoplasm. (Refer also to SINQ 20091040.)
The key word used to determine the appropriate histology in this case is "adenocarcinoma." This is a papillary adenocarcinoma and not a papillary squamous neoplasm.
MP/H Rules/Histology--Breast: If the abstractor only has the CAP protocol information from a pathology report and it does not include a "final diagnosis" label, which fields of the protocol are used to determine the histology and whether there is carcinoma in situ present in the specimen?
For cases diagnosed 2007 or later, if the CAP protocol is used in lieu of a final diagnosis, use all of the information in the CAP protocol.
Histology (Pre-2007)--Melanoma: Is the code 8740/3 [malignant melanoma in a junctional nevus] to be used when the pathologic diagnosis is "malignant melanoma arising in a compound nevus"?
For tumors diagnosed prior to 2007:
Assign code 8720/3 [malignant melanoma, NOS] for malignant melanoma arising in a compound nevus. A compound nevus is not the same as a junctional nevus.
ICD-O-3 does not have a specific code for melanoma in a compound nevus. Assign the code for the type of melanoma specified; for example, NOS, superficial spreading, etc.
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.
MP/H Rules--Bladder: Is a TURBT in 4/07 that demonstrates papillary carcinoma (8130/3) followed two weeks later with biopsies that demonstrate high grade flat dysplasia/carcinoma in situ (8010/2) two primaries?
For cases diagnosed 2007 or later, rule M6 applies and this is a single primary.
Flat transitional cell carcinoma and carcinoma in situ of the bladder are synonymous. See the definition of "Flat Tumor (bladder)/Noninvasive flat TCC" in the Urinary Terms and Definitions section of the 2007 MP/H manual.
Histology--Heme & Lymphoid Neoplasms: How is the histology coded for a "cutaneous diffuse large B-cell lymphoma, leg type" that has been verified as a valid diagnosis with prognostic factors including age and number of lesions on the legs?
Code this histology to 9680/3 [diffuse large B-cell lymphoma]. Primary cutaneous DLBCL, leg type, is listed as an Alternate Name for DLBCL per the Heme DB.
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.
Race: How is race coded for a patient who self-reports as white? In the Family History portion of the genetics consult, it states the maternal family is of mixed European and Cherokee descent; the paternal side is of mixed German/mixed European descent. Is race coded as Race 1: 03-American Indian and Race 2: 01-White, or as 01-White according to self-report by the patient?
Self-reported information is the highest priority for coding race. That is because the race information for the U.S. population comes from census data and that information is self-reported. For national cancer statistics, in order for the numerator (cancer cases) and the denominator (population) to be comparable, use self-reported race information whenever it is available. We will add this clarification to the SEER manual.
CS Extension/Histology (Pre-2007)--Breast: Paget disease with underlying DCIS. How should CS Extension, SEER Summary Stage 2000, histology, and behavior be coded?
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.
For tumors diagnosed prior to 2007:
Based only on the information provided above,
1. The CS extension code is 07 [Paget disease of nipple (without underlying invasive carcinoma pathologically)].
2. The SS 2000 stage is 1 [Localized].
3. The histology code is 8543 [Paget disease and intraductal carcinoma of breast]. The behavior code is 3 [Malignant].
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.
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