MP/H Rules/Histology: What is the correct histology code for a NUT midline carcinoma?
Code histology to 8010/3.
NUT carcinoma is identified by the NUTM1 gene rearrangement.
NUT midline carcinomas (NMC) are lethal and morphologically indistinguishable from other poorly diff carcinomas. They are epithelial tumors which can range from undifferentiated carcinomas to carcinomas with prominent squamous differentiation.
A new proposed ICD-O-3 code has been suggested for NUT tumors but it is not yet approved for implementation. Do not use the new code until it is approved for use in the United States.
Surgery of Primary Site--Bladder: Should a TURB be coded to 27 [Excisional biopsy; SEER Note: Code TURB as 27] when there is obvious extravesicular extension demonstrated because the 2004 SEER Manual states "Do not code an excisional biopsy when there is macroscopic residual disease"?
Assign code 27 [excisional biopsy]. The site-specific instructions have priority over the general instructions. According to the instructions for coding surgery of the bladder, use code 27 for TURB.
Code histology to 9732/3 [multiple myeloma]. The plasmablastic subtype/variant does have a prognostic indication, but the disease is still coded as multiple myeloma.
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/Histology--Ovary: How is histology coded for "serous carcinoma, papillary invasive pattern"?
For cases diagnosed 2007 or later, code the histology 8441/3 [Serous carcinoma, NOS]. Use the Other Sites rules. Start with rule H8 and stop at rule H11. "Pattern" is not one of the terms used to identify a specific type (See H16), so papillary is ignored.
When coding the Covid testing results, does SEER have any guidance on whether or not at home tests fall within reportability? For instance, if a medical provider says pt tested positive on an at home test, do we record that?
When you have information about home COVID tests, record this information. For example, if the home test was positive record as follows: COVID-19 rapid viral antigen test POS 08/09/2022
EOD-Clinical Extension--Prostate: In the SEER EOD manual, there is a list of terms to distinguish apparent from inapparent tumor for prostate primaries. If a physician uses a term not currently on the list or if a physician uses a list in the "maybe" category, should we assume the tumor to be clinically inapparent or clinically apparent tumor?
For cases diagnosed 1998-2003:
If the physician used a term not on the clinically apparent/inapparent list, ignore that term and use the best information available from other sources to code the EOD-Extension field.
If clarifying stage information is missing and the term is in the maybe category or the term is not on the list, then code EOD-Extension as 30 [localized, NOS] for cases that appear localized.
Radiation/Chemotherapy: How do we code radiation and chemotherapy when the only statement we have is that the patient is "referred to either an oncologist or a radiation therapist"?
For cases diagnosed 1/1/2003 and after: A referral does not mean that the radiation therapy or chemotherapy was actually recommended. These cases need follow-back to see if treatment was recommended and/or administered. Some registries code these cases as 8 [Radiation recommended, unknown if administered] or 88 [Chemotherapy recommended, unknown if it was administered] and routinely review all cases with 8 or 88 codes. Upon review, the codes are updated depending on the information found. If there is no information available, the code 8 or 88 is changed to 0 or 00 [None].
MP/H Rules/Histology--Bladder:What is the correct histology code for the following bladder histology? High grade urothelial cancer with extensive neuroendocrine differentiation.
Code neuroendocrine carcinoma, 8246/3. Note 2 under Rule H7 applies.
We are reviewing mixed histologies for the next version of the rules.
First Course Treatment/Surgical Margins of the Primary Site--Melanoma: Is margin status positive or negative when the lesion “approximates” margins? This was noted in the pathology report comment on a malignant melanoma in-situ shave biopsy. Follow-up with physicians is not possible in this situation.
Assign margin status as “positive” when stated as approximates margins as recommended by our expert pathologists. Approximating means coming right up to inked margin without the margin transecting the tumor.
Terminology: Do focus, focal, foci and chips mean the same thing?
Focus, focal, and foci are variations of the same word. Focus (noun) describes an area or point of disease, either grossly or microscopically. Focal (adjective) relates to the area/focus of disease; an example is a prostate with focal adenocarcinoma. This means that the majority of the prostate is benign and the adenocarcinoma is confined to one small area/point. Foci (plural) describe more than one area/focus of disease. A prostate with foci of adenocarcinoma means the disease is multifocal (several areas/points of disease).
Chips are microscopic amounts of either tissue or tumor. A pathologist might examine several chips of prostate tissue, one of which contains a focus of adenocarcinoma.