Surgery of Primary Site--Brain and CNS: Is "debulking" of a primary brain tumor coded to 21 [subtotal resection of tumor] or 30 [gross resection of tumor]?
Assign code 21 [subtotal resection of tumor, lesion, or mass]. Debulking removes as much of the tumor volume as possible in cases where it is not possible to remove the entire tumor. Debulking should improve the effectiveness of subsequent radiation therapy and/or chemotherapy.
Histology--Leukemia: How is "T-Cell prolymphocytic leukemia, cerebriform (Sezary cell-like) variant" coded when the pathology report COMMENT states: The cerebriform (Sezary cell-like) variant accounts for about 5% of cases of T-cell prolymphocytic leukemia?
For cases diagnosed prior to 1/1/2010:
9834/3 [Prolymphocytic leukemia, T-cell type]. According to the WHO Classification of Haematopeietic and Lymphoid Tissue Tumours, cerebriform or Sezary cell-like is a variant form of T-cell prolymphocytic leukemia.
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.
Reporting Source: Is an ER patient who is diagnosed on peripheral smear with an acute leukemia coded as an outpatient if the patient died while in the process of being admitted for treatment or is the patient coded as a death certificate case?
Code reporting source as 1 [Hospital Inpatient/Outpatient or Clinic] for the case above. This case will be abstracted using information from the outpatient/ER record (and the death certificate).
Multiple Primaries (Pre-2007): Whenever two hollow organs are diagnosed simultaneously with the same histology, one being invasive and the other in situ, can one assume that mucosal spread has occurred and that this situation represents one primary? In the absence of a physician statement, how do you determine mucosal spread from one organ to another?
For tumors diagnosed prior to 2007:
Yes, this type of situation represents one primary. A tumor that is breaking down can be invasive in the center with in situ cancer at the margins. Occasionally the in situ margin can move into a contiguous organ with the same type of epithelium.
Physicians may describe mucosal spread in various manners. You will see the terms "intramucosal extension," "in situ component extending to," or statements of an invasive component in one organ, with adjacent/associated in situ carcinoma in a contiguous organ with the same type of epithelium. A frequent example of this process is bladder cancer extending into the prostatic urethra via mucosal spread.
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 Site Specific Factor/Terminology--Breast: Does the term "focal areas" of in situ carcinoma qualify as "minimal" in situ component when coding SSF6 field (assessment of the invasive and in situ components present) in the CS breast scheme?
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.
Yes, the term "focal areas" of in situ carcinoma describes a minimal in situ component.
MP/H rules/Histology--Breast: How many primaries and what histologies are coded for a left breast when a bi-lumpectomy path reveals one tumor with a microscopic focus of mucinous adenocarcinoma and extensive DCIS and a second .9 cm mucinous adenocarcinoma with extensive DCIS, and the subsequent mastectomy reveals foci of residual DCIS and Paget's disease of the nipple?
For cases diagnosed 2007 or later:
There are two primaries. Primary 1: The two tumors described on the pathology report from the lumpectomy are a single primary using rule M13. Primary 2: Disregard the foci of residual DCIS. Paget disease of the nipple is a separate primary using rule M12.
Primary 1: invasive mucinous adenocarcinoma and extensive ductal carcinoma in situ: Code the histology as 8480/3 [mucinous adenocarcinoma] using rule H27.
Primary 2: Paget disease of nipple: Code the histology as 8540/3 [Paget disease] using rule H14.
MP/H Rules/Multiple primaries--Breast: Does breast Rule M10, 'Tumors that are lobular (8520) and intraductal or duct are a single primary" apply if you have two tumors in the same breast, one ductal and the other tubulolobular (8524) or are they separate primaries per Rule M12?
Apply Rule M10 to this case. Tubulolobular is now classified as a variant of lobular. Code to lobular, NOS (8520) because Tubulolobular does not have a specific ICD-O-3 code.
MP/H Rules/Primary site: What is the primary site and histology for a focus of papillary thyroid cancinoma, follicular variant, arising in thyroid tissue of mature cystic teratoma of the ovary?
For cases diagnosed 2007 or later, code the primary site to ovary [C56.9] and the histology to papillary carcinoma, follicular variant [8340/3].
The steps used to arrive at this decision are:
Refer to the 2012 SEER Manual for help to determine the primary site. This neoplasm is arising in a teratoma of the ovary. Per the 2012 SEER Manual, in this case the site is coded to ovary [56.9] because that is where the tumor originated. Although the teratoma contains thyroid tissue, it arose in the ovary. Teratomas are unusual in that they contain all three germ cell layers from which an embryo forms. It is not unusual to have malignancies that are usually primary to the thyroid, liver, brain, lung, etc., originate in a teratoma.
Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Other Sites Histology rules because site specific rules have not been developed for this primary.
Start with the SINGLE TUMOR: INVASIVE ONLY module, rule H8. The rules are intended to be reviewed in consecutive order within a module. Code the histology as papillary carcinoma, follicular variant [8340/3].
Primary Site: How do we code site when endometrioid carcinoma arises in "endometriosis"?
Code the Primary Site to where the endometriosis implanted, which may or may not be the endometrium. Endometrioid carcinoma can arise in the ovary, endometrium and other internal genital sites. The site/histology edit for endometrioid and ovary has been removed from the SEER edit set.
Reportability: When a hospital pathologist sends the slides from an original biopsy to two or more outside reviewers and the reviewers differ on whether or not the case is reportable, is the case SEER reportable? Does the decision to treat the patient have any bearing on whether the case would be reportable?
Typically, the final diagnosis of the reviewing pathologist is the one used to determine whether the case is SEER reportable. If two or more reviewing pathologists disagree as to whether the case should be reportable, determine reportability based on the following priority order:
1) If the patient is treated for cancer, the case is reportable.
2) If the patient is not treated for cancer, use the amended diagnosis on the original pathology report if the hospital pathologist used the reviewing pathologists' opinions in establishing his new diagnosis.
3) If there is not an amended diagnosis for the original hospital pathology report, use the clinician's opinion regarding what the diagnosis is to determine whether the case is reportable.
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