Primary Site--Brain and CNS: Are meninges surrounding cranial nerves cranial meninges [C700] or a part of the specific nerve's sheath? Is the primary site for an optic nerve sheath meningioma coded to optic nerve [C723] or cranial meninges [C700]?
EOD-Extension--Colon: How is this field coded for an appendical primary when the appendix has ruptured and intrapentoneal fluid is positive?
For cases diagnosed 1998-2003: Code EOD extension as 85 [Metastasis]. Positive intraperitoneal fluid is equivalent to distant metastasis (implantation) for colon, including appendix, primaries.
Ambiguous Terminology/Reportability: Is the phrase "indicative of cancer" SEER reportable?
No. The phrase "indicative of cancer" alone is not a definitive cancer diagnosis. The word "indicative" is not on the list of ambiguous terms that is equivalent to a diagnosis of cancer.
Primary site--Heme & Lymphoid Neoplasms: Is the primary site coded to C778 or C779 for a diffuse large B cell lymphoma with abdominal lymph node, neck lymph node, and spleen involvement?
Use Rule PH21 to code the primary site to C778 [lymph nodes of multiple regions]. The spleen is not listed under the Primary Site(s) section in the Heme DB for diffuse large B-cell lymphoma. Per Rule PH21 code the primary site to multiple lymph node regions, NOS (C778) when multiple lymph node regions, as defined by ICD-O-3, are involved and it is not possible to identify the lymph node region where the lymphoma originated. The spleen is a primary site for only a few lymphomas (noted in the Heme DB). Because the spleen filters blood, it is often reactive (splenomegaly) or frankly involved with the lymphoma. That reaction or involvement, however, does not affect the primary site coding. Only the involved nodes are used in coding primary site.
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.
Grade--Heme & Lymphoid Neoplasms: How is grade coded for a malignant non-Hodgkin lymphoma, large B-cell type, with features consistent with T-cell rich variant?
Code grade to 6 [B-cell] for the histology malignant non-Hodgkin lymphoma, large B-cell type, with features consistent with T-cell rich variant [9680/3]. Under the Definition section for histology code 9680/3 it states there are morphologic variants of the disease: centroblastic, immunoblastic, plasmablastic, T-cell/histiocyte-rich, anaplastic.
Rule G3 in the Heme Manual confirms the grade listed in the Heme DB under its Grade section for the histology 9680/3. While the patient presented with a variant of DLBCL that is T-cell/histiocyte rich, it is still a B-cell phenotype. The grade is coded accordingly.
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.
Primary Site: How is this field coded for cholangiocarcinoma involving the intrapancreatic bile duct?
Code the primary site as C24.0 [Extrahepatic bile duct, includes Common bile duct] for a cholagiocarcinoma originating in the common bile duct. A portion of the common bile duct is within the head of the pancreas: The intrapancreatic segment of the common bile duct.
Multiple Primaries (Pre-2007)--Breast: Synchronous invasive right breast tumors. Ductal carcinoma, NOS in UIQ and Ductal carcinoma, tubular type in LOQ. Are these two primaries or a single primary coded to 8523/3?
For tumors diagnosed prior to 2007:
Code as two primaries, one 8500/3 [Infiltrating duct carcinoma] and one 8211/3 [Tubular carcinoma].
Apply the multiple primary rules first. These are synchronous right breast tumors with different histologies. Therefore, they are separate primaries according to rule 5.a on page 12 of the SEER Program Code Manual. ICD-O-3 histology code 8523/3 is NOT to be used to combine histologies from separate primaries; it is used for mixed histologies in a single primary.
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.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Kidney: How many primaries, with what histology(ies) should be coded when nephrectomy pathology specimen shows separate tumors of "renal cell carcinoma [clear cell type]" and "renal cell carcinoma [granular cell type]"?
For tumors diagnosed prior to 2007:
Abstract two primaries. This is an example of two tumors with different histologic types in the same site. The right kidney has two separate tumors.
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.
Reason No Cancer-Directed Surgery--Hematopoietic, NOS: Is this field always coded to 1 [not performed, not part of first course] for leukemias & other hematopoietic diseases?
For cases diagnosed 2003 and later: For sites where "Surgery of the primary site" is coded 00 or 98 (hematopoietic included), Reason for No Surgery of Primary Site should be coded as 1 [Surgery of the primary site not performed because it was not part of the planned first course of treatment]. On rare occasions, there may be surgery to the primary site for a hematopoietic disease, such as an excisional biopsy of a myeloid sarcoma. Refer to the "Abstracting and Coding Guide for the Hematopoietic Diseases" for cell-type-specific treatment information.
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