MP/H Rules/Histology--Lung: How is micropapillary adenocarcinoma of the lung coded given that a literature search indicates that this is a distinct subtype of adenocarcinoma of the lung with poor prognosis?
Code the histology to 8260/3 [papillary adenocarcinoma]. An expert pathologist states that the WHO notes micropapillary to be a pattern seen in papillary carcinomas, but does not specify it as a separate histologic type.
Reportability/Ambiguous Terminology--Prostate: Is a prostate biopsy that states "highly suspicious for, but not diagnostic of adenocarcinoma, suggest another biopsy" reportable?
Do not report. "Not diagnostic of" means that while the pathologist is seeing some features that resemble cancer, there are not enough features to feel comfortable making an unquestionable diagnosis. Watch for another biopsy of the patient in the next 3-6 months. The statement "not diagnostic of" overrules the "highly suspicious" statement.
CS Extension--Bladder: How is extension coded if the bladder tumor involves the right ureter per cystoscopy but the TURB specimen demonstrates muscularis propria invasion?
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 extension based on the area of deepest invasion. According to the TNM Supplement, which was used as a resource in the development of CS, "Direct invasion of the distal ureter is classified by the depth of greatest invasion in any of the involved organs." Record the greatest extent of disease using both clinical and operative/pathologic assessment.
Reportability/Grade, Differentiation: Does the term "grade 0" refer to differentiation or does its use as a modifying phrase in the final diagnosis of "grade 0 immature teratoma" impact reportability?
Regarding the term "grade 0" for an immature teratoma, determine whether the pathologist is using that term to describe the primary tumor or its implants. The term can be used to describe both situations.
An immature teratoma (IT) may have grade 0 (benign) implants. Grade 0 implants may affect the prognosis and treatment, but the primary tumor (IT) would still be malignant and therefore reportable. If grade 0 pertains to the primary tumor (as opposed to implants) it is benign, and therefore not reportable.
Histology: Is there any guidance on using STRATA Oncology testing (molecular tumor profiling tests), such as StrataNGS and StrataEXP, to code SSDIs, histology, etc? I do not see anything in STR, SEER Program Manual, SINQ, or CAnswerForum. We are seeing the testing with our 2021 paths.
We recommend that you do not use information from these molecular tumor profiling tests until they become a standard diagnostic tool. If/when that happens, we will add information to the various manuals.
CS Extension--Ovary: What code is used to capture omental caking?
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.The term "omental caking" refers to a thickened omentum. In the case of ovarian cancer, omental caking is always indicative of involvement of the omentum. The omentum is an abdominal structure for the purposes of CS extension. Assign the appropriate code between 70-73.
When the size of implants is not stated, but operative report and scans state omental caking, code 71 would be best. When there are no size measurements on the operative report or scan or elsewhere, there is not enough information to assign 72. The choice of code between 70 and 73 will depend on the details of the specific case.
Reportability/History (Pre-2007)/Behavior Code--Ovary: Should the matrix principal in Rule F be applied to code a 2002 right ovary case to 8462/3 [Papillary serous borderline ovarian tumor] when peritoneal washings reveal the same histology?
For tumors diagnosed prior to 2007:
Do not apply the matrix principle in this case. This ovarian tumor is not reportable (behavior /1 per ICD-O-3). The peritoneal washings reveal the same histology (/1), rather than malignant cells. Based on the information provided, there is no evidence to support changing the behavior code.
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.
Primary site--Heme & Lymphoid Neoplasms: How is this field coded when a 5/26/10 colonoscopy reveals ulcers in the cecum, ascending, transverse, descending, and sigmoid colon and, the final diagnosis on the pathology report is post-transplant lymphoproliferative disorder [9971/3]?
Code the primary site to C189 [Colon, NOS] per Rule PH1.
Code the primary site to C189 [Colon, NOS] and not C188 [Colon, overlapping lesion] because there are multiple ulcers in different segments of the colon. The .8 code is used only for a single lesion that overlaps subsites.
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.
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