Reporting Source: If the only patient record available for a physician office biopsy is the pathology report identified from a freestanding laboratory, is reporting source coded to 3 [Laboratory Only (hospital-affiliated or independent)] or 4 [Physicians office/Private Medical Practitioner (LMD)]? See Discussion.
A case was identified through a pathology report from a freestanding lab. The doctor who submitted the specimen left the state. His records cannot be located. Because the patient had the specimen removed at a physician's office, not at a path lab, is Type of Reporting Source field coded to the physicians office?
Reporting Source is the source that provided the best information used to abstract the case.
For this case, assign code 3 [Laboratory Only (hospital-affiliated or independent)]. Reporting source should reflect the lab where this case was identified. The MD office added nothing to the case, not even a confirmation of malignancy.
MP/H Rules/Histology--Brain and CNS: Is it generally correct that the code for PNET [9473/3] should be used to code tumors arising in the brain and spinal cord, and the code for pPNET [9364/3] should be used to code tumors arising in the bone and soft tissue? See Discussion.
The terms and definitions for "Brain" in the 2007 MP/H rules distinguish between pPNET and PNET. Is it correct even when the diagnostic terminology alone would lead to other coding, such as "PNET" used to diagnose a soft tissue mass in the chest and "neuroectodermal tumor" used to diagnose a brain mass?
Should additional rules be added to both "Brain" and "Other Sites" to enforce this distinction?
For cases diagnosed 2007 or later:
Yes. Assign code 9473/3 for tumors arising in the brain and spinal cord and assign code 9364/3 for tumors arising in the bone and soft tissue.
Clarification and reinforcement of this distinction will be added to the "Other sites" terms and definitions with the first revision to the MP/H rules.
Histology--Pancreas: How is a "gastrin and somatostatin producing endocrine neoplasm" coded that has lymph node metastasis?
The best code available for this situation is 8153/3 [Gastrinoma, malignant].
Many pancreatic endocrine tumors produce more than one peptide, such as gastrin and somatostatin in this case. ICD-O-3 does not provide a code for pancreatic endocrine tumors which produce more than one peptide. According to the WHO Classification of Tumours of Endocrine Organs, there is a distinct hormonal syndrome associated with gastrin producing tumors, and not with many of the somatostatin producing tumors. Therefore, our pathologist consultant advises us to code to gastrinoma in this case.
Behavior--Bladder: What behavior code is used for a TURB path specimen diagnosis of "non-invasive urothelial carcinoma, no muscle found, depth of invasion cannot be assessed" when the clinician stages the case as Ta? See Discussion.
The SEER site specific coding module for bladder says, "If the only surgery performed is a TURB and if it is documented that depth of invasion cannot be measured because there is no muscle in the specimen, code the behavior as malignant and not in situ."
Assign behavior code 2 [in situ] based on the physician's stage Ta.
When no other information is available and the TNM designation is not available, use the instructions on page C-844 in Appendix C of the 2007 SEER manual as a default.
Grade, Differentiation: How is grade coded for cases using the FNCLCC (Federation Nationale des Centres de Lutte Contre Ie Cancer) system? See Discussion.
Is FNCLCC a recognized system in the United States? Tongue was the primary site for the case we saw that used FNCLCC.
Do not code the data item Grade based on the FNCLCC grade. You may record the FNCLCC grade in a text field.
MP/H Rules/Multiple Primaries--Bladder/Renal Pelvis: Is a non-invasive papillary transitional cell carcinoma of the bladder diagnosed one year after the occurrence of an invasive papillary transitional cell carcinoma of the renal pelvis reported as one or two primaries?
For cases diagnosed 2007 or later:
This is a single primary with renal pelvis as primary site.
Use the 2007 MP/H rules to determine if the 2007 diagnosis is a new primary. Use the Urinary rules, multiple tumors module. Start with rule M3. Follow the rules down to Rule M8 and stop. This is an example of implantation effect.
Ambiguous Terminology: Why was 60 days chosen for ambiguous terminology?
The Histology Task Force approved a 60 day time frame for ambiguous terminology.
The majority of cases are first identified by ambiguous terminology; for example, a patient has a mammogram that shows a lesion suspicious for cancer. That first indication of cancer prompts a work-up to either confirm or rule-out the cancer diagnosis.
The data item "Ambiguous terminology" is not intended to capture information on this routine method of detecting and diagnosing cancer. The 60 day time frame should keep these cases out of the ambiguous terminology data item.
The data item is intended to identify those cases where the cancer diagnosis is NOT confirmed during the work-up, but the case is still entered into the database. For example a patient who has a TRUS because of elevated PSA. The pathology from the TRUS says "Suspicious for adenocarcinoma of the prostate." The physician only documents that the patient is to return in 6 months for another PSA and TRUS. The registrar would enter this case into the data base because the word "suspicious" is on the ambiguous terminology list.
Reportability/Histology: Is a case reportable if the Final Diagnosis in a pathology report indicates a non reportable diagnosis but the Diagnosis Comment on the same report indicates a non reportable diagnosis followed by a reportable diagnosis in parenthesis? See Discussion.
08/13/2007 polypectomy final diagnosis: tubulovillous adenoma with severe epithelial atypia. Dx Comment (on same path) ...atypia including focal cribriform glandular architecture (carcinoma in situ).
This case is reportable as carcinoma in situ. The histology code is 8263/2 [adenocarcinoma in situ in a tubulovillous adenoma].
According to our pathologist consultant, a "comment" in a path report is a part of the diagnosis - it often elaborates on or clarifies the diagnosis. Placing [carcinoma in situ] in the comment, even in parentheses, indicates that is the appropriate diagnosis for our purposes.
Histology--Corpus uteri: Because coding a pathology final diagnosis of "serous carcinoma" for an endometrial primary to 8441/3 triggers the site/histology error in the SEER Edits, should histology be coded to 8010/3 [Carcinoma, NOS] instead?
Assign histology code 8441 [serous carcinoma] and override the edit. Endometrium with serous carcinoma is NOT one of the "impossible" site / histology combinations.
Reportability--Breast: Is a final path diagnosis of "phyllodes tumor, borderline (malignant, low grade)" reportable if the comment states "Features favor the diagnosis of a borderline phyllodes tumor (or also called malignant phyllodes tumor of low grade)"?
No, borderline phyllodes tumors (PT) are not reportable. The ICD-O-3 code is 9020/1. According to the WHO Classification of Tumours of the Breast and Female Genital Organs, borderline PT's are also called low grade malignant PT's.
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