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Report Produced: 09/11/2025 18:13 PM

Report Question ID Question Discussion Answer Year
20031032 Diagnostic Confirmation--Hematopoietic, NOS: How should diagnostic confirmation of Hematopoietic diseases be coded in the absence of positive bone marrow? See Description.

Case 1. Patient admitted 9-12-02 with diagnosis of essential thrombocythemia. Per the H&P, patient obviously has had this since January 2001. Per the clinical history: patient with elevated platelets. Path diagnosis of bone marrow biopsy done 9-20-02 showed mildly increased megakaryocytes. 10-31-02 clinical sign-out diagnosis was: essential thrombocythemia.

Case 2. Patient admitted for evaluation of erythrocytosis. Assessment: Increased hematocrit only. It is most likely that patient has polycythemia vera. I think it is reasonable to initiate phlebotomy treatment.

Code 1, Positive histology, includes diagnostic hematologic findings and peripheral blood smears when these are the basis for diagnosis.

When the clinician makes a specific diagnosis and the blood work is not diagnostic, code diagnostic confirmation as 8 [Clinical diagnosis only]. The clinician is putting together all evidence, including the blood work and using his/her professional experience to diagnose the case.

Case 1. The diagnosis is not based on microscopic findings. Assign code 8 [Clinical diagnosis only]. Megakaryocytes are the immature form of thrombocytes, but mildly increased megakaryocytes are not diagnostic of essential thrombocythemia.

Case 2. The diagnosis is not based on microscopic findings. Assign code 8 [Clinical diagnosis only].

 2003
20031145 EOD-Extension--Head & Neck: Is this field coded 10 [Invasive tumor confined to one of the following subsites: interior wall, one lateral wall, posterior wall] or 30 [Localized, NOS] for tonsillar primary when there is no mention of involvement of surrounding structures? See Description. Site is stated to be "left tonsil" and was coded to site C099. "The lesion is admixed in tonsillar tissue." No surrounding structures are stated to be involved. Is it logical to assume that since code C099 includes the palantine tonsils and the palatine tonsils are on the lateral wall and since no other areas are stated to be involved that extension code 10 [confined to one lateral wall] would be more appropriate than code 30 [localized NOS]? For cases diagnosed 1998-2003: Code EOD-extension for the case example to 10 [Invasive tumor confined to one of the following subsites: anterior wall, one lateral wall, posterior wall]. The tonsil lies in a pocket on the wall (tonsillar fossa), so you know it is confined to the wall. 2003
20031079 Primary Site: Should we code C80.9 [unknown primary] or code C34.9 [Lung] according to the terminology, "most likely site of origin is lung"? See Description.

We have a case of metastatic keratinizing squamous cell ca. The work-up shows small densities in the lung that may represent inflammatory or chronic changes. No other imaging that shows origin. Physical exam states 2 months of left axillary mass. H/O SCCA of the skin involving chest wall.

Path reads: Metastatic w/d keratinizing SCCA. This lesion almost undoubtedly represents mets. The most likely site of origin is lung followed by esophageal primary or head & neck. The final discharge states, "Metastatic SCCA to Left Axilla".

Code the primary site according to the physicians' opinion, especially the treatment decision. If the physician treats the patient for a lung primary, code primary site as lung. If the primary site cannot be determined, code C80.9.

According to the pathologist, the most likely primary site for the example above is lung. The final discharge diagnosis does not reflect the pathologist's opinion, and does not contradict it either. If there is no conflicting medical opinion, code primary site to C34.9 [lung].

 2003
20031206 EOD-Extension: How is this field coded for synchronous primaries when metastatic disease is found and there is no statement to indicate which primary is the source of the metastases? See Description. Patient was diagnosed with both esophageal and pancreatic cancer. Liver metastases were also identified. The source of the liver mets is unknown. For cases diagnosed 1998-2003: Search the record for information about the source of the metastasis. If no such information can be found, code the metastasis to both primaries. Update the abstracts when information becomes available confirming the primary site responsible for the metastasis. Assuming the liver metastases in the example above are distant (i.e. not contiguous) code extension as 85 [Metastasis]. 2003
20031165

Behavior Code/EOD-Extension--Colon: Are extension codes 10 [Mucosa, NOS (incl. Intramucosal, NOS)] and 11 [Lamina propria] in situ, in accordance with AJCC stage for this site?

For cases diagnosed 1998-2003: EOD codes 10 and 11 are invasive. SEER, to be compatible with Summary Stage 77 and 2000, calls EOD extension codes 10 and 11 invasive because invasion of the lamina propria is invasion through the lamina propria/basement membrane and therefore invasive.

According to AJCC, the survivial rates for tumors that invade only the mucosa or lamina propria are similar to Tis tumors, so the AJCC classifies them as Tis.

 2003
20031094 Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: How many primaries are coded and what code(s) is/are used to represent the histology "invasive ductal carcinoma with extensive spindle metaplastic change [metaplastic carcinoma] with a second, separate, tumor "invasive ductal carcinoma, moderately differentiated with extensive associated DCIS"? See Description. The comment on the pathology report states, "due to the associated DCIS this smaller lesion is felt to most likely represent a synchronous second primary." Is this two primaries, one coded 8575/33 and the other coded 8500/32 or is this a single primary with a combination code -- 8523/33?

For tumors diagnosed prior to 2007:

Abstract as two breast primaries. Code to 8575/33 (metaplastic carcinoma) and 8500/32 (infiltrating duct carcinoma). There are two lesions with different histologic types.

Do not use code 8523 to combine separate tumors with different histologies.

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.

 2003
20031024 Surgical Fields--Head & Neck: How does one code the removal of benign submandibular and sublingual glands performed during a neck dissection for a head and neck cancer? See discussion. Should the removal be coded as incidental in the surgical Procedure if the Other Site field? Does it make a difference if the submandibular gland is removed en toto with lymph nodes or if the gland is submitted as a separate specimen? Does it make a difference if the glands are involved?

Removal of the lower salivary glands is part of a radical neck dissection and is not recorded in Surgery of Primary Site or Surgery of Other Site. Radical neck dissection is coded under "Scope of Regional Lymph Node Surgery."

It does not matter whether or not the gland is submitted as a separate specimen. It does not matter whether or not the gland is involved.

 2003
20031144 Histology (Pre-2007)--Breast: What code is used to represent the histology "Ductal carcinoma in situ; 6 mm focus of invasion is a pure mucinous carcinoma that appears to have arisen in the background of encysted papillary carcinoma."

Code to mucinous (8480) since that is the only clearly invasive component of this diagnosis.

According to our pathologist consultant, "Encysted papillary carcinoma is the same thing as intracystic papillry carcinoma, which I think of as an intraductal papillary carcinoma which has greatly expanded the duct to form a cyst-like structure. It generally behaves in an in-situ rather than an invasive fashion. The only clearly invasive component is the mucinous carcinoma, which is what I would code."

 2003
20031101 Primary Site/Behavior Code/EOD-Extension: How would these fields be coded for "squamous cell carcinoma in situ involving papilloma -- locally aggressive but not technically invasive" found in the sphenoid sinus, soft tissue of the skull base and brain? See Description.

The managing physician has staged this pathologically as T4 N0 M0 squamous cell carcinoma of the ethmoid sinuses. The final pathology report says " Sinus, sphenoid, resection: papillary neoplasm most consistent with inverted papilloma with squamous cell carcinoma in situ, 7 cm in greatest extent, focus of probable superficial invasion (see comment).

Soft tissue, skull base, excision: involved by papillary neoplasm with squamous cell carcinoma in situ (see comment). Brain, extradural, intercranial biopsy: involved by papilloma with squamous cell carcinoma in situ. COMMENT:

This is a predominantly exophytic neoplasm with infolding of the tumor epithelium and in situ extension into submucosal glands. There are only focal areas suspicious for invasive squamous cell carcinoma, with probable invasion (<2mm) in one section....The histologic features are most consistent with an inverted papilloma with carcinoma in situ." When asked to comfirm if the diagnosis were in situ or superficially invasive, the pathologist responded "Squamous cell carcinoma in situ involving a papilloma. Locally aggressive but not technically invasive."

Code site to C31.3 [sphenoid sinus]. Code the site based on the final pathology report diagnosis. In the case example, the site attributed to the managing physician appears to be an error.

Code behavior to 3 [malignant, primary site]. The SEER list of terms meaning involvement may be used to help determine behavior. The terms used by the pathologist are "probable" superficial invasion and "suspicious" for invasive squamous cell carcinoma with "probable" invasion. Interpret as invasive.

For cases diagnosed 1998-2003: Code extension to 70 [Brain] because this tumor involves the brain.

 2003
20031078 EOD-Lymph Nodes--Colon: Are "multiple submucosal lymphoid collections infiltrated with tumor" or "lymphoid areas" coded as lymph node involvement, similar to the way nodules in the pericolic fat are coded? See Description. For an adenocarcinoma in the colon, under the "lymph node" section of the final path diagnosis it states "multiple submucosal lymphoid collections infiltrated with tumor" in addition to "one of two involved lymph nodes." The micro description states "There are multiple small lymphoid areas with tumor. A definite node excised from the mesentery shows...replacement of stroma and an additional very small node shows no tumor."

For cases diagnosed 1998-2003: No, do not code tumor infiltration of lymphoid collections or lymphoid areas as lymph node involvement.

However, code lymph node involvement for this case as 3 [mesenteric, NOS] because a mesenteric node is involved.

Regarding tumor infiltration of lymphoid collections or lymphoid areas from our pathologist consultant: Unless the anatomy of lymph node is evident (sinuses, trabeculae, primary and secondary follicles) these aren't lymph nodes and should not be coded as such. Unless there is evidence to the contrary in the path report, I would suggest that this be considered intramural spread, not lymph node spread.

 2003