Report | Question ID | Question | Discussion | Answer | Year |
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20091126 | MP/H Rules/Multiple primaries--Vagina: How many primaries should be abstracted for a patient with a complex history of multiple occurrences of vaginal intraepithelial neoplasia (VAIN III) between 2001 and 2008 and invasive squamous cell carcinoma (SCCA) of the vagina diagnosed in 2006 and again in 2008? See Discussion. | Patient had VAIN III in March of 2001. She had a partial vaginectomy and then continues to have laser surgery in 2002, 2003, 2005 and 2006 for recurrences. In 12/2006 she is diagnosed with SCCA of the vagina with microinvasion (new primary). Then in 2/2008 she has VAIN III again -- new primary according to rule M10 (more than 1 year later). An invasive SCCA of the vagina is again diagnosed in 9/2008. Is this another new primary per rule M15 (invasive after in situ)? Every instance in 2008 is called a recurrence, but we disregard that statement. | There are two primaries according to the information provided.
1. VAIN III March 2001. 2. SCCA of vagina Dec. 2006 (invasive tumor following an in situ
For cases diagnosed 2007 or later, the MP/H rules apply to new tumors, which means that there has been a disease-free interval at some point. In this case, the patient has never been declared disease-free (NED) using the information provided in the question. The consistent recurrence of VAIN is typical of this disease. |
2009 |
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20091045 | CS Tumor Size/CS Site Specific Factor--Breast: When tumor size is unknown, but it is known that both in situ and invasive components are present, how should CS Tumor Size and SSF6 be coded? See Discussion. | We coded CS Tumor Size 990 and SSF 6 to 060 for a case in which no tumor size was mentioned and the breast core biopsy identified microinvasive infiltrating lobular carcinoma and lobular carcinoma insitu. The lumpectomy identified no residual tumor. SEER edit 218 states we must have CS Tumor Size as 999 if the CS SSF 6 is 060. Yet the tumor size code of 990 (Microinvasion; microscopic focus or foci only, no size given; described as less than 1 mm) would more accurately reflect this case. Even in a situation where there was microinvasion described as less than 1mm, the edit will not allow one to code CS Tumor Size to 990 with the CS SSF 6 as 060. Should these types of cases have CS Tumor Size coded 999 or should the edit be adjusted to allow for this combination? | 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 tumor size 990 [Microinvasion; microscopic focus or foci only, no size given; described as less than 1 mm] and CS SSF6 050 [Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated AND proportions of in situ and invasive not known].
This combination of codes captures the information available for this case. |
2009 |
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20091010 | MP/H Rules/Histology--Breast: What histology is coded when a final diagnosis on a lumpectomy specimen states "adenocarcinoma" but the regional lymph nodes show "poorly differentiated adenocarcinoma with signet ring differentiation"? See Discussion. | 3/23 left breast mass bx: infiltrating lobular carcinoma. 6/22 left breast lumpectomy: infiltrating adenocarcinoma; sentinel lymph nodes with metastatic poorly differentiated adenocarcinoma with signet ring differentiation. Axillary resection with poorly differentiated metastasis in 8/9 nodes. The path micro states: tissue consists of sections of breast tissue having an infiltrating ca which in some areas infiltrates as small duct-like structures, and in other areas as small gland-like structures. In addition, there are foci in which the cells infiltrate in a single file fashion. In a few areas, cells having a signet ring appearance similar to those seen in the lymph nodes are encountered. In other areas, the signet ring appearance is not prominent. Areas of ductal or lobular ca in situ are not identified (the lymph node resection specimen shows 'signet ring appearance in some areas but no ductlike or tubular structures observed')
The comment on the lumpectomy path states: 'This is an unusual tumor in that it has histologic characteristics in varying areas, which would be consistent with infiltrating ductal carcinoma, infiltrating lobular carcinoma, tubular carcinoma or signet ring cell carcinoma. The metastatic material (8/9 total axillary lymph nodes) is most consistent with the poorly differentiated signet ring type portion of the tumor undergoing metastasis.' |
For cases diagnosed 2007 or later: Code the histology 8140 [Adenocarcinoma, NOS] using Breast rule H14. Code the histology from the final diagnosis on the pathology report of the most representative specimen (the lumpectomy in this case). Do not code histology from the microscopic description. Code the histology from the primary site whenever available, not the metastatic site.
Comments on pathology reports can be used to code histology. However, in this case the final diagnosis is more definitive than the comments. The comment provides several choices and none of these appear in the final diagnosis; an indication that the pathologist was not able to clearly identify a more specific type in this case. |
2009 |
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20091017 | Primary site--Esophagus: How is primary site coded for a tumor arising in a segment of the esophagus that was reconstructed using a segment of the colon? See Discussion. |
A patient had a ruptured esophagus 25 years ago and had a segment of colon removed and transplanted to serve as esophagus. In 2007, the patient was diagnosed with carcinoma in a polyp by endoscopic biopsy of the transplanted 'esophagus'. What is the primary site code? Is this the same site schema to be used for Collaborative staging and surgery coding? |
Code the primary site esophagus, NOS [C159]. Use the surgery codes and collaborative staging schema for esophagus. Document the unusual nature of this case in text fields. |
2009 |
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20091035 | 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. |
2009 | |
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20091036 | CS Mets at DX/CS Extension--Ovary: Is carcinomatosis always captured in the CS Mets field? Can the term carcinomatosis be used to describe peritoneal implants as well? See Discussion. | 1/18/06 CT guided biopsy of abdominal mass & ant peritoneum nodule: Extensive carcinomatosis affecting the paracolic gutters, liver surface & pelvis. 6 cm tumor mass was visibly engulfing the small bowel & tube; poorly differentiated adenoca, mullerian derived, shows attributes of clear cell carcinoma, high grade (FIGO III), 2.5 cm size, does not involve fallopian tube. R&L abdominal wall & mesentery, mets adenoca. 5/31/06: tumor debulking with right salpingo-oophorectomy. Final DX: Poorly differentiated adenocarcinoma, clear cell type, right ovary (FIGO III), stage IV per MD. |
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.In the case of ovarian cancer, the term carcinomatosis may refer to peritoneal implants, especially when the implants are numerous. It does not refer to distant metastases in this context. This issue has been forwarded to the CS version 2 committee. |
2009 |
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20091131 | Multiplicity Counter/Type of Multiple Tumors--Breast: How are these fields coded when a patient underwent a lumpectomy demonstrating two measured foci of invasive ductal carcinoma (1.5 cm and 3 mm) and "focally seen" in situ ductal carcinoma (DCIS) followed by a re-excision that is positive for 1.5 mm focus of residual invasive carcinoma? See Discussion. | Lumpectomy path shows two foci of invasive ductal carcinoma, 1.5 cm & 3 mm sizes, and CAP summary lists "DCIS: focally seen", no further description. The re-excision pathology specimen finds a 1.5 mm focus of residual invasive carcinoma, very close to the new inferior margin (so registrar assumed this was probably not part of the previously excised mass), and no mention of any more in situ.
Can we assume the DCIS was associated with/part of the invasive tumors because it was not measured or described separately? If we say there are 3 tumors (for the measured invasive foci), should Type of Multiple Tumors be coded 30 [In situ and invasive] or 40 [Multiple invasive]?
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Code 03 [3 tumors] in the multiplicity counter. Do not count the "focally seen" DCIS because it was not measured. Code 30 [In situ and invasive] in Type of Multiple Tumors Reported as One Primary. The single primary reported for this case is a combination of in situ and invasive tumors. |
2009 |
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20091097 | Multiple Primaries--Lymphoma: How many primaries should be abstracted if DLBCL (9680/3) and Mantle Cell Lymphoma (9673/3) occur at the same time in different lymph nodes? How would Sequence be coded if the case is multiple primaries? |
For cases diagnosed prior to 1/1/2010:It is important to note for this case that the two different types of NHL occurred in different lymph nodes; one type in one lymph node and the other type in another lymph node. Use the fold-out table to determine single vs multiple primaries. According to the table, 9673/3 and 9680/3 would be two primaries no matter which of these was "first." Assign the lower sequence number to the primary with the worse prognosis when two primaries are diagnosed simultaneously. Base the prognosis decision on the primary site, histology, and extent of disease for each of the primaries. If there is no difference in prognosis, the sequence numbers may be assigned in any order. For cases diagnosed 1/1/10 and later, 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. |
2009 | |
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20091058 | MP/H Rules/Histology--Kidney: How is histology coded when it is described in the pathology report as "Histologic type: Clear cell (conventional) renal cell carcinoma. Percent of sarcomatoid component: 10%"? See Discussion. | MP/H rules for kidney, Table 1 lists both clear cell and sarcomatoid as specific types of renal cell carcinoma. The MP/H terms and definitions for kidney state that clear cell is architecturally diverse. For this case, does the sarcomatoid component represent a subtype of clear cell that has not been assigned an ICD-O code, and thus histology should be coded to 8310? Or does the sarcomatoid component represent a specific type of renal cell carcinoma for which rule H6 would apply? Should histology be coded 8255 for this case? | For cases diagnosed 2007 or later, assign code 8310 [clear cell adenocarcinoma] according to rule H5. Renal cell, clear cell and sarcomatoid are mentioned in the diagnosis. Sarcomatoid is referred to as a component. Component is not one of the terms listed in rule H5 that indicate a more specific type. Ignore sarcomatoid in this case. Use table 1 to identify clear cell as a specific renal cell type. Code the specific type (clear cell) according to rule H5. | 2009 |
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20091110 | MP/H Rules--Bladder: Should an invasive urothelial carcinoma of the bladder diagnosed in 2004 followed by an in situ urothelial carcinoma of the ureter diagnosed in 2008 be reported as multiple primaries per the three-year guideline in Rule M7 or a single primary per the subsite guideline in Rule M8? See Discussion. | Rule M7 states, "Tumors diagnosed more than three (3) years apart are multiple primaries." Should this rule be modified to say, "Bladder tumors diagnosed more than three (3) years apart are multiple primaries"? Does Rule M7 apply to only bladder tumors or does this rule apply to tumors in any of the urinary sites similarly to Rule M8 which states, "Urothelial tumors in two or more of the following sites are a single primary: Renal pelvis (C659) Ureter (C669) Bladder (C670-C679) Urethra/prostatic urethra (C680)"? | For cases diagnosed 2007 or later, Rule M7 pertains to renal pelvis, ureter, bladder and other urinary sites as defined by the topography codes listed in the header of these rules.
An invasive urothelial bladder tumor followed more than three years later by an in situ TCC of the ureter are reported separate primaries. Rule M8 applies when the tumors in these sites are diagnosed within three years of each other.
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2009 |