Report | Question ID | Question | Discussion | Answer | Year |
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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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20091037 | MP/H Rules/Histology--Brain: How is histology coded for a "low grade neuroglial tumor" of the fourth ventricle? | For cases diagnosed 2007 or later, assign histology code 9505/1 [Ganglioglioma, NOS].
According to our pathologist consultant, low grade neuroglial tumor of the fourth ventricle correlates best to the "rosette-forming glioneuronal tumor of the 4th ventricle" which is a new WHO entity. There is no current ICD-O-3 code for this. The best code available at this time is 9505/1. |
2009 | |
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20091048 | Surgery of Primary Site--Lymphoma/Soft Tissue: How is this field coded for an excision of a neck mass that found lymphoma in soft tissue (C49.0)? See Discussion. | CT scan showed soft tissue mass in the retropharynx. 9/23/2008 Laryngoscopy with biopsy taken of left tonsil and left base of tongue and random biopsies of nasopharynx; FNA of left neck. Path stated left tonsil, squamous papilloma. Left base of tongue, no significant histopathology. Nasopharynx biopsies, compatible with tonsillar tissue. Pretracheal lymph node biopsies, mild reactive lymphoid hyperplasia. 9/30/2008 Excision of left neck mass with limited deep jugular chain lymph node dissection. Path stated lymph node left jugular biopsy, no tumor seen. Soft tissue, left neck biopsy, malignant B cell lymphoma with plasmacytoid differentiation. Addendum from consult: favor a diagnosis of a marginal zone lymphoma. Per the gross description, the specimen was fibrofatty connective tissue in which there is a tumor infiltrate. | Assign code 26 [partial resection]. Use the surgery codes that apply to the primary site. See page C-597 of the 2007 SEER manual for surgery of primary site codes applicable to primary sites of soft tissue coded to C490 - C499. | 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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20091109 | Surgery of Primary Site - - Esophagus/Stomach/Colon: Is an endoscopic mucosal resection (EMR) for an esophagus, stomach or colon malignancy coded to 20 [local tumor excision, NOS] or to a more specific code such as 22 [local tumor excision combined with electrocautery]? | Assign code 20 [local tumor excision, NOS] for a procedure described as an esophagus stomach or colon endoscopic mucosal resection (EMR), NOS. If there is additional information specifying electrocautery, laser or PDT (for example), assign a more specific code. | 2009 | |
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20091034 | CS Extension--Ovary: How are the following terms coded when they are described in the medical record without any other qualifying information? Seeding, talcum powder appearance, salting, miliary, and studding. | 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.Seeding, talcum powder appearance, salting and studding are synonymous with implants. When the size of implants is not stated, but operative report and scans state "seeding," "talcum powder appearance," "salting," and "studding" the CS extension code choice will depend on the location of the seeding, talcum powder appearance, salting, or studding.
The word "miliary" is not documented as a synonym for implants. The term miliary does not affect the CS extension code choice according to the current CS instructions. |
2009 | |
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20091115 | MP/H Rules/Multiple primaries - - Melanoma: How many primaries are reported when a patient presents with a malignant melanoma (NOS) and a separate lentigo maligna, both on right chest? See Discussion. | MP/H rule M5 states that melanomas with ICD-O-3 histology codes that are different at the third number are multiple primaries. However, the 2007 MP/H fundamentals Webcast session on melanoma rules states that this is not two histologic types. Lentigo maligna is a growth pattern, not a histologic type. Will clarification be included in the next MP/H rules revision? |
For cases diagnosed 2007 or later, two primaries are to be reported for this case. Rule M5 applies because there is a difference in the histology codes at the third digit.
Clarifications regarding histologic types of melanoma will be added to the rules when they are revised. |
2009 |
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20091050 | Date of Multiple Tumors--Breast: How is this field coded when a second breast tumor is found at mastectomy two months after the original breast cancer was diagnosed, but during initial workup and treatment? See Discussion. | Breast cancer was diagnosed on core biopsy on 02-27-07. It was not known that the breast was harboring 2 tumors until mastectomy was done on 4-01-07. Both tumors are counted as one primary. | Code "Date of Multiple Tumors" field to the date of the mastectomy. That is the date that multiple tumors were discovered. | 2009 |
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20091092 | MP/H Rules/Histology--Lung: How should Diagnosis Date, Diagnostic Confirmation and Histology be coded for the LEFT lung mass in the following case? PET shows a 3 cm mass in the left lung and a 2.9 cm mass in the right lung. No reportable terminology in PET. The right mass is biopsied and shows adenocarcinoma. The left mass is not biopsied. Based on rule M6, this should be reported as two primaries. No additional information in medical record. Patient expired. |
For cases diagnosed 2007 or later: For date of diagnosis, use the date of the PET scan for both primaries. For the left tumor, assign diagnostic confirmation code 8 [Clinical diagnosis only] and assign histology code 8000/3 [malignant neoplasm]. The left lung mass is reported as a separate primary because there is one tumor in each lung. According to Rule M6, when there is one tumor in the left lung and one tumor in the right lung, each tumor is a separate primary. Tumor and mass are equivalent terms for purposes of the multiple primary rules. |
2009 | |
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20091117 | MP/H Rules/Histology--Breast: How is histology to be coded for a breast primary described as "tubular carcinoma (well differentiated invasive ductal carcinoma)"? See Discussion. | How are terms that are modified by parentheses to be interpreted? Do terms in parentheses modify the stated diagnosis and thus have priority over the stated diagnosis? Or would rule H17 apply and histology would be coded as duct and other carcinoma? For this case, the wording of the diagnosis and use of parentheses seem to indicate that tubular is a type of ductal carcinoma. Tubular is not listed as a specific duct carcinoma in the MP/H rules histology tables for breast. |
For cases diagnosed 2007 or later, code the histology as tubular carcinoma [8211/3]. This is not a case of tubular AND infiltrating duct. The histology is stated to be tubular. Tubular is not a specific type of duct carcinoma. | 2009 |