Report | Question ID | Question | Discussion | Answer | Year |
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20081134 | MP/H Rules--Breast: For tubulolobular carcinoma, do we use 8522? See Discussion. |
Path comment: This mixed variant of ductal and lobular carcinoma has been called in the past tubulolobular carcinoma, however, more recently is a mixed pattern of ductal and lobular carcinoma and not a variant of lobular carcinoma. |
For cases diagnosed 2007 or later, use rule H18 and assign code 8524 [lobular mixed with other types of carcinoma]. According to the MP/H rules, tubular is not a specific type of duct or lobular. This is based on the latest WHO classification of breast tumors. The combination histology of tubular and lobular will be reviewed during the upcoming revision of the MP/H rules. |
2008 |
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20081116 | CS Extension--Brain and CNS: How is this field coded for a malignant brain tumor that presents as a lesion with significant pressure on the left frontal ventricle and dilation of the right ventricles? See Discussion. | CS Extension code 30 includes tumor that invades or encroaches upon the ventricular system. Does significant pressure mean the same thing as encroach? | 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.Do not assign extension code 30 in this case unless there is evidence elsewhere of ventricular system involvement. "Significant pressure" is not synonymous with encroachment or involvement. See the list of ambiguous terms for CS staging on page 121 of the 2007 SEER manual. |
2008 |
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20081138 | MP/H Rules/Histology--Lung: What is the correct histology code for a neuroendocrine neoplasm described as a carcinoid and also referred to as oncocytic? See Discussion. | Left mainstem bronchus mass excised: metaplastic endobronchial mucosa with submucosa containing an infiltrating poorly diff malignant tumor. Origin of tumor is not identified in overlying mucosa. IHC stains will be performed. Addendum #1. IHC stains show well diff neuroendocrine neoplasm, favor carcinoid. Recommend sending this to expert in lung neoplastic pathologist. Addendum #2. (lung path specialist) oncocytic neuroendocrine neoplasm. Is this 8246 or 8290 or something else? |
For cases diagnosed 2007 or later, code as 8246 [Neuroendocrine carcinoma, NOS]. According to our pathologist consultant, the neuroendocrine description is more specific than the oncocytic description in this case. | 2008 |
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20081039 | Diagnostic Confirmation/Histology--Hematopoietic: How are these fields coded when the final pathologic diagnosis for a bone marrow biopsy differs from the final clinical diagnosis of a hematopoietic disease? See Discussion. | Frequently, pathology reports describe hematopoietic diseases using ambiguous terms. Flow cytology and cytogenetics may be obtained. It appears that the clinician is the person who pulls all the information together for a diagnosis. Example: Bone marrow biopsy is most compatible with chronic phase myeloproliferative disease. Path comment: Differential would include CML. Outside hematology report indicates an elevated peripheral WBC, primarily neutrophils. Flow cytometry showed 1.0 % of the white cells are myeloid blasts of abnormal phenotype, additionally finding 7.3 % basophils. Flow reported peripheral blasts at 1.2 % and peripheral basophilia. Cytogenetics report showed abnormality with trisomy of chromosomes 13 and 21. This finding is consistent with a clonal abnormality suggestive of acquired disease. Results were consistent with the absence of the t(9,22)(q34;q11) translocation or fusion product associated with CML. Subsequent clinical impression: Bone marrow evaluation most consistent with CML. Overall features most consistent with CML. |
For cases diagnosed prior to 1/1/2010:Code the Diagnostic Confirmation field as 1 [positive histology]. Code the ICD-O-3 morphology based on the clinician's statement. The code in Diagnostic Confirmation pertains to the best method used to confirm the presence of cancer over the entire course of the disease. Therefore, if a bone marrow report confirms cancer, code 1 [positive histology] in Diagnostic Confirmation. Code the histology using all of the information available. The clinician has access to all of the information relating to this case. The pathologist had only the bone marrow. Code the histology recorded by the clinician. 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. |
2008 |
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20081018 | CS Tumor Size: Is a 5.5 mm tumor coded as 005 or 006? See Discussion. | We interpret the CS Manual general instructions to indicate to ONLY round up to 001 when the tumor size is stated to be 0.1 to 0.9mm. | 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 006. Because only whole numbers in mm can be collected, basic mathematical principles are used for rounding; 1-4 round down, 5-9 round up. |
2008 |
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20081051 | MP/H Rules/Histology--Prostate: Path said adenocarcinoma of the prostate with an endometroid adenocarcinoma component. What histology code is used? | For cases diagnosed 2007 or later: Assign code 8500 [duct carcinoma]. According to The World Health Organization (WHO), the term endometrioid carcinoma of the prostate is now called Prostate Duct Carcinoma. Using Rule H11 (one type), code 8500 (duct carcinoma) for this rare type of tumor. Do not stop at Rule H10 because this is not acinar. |
2008 | |
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20081086 | Reportability: Is a case reportable if a benign diagnosis is obtained on a resection that follows a positive needle aspiration? See Discussion. | Fine needle aspiration of the thyroid diagnosis was "positive for malignant cells, favor medullary carcinoma." Subsequent thyroidectomy was reported as benign. | This case is reportable. The cytology is positive. Report as medulary carcinoma of the thyroid. | 2008 |
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20081055 | MP/H Rules--Melanoma: How many primaries are represented if subsequent to a diagnosis of malignant melanoma of skin of left thorax in April 2006, a metastatic melanoma is discovered in the soft tissue of the abdomen and in the skin and subcutaneous tissue of the groin in late 2007? See Discussion. | 4/20/06: skin left lateral thorax, excision: Pedunculated malignant melanoma, 0.5 CM in height, Clark's level 3, Breslow depth 0.5 CM, superficial ulceration noted. No host response. Margins clear. 6/19/06: Four sentinel LNs negative. Interferon therapy. 10/30/07: FNA of soft tissue, left lower abdomen: consistent with metastatic melanoma. 12/20/07 A) sentinel lymph node, left groin, biopsy: No morphologic or immunophenotypic findings support for metastatic melanoma (see comment). B) skin and subcutaneous tissue, left groin, excisional biopsy: Metastatic malignant melanoma (see comment). Lymphovascular invasion identified. Margins free of melanoma. Melanoma 1.5 MM from the closest designated deep margin and 5 MM from the designated 6:00 margin. C) skin, left groin/additional inferior margin, excisional biopsy: No significant histopathologic abnormality. No evidence of villus or melanoma or malignancy. Comment: A 0.8 cm metastatic nodular melanoma is present in the adipose tissue. The underlying skin is unremarkable. There is no evidence of ulceration, melanocytic lesion, melanoma in situ, or regression of melanoma. Block A1 is sent for immunohistochemical studies. The immunophenotypic findings provide no support for metastatic melanoma in lymph node. Please see the immunohistochemical study. The primary MD states "Recurrent intransit mets, left groin." |
For cases diagnosed 2007 or later, this is a single primary, melanoma of the thorax 4/20/06. The subsequent reports mention metastases, but do not document another primary. Do not count metastatic lesions as new primaries. | 2008 |
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20081100 | MP/H Rules/Histology--Rectum: When not specifically mentioned as part of the histology, is the adenoma a second histologic type, or just a further physical description of the tumor? See Discussion. |
Rectal tumor resection (APR) path report final dx: "mucinous carcinoma, see comment". The comment is the CAP-format tumor summary, which states "histologic type: adenocarcinoma with extensive mucin production (mucinous or colloid carcinoma). Additional pathologic findings: adenomas - tumor arises in a tubulovillous adenoma". If you follow the rules and only use the final dx, you would code a different histology than if you use the 'additional path findings.' |
For cases diagnosed 2007 or later Other Sites histology rule H12 applies in this case. Assign histology code 8263 [adenocarcinoma in tubulovillous adenoma]. Use information from the CAP protocol and from comments associated with the final diagnosis to code histology. The fact that the malignancy arose in a polyp can be taken from anywhere in the medical record; not limited to the final diagnosis. Based on the information provided for this case, the histology is adenocarcinoma with extensive mucin production (mucinous or colloid carcinoma) arising in a tubulovillous adenoma. |
2008 |
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20081103 | CS Lymph Nodes--Breast: What code should be used for the the following? There is no mention of LNS clinically; the patient has neoadjuvant therapy; and the LNS are matted pathologically. | 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.Use the information from the pathologic evaluation to code CS Lymph nodes. In the nodes evaluation field, assign code 6 [Regional lymph nodes removed for examination with pre-surgical systemic treatment or radiation and lymph node evaluation based on pathologic evidence]. See CS Lymph Nodes note 4. |
2008 |