Ambiguous terminology/Reportability--Kidney: Is a case reportable if a biopsy diagnosis of "suggestive of oncocytoma, malignant neoplasm cannot be excluded" follows a CT scan that was read as "suspicious for carcinoma"? See Discussion.
Pt is nursing home resident. CT abdomen/pelvis shows a "mass in the right kidney, highly suspicious for renal cell carcinoma". CT-guided needle biopsy performed with final diagnosis: "Neoplasm suggestive of oncocytoma. A malignant neoplasm cannot be excluded." No other information is available.
This case is not reportable based on the information provided. The suspicious CT finding was biopsied and not proven to be malignant. "Suggestive of" is not a reportable ambiguous term.
CS Tumor Size: Can an 'ulcerated mass' be used to code CS tumor size? See Discussion.
The CS Manual (p. 26, 4.a.) states do not code the size of the polyp, ulcer or cyst. However it states that a 'cystic mass' can be used to code TS if it is the only size given. Scopes Text: 'ulcerated' mass based at anal verge & ext 3-4 cm up into rectum.
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 code CS Tumor size using the size of an ulcerated mass.
MP/H Rules--Breast: What histology code is used for lobular with focal ductal features? Do we ignore the focal features and code as lobular or do we use the combination code for duct and lobular?
For cases diagnosed 2007 or later, use rule H14 and assign code 8520 [lobular]. Ignore histologies described as "focal," "foci," or "focus." This instruction will be added to the next version of the MP/H manual.
#2: Invasive ductal carcinoma, well-differentiated, 1.0cm (12:30 o'clock). -Minor component of DCIS, low-grade? See Discussion.
In the MP/H Rules, Table 1 lists apocrine as a type of intraductal carcinoma. Apocrine does not appear in Table 2, the list of specific duct carcinomas. If Apocrine is a type of ductal carcinoma, then Rule M11 would make this a single primary. If it is a single primary, what is the histology?
For cases diagnosed 2007 or later:
Using rule M11, there is one primary in the left breast. Apocrine is a specific duct carcinoma. To make this more clear, apocrine will be added to Table 2 in a future revision.
To code the histology, go to the multiple tumors module and start with rule H20. Stop at rule H29 and code the histology with the numerically higher ICD-O-3 code, 8500/3.
Race, ethnicity/Spanish surname or origin: SEER Program Manual instructions state, "Portugese, Brazilians and Filipinos are not Spanish; Code non-Spanish (code 0)." How is that determined? Is that based SOLELY on birthplace? See Discussion.
The following are scenarios for which we would like clarification on how to code Spanish Ethnicity.
Birthplace Portugal; text states Spanish, south American or European Spanish
Birthplace Brazil, last name is on Spanish surname list; pt is married female. Text states "Hispanic female, NOS"
Birthplace Brazil or Portugal, text states patient is "Mexican", last name is on Spanish surname list
Information about Spanish origin is available for both of these cases; code the race as Hispanic. Use the SEER manual instruction when the only information available is that the patient was born in Portugal, Brazil or the Philippines. In the absence of additional information, do not assume Hispanic. However, if additional information is available stating that the patient is Hispanic, code as Hispanic.
First course treatment: Is subsequent treatment with R-ICE first course or second course therapy if the patient underwent ABVD x2 cycles and subsequent imaging showed no response to treatment and evidence of progression [new adenopathy] for a lymphoma case? See Discussion.
Patient was initially diagnosed with Hodgkin Lymphoma, Nodular Sclerosing on 3/3/06.
Patient received ABVD x 2 cycles. Had disease reassessed in May, 2006, no response to treatment, showed evidence of progression (new adenopathy). Patient's pathology from 3/06 was sent for consult: Diagnosis was Hodgkin with some overlapping features of B-cell Non Hodgkin Lymphoma. Treated 5/18/06 with R-ICE FOR NHL.
The R-ICE treatment in this case is not part of the first course. Documentation of treatment failure and/or disease progression signifies the end of the first course of treatment.
Histology--Breast: What is the histology code for a 2007 diagnosis of basal-type breast carcinoma?
Code basal-type breast carcinoma to 8500/3 [Infiltrating duct carcinoma, NOS].
Basal-type breast carcinoma is a subtype of infiltrating duct carcinoma thought to have a poorer prognosis. There is no specific ICD-O-3 code for basal-type breast carcinoma.
CS Lymph Nodes--Breast: Now that code 50 [fixed/matted ipsilateral axillary LNS, NOS] is obsolete, how is this field coded for a case in which there are clinically matted lymph nodes, no neoadjuvant therapy, and no lymph node size on the available pathology report?
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.From the American College of Surgeons: The pathologic information always takes precedence over the clinical information when there is no neoadjuvant therapy. The size reference is that this is not ITC or micromets. Clinically, I don't think you can have fixed or matted nodes that aren't greater than micromets. This would be coded to 52. The mapping for all of these codes is not taken from this, but from the value of SSF3 per the note at the bottom of the table. See CS Lymph Nodes note 2.
Reportability: Is a tubular adenoma reportable if the final diagnosis is "high grade atypia" and the diagnosis comment is "atypia limited to muscularis mucosa areas of pseudostratification [formerly qualifying for carcinoma in situ]"?
This case is not reportable.
The pathologist would need to include "carcinoma in situ" as part of the final diagnosis in order for this case to be reportable.
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