CS Extension--Pancreas: How is this field coded for a head of pancreas primary with involvement of the inferior vena cava?
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.Assign CS extension code 54 [Blood vessel(s) major]. The inferior vena cava is one of the major blood vessels.
The inferior vena cava is located just behind the head of the pancreas. The hepatic artery, the superior mesenteric vessels and the portal vein are nearby.
Histology--Brain and CNS: How is histology to be coded for a pituicytoma WHO grade I, of the pituitary?
Assign code 9380/1 [glioma, borderline].
According to our pathologist consultant, the term pituicytoma is restricted to low-grade glial neoplasms of the neurohypophysis or infundibulum. The best category currently available for these is glioma.
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.
MP/H Rules/Date of Diagnosis/Behavior--Brain and CNS: How many primaries would be reported when a December 2004 MRI shows a pineal region mass with the major differential consideration being pineocytoma; a November 2007 MRI that shows the mass has almost tripled in size; and the December 2007 resection final diagnosis is consistent with pineoblastoma? How would diagnosis date[s] and behavior code[s] be coded? See Discussion.
Dec. 2004 MRI of brain: Pineal region mass. The major differential consideration given patient's gender, age group, and imaging characteristics is pineocytoma. The differential includes pineoblastoma or germ cell line tumor. These are felt less likely.
Nov. 2005 MRI brain: stable exam since last MRI. No change in size.
Nov. 2007 MRI studies: pineal mass has almost tripled in size.
Dec. 2007 Surgical resection of pineal tumor: High grade (WHO Grade IV) pineal parenchymal neoplasm consistent with pineoblastoma.
For cases diagnosed 2007 or later:
Abstract as separate primaries:
12/2004 pineocytoma (9361/1)
12/2007 pineoblastoma (9362/3)
Complete two abstracts when a previously diagnosed non-malignant tumor transforms or progresses to a malignancy. Refer to the CDC/NPCR guidelines for Data Collection of Primary Central Nervous System Tumors, 2004. Malignant transformation is discussed on page 50.
CS Site Specific Factor--Breast: How is SSF6 coded when CS tumor size is coded from a clinical report, not from pathology? See Discussion.
A breast ultrasound displays a 2 cm tumor. Core biopsy diagnosis is lobular carcinoma in situ. No further record for patient. Tumor size coded to 020. Should SSF 6 be coded to 010 "Entire tumor reported as in situ (no invasive component reported)" because it was pathologically confirmed, or to 888 because size was coded based on a clinical exam - the ultrasound?
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 SSF6 888 [Clinical tumor size coded]. When the size recorded in CS Tumor Size is not determined pathologically, 888 must be coded in SSF6. Note: The code in SSF 6 pertains to pathologic tumor size. It describes the relationship of invasive and in situ tumor in the tumor size coded.
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.
CS Extension--Brain and CNS: How is CS Extension coded for a malignant meningioma that demonstrates extension into adjacent brain tissue?
For malignant brain tumors, code 60 represents extension into the meninges. Would code 60 be the correct code for extension from a malignant meningioma into brain tissue?
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.Assign CS extension code 60 for malignant meningioma with extension to adjacent brain tissue.
According to the I&R, this section of CS was taken directly from SEER Summary Staging, since AJCC does not have a staging system for these tumors.
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.
MP/H Rules/Multiple primaries--Lung: If a 1.7 cm LUL lung tumor is not treated surgically, would a 2.1 cm tumor in the same lobe three years later be a new primary? See Discussion.
In 2004 the patient has a 1.7cm squamous cell carcinoma diagnosed in the LUL of the lung treated with radiation and chemotherapy. In 2007, the patient was diagnosed with a 2.1cm squamous cell carcinoma in the LUL treated with radiation. According to the lung MP/H rules, the 2007 tumor would be a new primary. Given that there was no surgery, would the second tumor be progression of disease or would it be a new primary?
For cases diagnosed 2007 or later:
If the tumor diagnosed in 2004 was successfully treated and disappeared, apply the MP/H rules for lung. According to rule M8, the 2004 tumor and the 2007 tumor are multiple primaries. If there was no disease-free interval between tumor occurrences, that is, if the 2007 tumor is still the same tumor that was diagnosed in 2004, the MP/H rules do not apply.
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.