Report | Question ID | Question | Discussion | Answer | Year |
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20081046 | MP/H Rules--Corpus uteri: How is histology coded for an endometrial tumor described as an "endometrioid adenocarcinoma with prominent squamous metaplasia"? | For cases diagnosed 2007 or later: Endometrioid adenocarcinoma with squamous metaplasia is coded 8570 [Adenocarcinoma with squamous metaplasia]. This falls under the Histology Coding Rules for Other Sites, rule H17. The code for Endometroid adenocarcinoma is 8380. The code for Adenocarcinoma with squamous metaplasia is 8570. The histology with the numerically higher ICD-O-3 code is Adenocarcinoma with squamous metaplasia -- 8570. |
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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20081096 | Computed Ethnicity: Should the Name--Alias field be used when generating Computed Ethnicity? | No, "Alias" is not used and should not be used to generate Computed Ethnicity. Computed Ethnicity records the ethnicity based on last name and/or maiden name using a computer algorithm. Alias is not part of the algorithm. | 2008 | |
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20081109 | MP/H Rules--Breast: Patient has 2 existing primaries, both of left breast and both were pure lobular carcinoma, one was diagnosed in 1994 and the other in 2005. Now a biopsy in 2008 of a supraclavicular lymph node (laterality unknown) and subcutaneous scalp tissue show metastatic DUCTAL carcinoma. Per path report, breast is the primary site. Slides from prior tumors were not reviewed. Should this be made a new primary or assumed to be metastasis from the prior breast tumors? See Discussion. |
A modified radical mastectomy was performed on 10/6/94. The 2007 MP/H rules tell us that multiple ductal and lobular tumors of breast are a single primary; however, the rules do not apply to metastatic tumors. |
For cases diagnosed 2007 or later: Abstract the 2008 diagnosis as a new primary. Since the primary site is unproven but stated to be breast, and since the laterality is unknown, we cannot determine that the 2008 diagnosis is the same as the 2005 or the 1994 diagnosis. Revise this case accordingly if more information becomes available. |
2008 |
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20081011 | Surgery of Primary Site/CS Reg LN Exam/Scope Regional LN Surgery--Rectum: How are these fields coded when a patient develops a non-tumor related complication that requires an additional sigmoid resection that removes 2 additional lymph nodes one week following a low anterior resection that removed 4 lymph nodes? See Discussion. | Patient had a low-lying rectal cancer that was biopsied and then treated with radiation and chemo followed by a low anterior resection. Four nodes were removed. There was no residual tumor. The patient returned one week later due to a rectal bleed, thought to be an abscess. During surgical exploration it was found that the anastomosis had broken down and it was decided to do a sigmoid colectomy. Residual disease was not suspected. Two additional nodes were removed. | Surgery of primary site: Assign code 30 [low anterior resection]. Code the most extensive surgery (i.e. the highest surgery code) applicable.
CS Reg LN Exam: Code 04 [four nodes removed].
Scope of regional lymph node surgery: Code 5 [4 or more regional lymph nodes removed].
The sigmoid colectomy was performed for a surgical complication, thus it was not cancer-directed therapy. The regional lymph nodes removed during that procedure were not removed to diagnose cancer or stage the disease, and they were not removed during the initial treatment. Please see SEER manual for instructions for coding Regional Lymph Node Surgery. |
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 | |
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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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20081124 | 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. |
2008 | |
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20081026 | MP/H rules/Multiple primaries: Is a 2007 cytology diagnosis of adenocarcinoma in bile duct a new primary for a patient with a 2005 diagnosis of adenocarcinoma of gallbladder? See Discussion. | A case abstracted for an adenocarcinoma of gallbladder (C23.9) in 2005. In 2007, cytology diagnosis of adenocarcinoma in bile duct(C24.0). Oncologist calls this recurrence. There is no pathologist statement of recurrence.
Using Other Sites multiple primary rules, rule M10 indicates this is multiple primaries. Sequence 01 dx in 2005 and sequence 02 dx in 2007. Is this correct? There is no statement of a primary tumor; the MP/H rules talk in terms of mass, lesion, tumor in a primary site. |
For cases diagnosed 2007 or later, abstract the 2007 bile duct diagnosis as a new primary unless it is described as metastatic. | 2008 |
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20081019 | Multiple Primaries--Lymphoma: How many primaries are abstracted for a patient with a 1995 periaortic lymph node biopsy showing lymphocytic lymphoma, diffuse small cleaved probable intermediate grade B cell positive, followed by stomach biopsies on 6/18/05 showing diffuse large B cell lymphoma and on 6/24/05 showing malignant lymphoma, tumor cells positive for [CD20] B cell respectively? | For cases diagnosed prior to 1/1/2010:There are two primaries:
According to the Single versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table, 9673 [Malignant lymphoma, lymphocytic, diffuse, intermediate] and 9680 [Malignant lymphoma, large B-Cell, diffuse] are separate primaries. Again, according to the table, 9680 [Malignant lymphoma, large B-Cell, diffuse] and 9591 [Malignant lymphoma, non-Hodgkin, NOS] are the same primary. 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 |