MP/H Rules--Bladder: Is a TURBT in 4/07 that demonstrates papillary carcinoma (8130/3) followed two weeks later with biopsies that demonstrate high grade flat dysplasia/carcinoma in situ (8010/2) two primaries?
For cases diagnosed 2007 or later, rule M6 applies and this is a single primary.
Flat transitional cell carcinoma and carcinoma in situ of the bladder are synonymous. See the definition of "Flat Tumor (bladder)/Noninvasive flat TCC" in the Urinary Terms and Definitions section of the 2007 MP/H manual.
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.
MP/H Rules--Breast: Is a ductal carcinoma diagnosed in August, 2008 following a lobular-ductal primary diagnosed in February 2007 a new primary? See Discussion.
Patient has two right breast tumors excised in February, 2007. One is lobular and the other ductal - abstracted as single primary per rule M10. Patient presents with new right breast tumor in August, 2008. This is a ductal carcinoma stated to be a recurrence. Would we again stop at M10 (single primary) or continue on to M12 and make this a new primary (difference at third number)?
For cases diagnosed 2007 or later:
Stop at rule M10 -- this is the first rule that applies. The 2008 diagnosis is not a new primary.
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.
Reportability/Date of diagnosis--Liver: Does the final diagnosis of a scan have higher priority than the findings in the discussion in the body of the report? See Discussion.
A patient with liver cancer becomes transplant eligible when the tumor is 2 cm in size. Frequently, liver tumors will be watched (no biopsy) for months until they meet the 2 cm size criteria. In the meantime, multiple scans will describe the tumor using variations of ambiguous terms that drift in and out of reportablility. One day the tumor is labeled "presumed hepatocellular carcinoma." Weeks later it is back to "worrisome for hepatoma." A single scan will use different terms in different sections of the report.
Example case: Abdominal CT reveals a 1 cm liver lesion. Per the discussion portion of the scan, the lesion is consistent with hepatocellular carcinoma. Per final diagnosis: 1 cm liver lesion, possibly hepatocellular carcinoma. Is this report diagnostic of cancer? Would the date of this report be the date of diagnosis? (Patient did receive a liver transplant for hepatocellular carcinoma months later.)
When a reportable ambiguous term is used in one part of a report or the medical record and a non-reportable ambiguous term is used in another part of the report or the medical record, accept the reportable term and accession the case.
The example above is reportable. "Consistent with" is a reportable ambiguous term. Accept "consistent with" over the non-reportable term "possibly."
The date of this report would be the date of diagnosis if this is the earliest report using reportable terminology.
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.
MP/H Rules--Breast: What histology code is used for lobular carcinoma, pleomorphic type?
For cases diagnosed 2007 or later, use rule H14 and code the histology 8520 [lobular carcinoma]. 8520 is the only ICD-O-3 code for lobular carcinoma. There are no codes for specific lobular types.
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.
CS Lymph Nodes/CS Site Specific Factor--Head and Neck: How should these fields be coded when the information is from an out of state data exchange and the record provides no supporting text, all the required fields are not coded and the codes that are provided are in conflict? See Discussion.
A parotid case with CS LN coded to 10 [single positive ipsilateral regional node]; Regional LNs Positive coded to 68 and Regional LNs Examined coded to 74. No SSFs were coded. Based on the number of nodes coded as positive, the CS LN code was incorrect. Because the only information available to the central registry was that multiple regional LNs NOS were positive, we coded CS LN to 80 [lymph nodes NOS] and coded all SSFs to 999. Upon running the SEER edits, this case popped up on edits yielding a CS Site-Specific Factor codes, CS Lymph Nodes and Head/Neck Schemas conflict. Provide some guidance as how to properly code CS LNs & SSFs 1-6 for this case given the very limited information provided to us?
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.This is an unusual situation with conflicting information. If possible, request the pathology report and/or audit the case.
If you cannot obtain any further information or clarification, there are two choices:
MP/H Rules--Breast: Is inflammatory breast cancer always one primary per lifetime? Or is a subsequent inflammatory breast cancer a second primary if diagnosed more than five years later?
For cases diagnosed 2007 or later, a diagnosis of inflammatory breast cancer more than five years after a previous diagnosis of inflammatory breast cancer is a separate (new) primary. See rule M5 in the Breast Multiple Primary Rules.