Multiple primaries/Histology--Lymphoma: How many primaries should be abstracted and how should the histology field(s) be coded in this situation?
How would the bone marrow involvement by only NHL be handled? Composite lymphoma (9596) as defined by SEER and ICD-O is NHL and HD in one node which fits the final impression on the removed cervical node. See Discussion.
Patient presented with cervical, supraclavicular & superior mediastinal lymphadenopathy. A cervical node was excised for pathological review. The final impression on that node was Composite lymphoma characterized by (1) Nodular Lymphocyte Predominant Hodgkin Lymphoma [HD] (2) CLL/SLL [NHL]. Then, a bone marrow aspirate/bx was performed revealing CLL/SLL [NHL].
For cases diagnosed prior to 1/1/2010:This is a single primary. The histology code is 9596/3 [composite Hodgkin and non-Hodgkin lymphoma].
According to the Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table, 9596/3 followed by 9670/3 is one 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.
CS Extension: How is CS Ext coded for the following?
Rretroperitoneal primary
Cystic mucinous tumor with intraepithelial carcinoma
There is no CS Extension code for intraepithelial ca in the retroperitoneal scheme.
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.According to the American College of Surgeons I & R system, assign code 10 [confined to site of origin] for intraepithelial carcinoma of the retroperitoneum.
First course treatment--Prostate: If a patient has a prostatectomy and the margins are positive, then several months later radiation is given because the PSA levels never decreased or have risen, is the radiation coded as first course of treatment or subsequent treatment?
Record the radiation as first course of treatment even though it was delayed for several months.
Radiation is highly effective when there is a small or microscopic amount of tissue left at the margin following prostatectomy. In most regions, radiation therapy is the standard of care for positive margins at prostatectomy.
CS Extension--Corpus uteri: Can a suspicious cytology be used to code extension? See Discussion.
Endometrial primary confirmed by biopsy on 10/26/06. Pelvic washing on 11/14/06 was 'suspicious for malignancy.' Resection path the same day stated the primary tumor invades the inner 1/3 of the myometrium.
Can we use the pelvic washing cytology & code CS extension 61 or should CS extension be coded 12?
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 extension code 61 [cancer cells in peritoneal washings] for the case described above.
"Suspicious" is listed as a term indicating involvement. There is no exception noted for cytology reports. See page 122 of the 2007 SEER manual.
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.
Multiplicity Counter: Is there a time frame for the Multiplicity Counter or is it related to the duration for counting new tumors (i.e. 5 years for breast, etc) to capture the number of "local recurrences"?
Record the number of tumors counted as a single primary at the time the case is abstracted. Later, if additional tumors are determined to be the same primary, update this field once. Do not update the multiplicity counter more than once.
MP/H Rules/Histology--Breast: What is the histology code for the following?
4/21/03 Left breast: infiltrating ductal carcinoma, grade 3 micropapillary type. Tumor size: 3.5 cms; deep margin negative. Skin, nipple & areola positive for invasive ductal carcinoma. Dermal lymphatic invasion by carcinoma breast. Extensive intraductal component absent. 6+/6. See Discussion.
How should histology be coded for a 2003 diagnosis and also for the same diagnosis in 2007 or later?
For a case diagnosed in 2003, code 8507/3 [Duct micropapillary carcinoma]. See Coding Complex Morphologic Diagnoses, revised August 2002, 3rd example on page 5 and page 3, #4.
For cases diagnosed 2007 or later, code 8507/3 [Duct micropapillary carcinoma]. Use rule H12.
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.
Reportability/Histology--Head and Neck: Is a right cerebellopontine (CP) angle endolymphatic sac papillary tumor (ELST) reportable? If so, what is the histology code?
Revised December 2015
ELST is reportable. Code histology to adenocarcinoma (8140/3). Code primary site to inner ear (C301).
Endolymphatic sac tumors are rare non-metastasizing adenocarcinomas that originate in the endolymphatic sac of the inner ear (C301). They are slow growing and widely invade, and in later stages often destroy, the petrous bone. The WHO Classification assigns ICD-O-3 code 8140/3.
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