Report | Question ID | Question | Discussion | Answer | Year |
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20081004 | First course treatment/Histology--Lymphoma: What treatment, if any, is coded for a patient with methotrexate induced lymphoma when the treatment plan is to take the patient off methotrexate? Also, is there a specific histology for drug induced lymphoma? See Discussion. | Diffuse Large B-cell Lymphoma of soft palate & nasal septum, methotrexate induced, in 5/07. Patient was taken off methotrexate with complete resolution of disease. No other treatment was given. Patient was on methotrexate for treatment of rheumatoid arthritis. | For cases diagnosed prior to 1/1/2010:Treatment: Code the treatment fields to 00 [not done] in this case. Document the discontinuation of methotrexate for rheumatoid arthritis in a text field. Histology: Assign code 9680/36 [Malignant lymphoma, large B-cell, diffuse, NOS]. There is no specific histology code for therapy-related lymphoma. 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 |
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20081008 | Surgery of Primary Site--Breast: How is this field coded when a re-excision follows a prior mastectomy? | Code the most extensive surgery in Surgery of Primary Site. This is a cumulative field. Assign the appropriate code including all surgeries of the primary site performed during the first course of treatment. The correct code for mastectomy followed by re-excision will depend on the extent of the re-excision. For example, if the re-excision removed muscle, code radical mastectomy. |
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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20081106 | MP/H Rules--Breast: How many primaries for the following? Breast lumpectomy: Three foci of invasive ductal carcinoma. Tumor nodule #1 - Invasive ductal carcinoma. Tumor nodule #2 - Invasive ductal carcinoma with tubular features. Tumor nodule #3 - Invasive tubular carcinoma. See Discussion. |
According to the MP/H rules, this case is reportable as three primaries with histologies coded 8500, 8523 and 8211. However, our QC staff is having a problem accepting this. When the pathologist specifies that a ductal carcinoma has tubular features or is tubular type, isn't s/he saying that tubular is a type of duct? In addition, the first line of the FDx states, "Three foci of ductal carcinoma," which indicates that the pathologists interprets the three nodules to be ductal carcinoma. |
For cases diagnosed 2007 or later: These three tumors are three separate primaries. Rule M12 applies. According to the 2007 MP/H rules, tubular carcinoma is not a type of duct carcinoma. Among the paramount reasons for writing the MP/H rules are the non-standard usage of nomenclature by physicians and the inconsistency in interpretation of these non-standard phrases. The MP/H rules must be applied consistently by each cancer registrar in order for data to be comparable across registries. |
2008 |
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20081035 | MP/H Rules/Histology--Breast: What histology code is used for a single tumor, micropapillary carcinoma with components of mixed ductal and lobular carcinoma? | For cases diagnosed 2007 or later, use rule H16 and assign code 8522 [Duct and lobular carcinoma]. Micropapillary is specific duct type (see Table 1). |
2008 | |
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20081074 | Primary site/Histology: Does SEER accept the site/type combination of lymph nodes (C77.0-C77.9) with the histology of either 9823 (B-cell chronic lymphocytic leukemia/small cell lymphocytic lymphoma) or 9827 (Adult T-cell leukemia/lymphoma)? See Discussion. | There is a discrepancy between the SEER Site/Type table and the CS histology codes under Lymph Nodes. | For cases diagnosed prior to 1/1/2010:These are not "impossible" site/histology edits. You can override them. However, if the lymph nodes are involved and a lymphoma histology is available, the lymphoma histology should be coded rather than leukemia histology. For example, assign histology code 9670 (Malignant lymphoma, small B lymphocytic, NOS) instead of 9823 (B-cell chronic lymphocytic leukemia/small cell lymphocytic lymphoma) if the disease is identified in the lymph nodes. 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 |
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20081108 | 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. |
2008 | |
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20081080 | 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: |
2008 |
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20081133 | 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. | 2008 | |
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20081044 | MP/H Rules/Behavior--Melanoma of Skin: How are histology and behavior coded for a "malignant melanoma in situ with regression"? See Discussion. | Per the microscopic portion of the path report, there is a zone of regression within the confines of the lesion, such that the possibility of antecedent invasive disease at the site cannot be ruled out with certainty. | For cases diagnosed 2007 or later: Code malignant melanoma in situ with regression to 8720/2 [Melanoma in situ]. Code the histology according to the histologic type specified in the pathology report final diagnosis. Code the behavior as specified in the pathology report. Regression does not affect the coding of histology or behavior. See Melanoma Histology Coding rule H5. See 2007 SEER manual instructions for coding behavior, page 84. |
2008 |