MPH rules--Rectum: How is the number of primaries to be determined when a treatment plan has been completed, but it is not possible to determine whether there was a disease-free interval between occurrences? See Discussion.
Patient diagnosed with adenocarcinoma of the rectum in March 2006, underwent chemo and radiation therapy as treatment. Patient seen in April 2007 for surveillance colonoscopy. HPI stated patient underwent chemorad with good results. Colonoscopy showed "persistent" disease. Abdominal perineal resection was done in May 2007. Path showed adenocarcinoma of the rectum.
Keeping in mind that we are not to use a clinical statement for determining recurrences, is the April 2007 occurrence counted as a new primary?
For cases diagnosed 2007 or later:
Do not abstract the 2007 events as a new primary. "Persistent disease" indicates there was never a disease free interval.
Primary Site/CS Extension--Lymphoma: How are these fields coded for an epidural lymphoma that extends into the bone marrow of the adjacent vertebral body?
For cases diagnosed prior to 1/1/2010:After verifying that the lymphoma originated in the epidural space, code to C729 [nervous system, NOS (epidural)]. This is a rare type of extranodal lymphoma.
Assign CS extension code 80 for lymphoma with bone marrow involvement.
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.
Histology--Head & Neck: How do you code histology for a myofibroblastic sarcoma of the soft tissue of the head and neck?
Assign code 8825/3 [Myofibroblastoma, malignant]. According to the WHO Classification of Soft Tissue Tumors, "Low grade myofibroblastic sarcoma represents a distinct atypical myofibroblastic tumor often with fibromatosis-like features and predilection for the head and neck." Also called myofibrosarcoma.
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.
MP/H Rules--Lung: In reference to lung, SINQ 20071028 states "'nodule' is not an equivalent term for tumor, mass, lesion, or neoplasm." However, slide 5 for the MPH lung section of "Beyond the Basics" states "we use the words 'mass, nodule and lesion' interchangeably." Which is it?
For cases diagnosed 2007 or later:
For the purpose of applying the Lung MP/H rules, the word "Nodule" can be used interchageably with "Tumor," "Mass," "Lesion" and "Neoplasm." HOWEVER, this does NOT apply to casefinding or staging.
This revision will be added to the next version of the MP/H rules. Sinq question 20071028 will be revised.
MP/H Rules--Breast: What is the histology code for a breast tumor that is ductal ca with focal squamous differentiation? See Discussion.
SINQ 20021062 states for cases Dx'd prior to 2007, use 8570. Is 8570 also used when the squamous differentiation is focal?
For cases diagnosed 2007 or later, use rule H14 and code the histology 8500 [duct carcinoma]. Ignore histologies described as "focal," "focus," or "foci." This instruction will be added to the histology rules in the upcoming revision of the MP/H manual.
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.
Primary Site/Surgery of Other Site--Leukemia: If hairy cell leukemia is diagnosed at splenectomy, and 1 month later a bone marrow confirms the same diagnosis, is the primary site coded to spleen or bone marrow? If the site is bone marrow, is the splenectomy coded to 2 (regional) or 4 (distant) in the surgery field?
For cases diagnosed prior to 1/1/2010:Primary site:
Code the primary site to C421 [bone marrow] per primary site coding instructions for leukemia in the 2007 SEER manual, page 70.
Surgery of other site:
Since all surgical procedures for hematopoietic diseases are coded in the data item Surgery of Other Site, assign code 1 [Nonprimary surgical procedure performed].
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.
Reportability: Is a tubular adenoma reportable if the final diagnosis is "high grade atypia" and the diagnosis comment is "atypia limited to muscularis mucosa areas of pseudostratification [formerly qualifying for carcinoma in situ]"?
This case is not reportable.
The pathologist would need to include "carcinoma in situ" as part of the final diagnosis in order for this case to be reportable.
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