Behavior/Date of Diagnosis--Lung: If the term "Pancoast tumor, NOS" is malignant by definition, should the date of diagnosis be coded to the date of the clinical diagnosis when the clinical diagnosis is made prior to the histologic confirmation of the malignancy?
Yes, Pancoast tumor is by definition malignant. It is defined as a lung cancer in the uppermost segment of the lung that directly invades into the brachial plexus (nerve bundles) of the neck, causing pain. If a Pancoast tumor was identified on imaging prior to the biopsy, the date of diagnosis should be linked to the Pancoast tumor report.
Primary Site--Bladder: What subsite is used for fundus of the bladder?
As of November 2005, Code fundus of bladder to C678 [overlapping lesion of bladder]. Opinions vary regarding the definition of bladder "fundus." However, according to our pathologist consultant, fundus includes posterior, anterior and lateral walls and dome. Fundus does not include the trigone.
A correction to page C-595 of the 2004 SEER manual will be included in the next errata.
Surgery of Primary Site--Skin: What surgery code is used to reflect the amputation of a finger for subungual melanoma?
47 [Wide excision or reexcision of lesion or minor (local) amputation with margins greater than 2cm] is the correct surgery code for amputation of a finger for melanoma.
Recurrence/Multiple Primaries (Pre-2007)/Primary Site--Breast: Is a malignancy that occurs in 2005 in a mastectomy scar years following an original diagnosis of breast cancer in 1971 a recurrence (not reportable) or a new primary (breast or chest wall, NOS)? See Discussion.
The patient had a right mastectomy for breast carcinoma in 1971. In 2005, she came in with a mass in the right axilla and a right chest wall mass in the mastectomy scar. Excision of the axillary mass and biopsy of the chest wall mass revealed invasive adenocarcinoma with a similar histologic pattern. The axilla specimen contained no benign breast tissue. IHC stains exhibit strongly positive for ER, mildly positive for PR and negative for HER2/neu. The pathologist says "Although these findings are consistent with recurrent breast carcinoma, they are not specific for such. Recurrence after 34 yrs. is most unusual."
For tumors diagnosed prior to 2007:
The 2005 diagnosis is a new primary. The 1971 site differs from the 2005 site and there are more than two months between the two. Without further information, assign topography code C761 [chest wall]. The pattern of spread, including regional extension, is different for a primary of the chest wall compared to a primary in the breast. Coding the primary site to C761 will group this case with similar cases.
If further information can be obtained, look for old records that describe the extent of the 1971 mastectomy. It is possible that there was breast tissue left on the chest wall. Residual breast tissue is often present following mastectomy (simple, modified, or even radical). New carcinoma can develop in the remaining breast tissue.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Lung: How is histology coded for the tumor(s) that exist if a left upper lobe of lung resection final diagnosis states the patient has a moderately differentiated adenocarcinoma and the path indicates there are "multiple carcinoid tumorlets"?
For tumors diagnosed prior to 2007:
Histology is coded 8140/3 [adenocarcinoma]. This is one reportable tumor of the left lung. According to our pathologist consultant, the tumorlets are collections of cells which appear to be of neuroendocrine origin, but are not malignant.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Primary Site--Peritoneum: During a second look staging lap following a diagnosis of serous carcinoma of the left ovary, did the physician correctly indicate a new peritoneum, NOS primary for disease described as an endometrioid adenocarcinoma in a "paracaval cyst" that appears to have arisen in endometriosis?
The primary site is C482 [Peritoneum, NOS]. "Paracaval" means alongside or near the vena cava.
Code the site in which the primary tumor originated.
Date of Diagnosis--Lung: Should the diagnosis date be coded to the date of the scan or the date of the resection when there is a negative biopsy that occurs between the two procedures? See Discussion.
11/2003 CT chest: 2 cm LLL mass should be considered carcinoma until proven otherwise.
2/2004 CT Chest: stable LLL mass still consistent with primary or metastatic lung neoplasm
11/2004 CT chest: LLL mass suspicious for slow growing carcinoma
3/2005 FNA L lung: atypical cells
4/2005 L lobectomy: well-diff adenocarcinoma
Code the date of diagnosis as 11/2003. A clinical diagnosis was made on 11/2003 and this is the earliest date of diagnosis for this case.
Reportability/Behavior--Brain and CNS: How is a brain "neoplasm" diagnosed only by CT scan reported to SEER? See Discussion.
We have a significant number of patients who come into our emergency room and are diagnosed with a brain neoplasm by CT scan. They are transferred to another facility for further care. Some of those facilities will give us information - histology, treatment, etc. Some will not. How are we supposed to report these brain neoplasms if we don't know if they are benign or malignant? Can we report them as behavior code 9 or do we just report them as benign if we can't get any further information?
The case above is reportable and 8000/1 is the most appropriate histology/behavior code. A clinical diagnosis alone from diagnostic imaging reporting a brain 'neoplasm' (with a diagnosis date supporting the reportable case requirements) even with no other information available (from biopsy or resection) is reportable. Care should be taken when reviewing terms used by the radiologist on these reports, since some tumors exhibit defining characteristics that can be picked up on diagnostic imaging.
Histology (Pre-2007)--All Sites: How are "malignant cells" in a cytology or "probably malignancy" in a CT scan coded?
For tumors diagnosed prior to 2007:
Assign code 8001/3 [Tumor cells, malignant] when the only information available is a cytology report stating "malignant cells."
Assign code 8000/3 [Neoplasm, malignant] when then only information available is a CT report stating "probable malignancy."
See ICD-O-3 page 27 for an explanation of "cancer" [8000] and "carcinoma" [8010].
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
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