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20071122 | MP/H Rules/Histology--Colon: How is histology coded when the final pathology diagnosis is "adenocarcinoma with extensive mucinous features" and the percent of mucinous features is not stated? |
Code 8140 using rule H6. Rule H6 applies because the percent of mucinous is not specified. |
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20061018 | Multiple Primaries (Pre-2007)--Brain and CNS: Is neurofibromatosis a separate and distinct primary in the presence of a longstanding glioma? Does the following show one or two primaries? See Discussion. | MRI of Brain: 1. Findings compatible with left optic nerve glioma. 2. Stable enhancing focus in left temporal white matter. Lack of interval change since Dec 2000 suggests a white matter finding typical of neurofibromatosis and makes more aggressive processes such as astrocytoma less likely. Small aneurysm can not be excluded. | For tumors diagnosed prior to 2007:
Neurofibromatosis and glioma would be separate brain/CNS primaries. However, there is only one primary in the case example above: Glioma, left opic nerve. "...suggests a white matter finding typical of neurofibromatosis" is not reportable. "Suggests" is not a reportable term. Therefore, in this example neurofibromatosis is not reportable unless there is a more definitive statement in the record.
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. |
2006 |
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20061091 | Reportability--Ovary: Is an "aggressive adult granulosa cell tumor with one of two lymph nodes positive for metastatic granulosa cell tumor" reportable? |
Malignant granulosa cell tumor is reportable. The case described above is malignant as proven by metastasis to the lymph node. |
2006 | |
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20061122 | CS Lymph Nodes--Head & Neck (Parotid): What code is used to represent a positive intraparotid or a periparotid lymph node for a parotid primary? See Discussion. | The CS scheme for parotid places intraparotid lymph nodes under code 10 as well as code 12. Periparotid lymph nodes are included under code 12. Should both intraparotid and periparotid lymph nodes be included under code 10 only?
For head and neck sites, several lymph node groups fall into the "Other groups" category. They are not included in the level I-VII groups. In the coding schemes for most (but not all) of the head and neck sites, the "other groups" category includes intraparotid and periparotid lymph nodes and is coded 12 (or 52). |
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 code 10 for a single positive intraparotid or periparotid lymph node. If multiple nodes are involved, assign the appropriate code from the 20 series. A recent revision to the CS lymph nodes scheme for parotid places both intraparotid and periparotid lymph nodes under code 10. Please see the August 21, 2006 update to the CS staging manual. http://www.cancerstaging.org/cstage/cshtml. |
2006 |
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20061129 | Multiple Primaries (Pre-2007)--Head & Neck: How many primaries are abstracted if a patient has bilateral involvement of tonsils with the same histology (e.g. squamous cell carcinoma)? See Discussion. | Patient was initially found to have mass on right tonsil. Biopsy of right tonsil on June 16 showed invasive carcinoma, favor squamous cell. On July 17 patient underwent right neck dissection, radical resection of right tonsil tumor and left tonsillectomy. Right tonsil showed squamous cell carcinoma, poorly differentiated. Left tonsil showed squamous cell carcinoma, poorly differentiated. Microscopic report stated: Right tonsil: Invasion of deep peritonsillar tissue and skeletal muscle. Sections of left tonsil demonstrate squamous cell ca focally distributed in the tonsil, predominantly in situ, but with focal microscopic invasion. Path staged each tonsil specimen. Right tonsil was T2N1. Left tonsil was T1Nx. | For tumors diagnosed prior to 2007:
Code as two primaries. Squamous cell carcinoma diagnosed in both left and right tonsils are multiple primaries unless one is stated to be metastatic from the other.
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. |
2006 |
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20061063 | CS Extension--Lung: Do notes 6A and 6B in the 2004 SEER manual offer conflicting instruction for determining the significance of pleural effusion for this primary site? See Discussion. | 1. Is note B to be used to modify or change what note A states? Does note B state -- If a pleural fluid bx(s) is negative; but the fluid is bloody and/or is an exudate, and clinical judgment indicates the effusion is related to tumor -- use code 72? If a pleural effusion is biopsied should the pathology report state the color of the pleural fluid or is an exudate? (Training issue)
2. Do the following clinical findings impact the clinical evaluation of involvement for a pleural effusion? If yes, why? (Training issue(s)) a. Heart problems? b. The location of the pleural effusion? i. Bilateral pleural effusion is noted; tumor in Rt or Lt lung only? ii. Bilateral pleural effusion is noted; tumor in both lungs? iii. Pleural effusion is noted on the opposite side from the tumor? iv. Pleural effusion is on same side as the tumor?
SUPPORTING CS MANUAL DOCUMENTATION Note 6: Pleural Effusion. A. Note from SEER manual: Ignore pleural effusion that is negative for tumor. Assume that a pleural effusion is negative if a resection is done. B. Note from AJCC manual: Most pleural effusions associated with lung cancers are due to tumor. However, there are a few patients in whom multiple cytopathologic examinations of pleural fluid are negative for tumor. In these cases, fluid is non-bloody and is not an exudate. When these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element and the patient should be staged T1, or T2, or T3. |
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. 1. Note B does not modify or change note A. Note B is explaining when an effusion should not be used to determine the stage. Pleural effusions are evaluated by cytology, not biopsy. 2. If relevant, the clinician should document the fact in the medical record. Heart problems can cause non-malignant pleural effusions (that are disregarded for staging). Pleural effusion will almost always be around the lower lobes due to gravity, but may envelop an entire lung. Pleural effusions can be unilateral or bilateral regardless of the location of the tumor, but are usually on the side where the tumor is. |
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20061099 | CS Extension--Lung: If only a "single" cytology is performed on pericardial fluid and it is negative, can Note 6 B, which states that pleural effusion [code 72] is coded as malignant unless there are "multiple" negative cytologies, be used to infer that the pericardial fluid should also be coded as involvement? | 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. No, do not apply the instructions for pleural effusion to pericardial effusion. Do not code a pericardial effusion proven negative by cytology in CS Extension. |
2006 | |
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20061006 | Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Testis: If an orchiectomy specimen contains non-seminomatous mixed germ cell tumor and a separate satellite of seminoma, how many tumors should be abstracted and how should the histology field(s) be coded? | Pathology: R Orchiectomy: 2.1 cm non-seminomatous mixed germ cell tumor (50% teratoma primarily mature, 50% embryonal CA and yolk sac tumor). Located 3cm from the main tumor is a 2mm satellite pure seminoma. | For tumors diagnosed prior to 2007:
This is a single primary because the first three digits of the ICD-O-3 histology codes are the same, according to Rule 3a on page 11 of the 2004 SEER manual. Code the histology 9065 [Germ cell tumor, nonseminomatous]. Code 9065 is preferred over the less-specific code of 9061 [Seminoma, NOS].
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. |
2006 |
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20061004 | CS Site Specific Factor--Breast: If the tumor is described as being a 1 cm poorly differentiated pleomorphic lobular carcinoma with scattered LCIS in breast tissue, for SSF6, do we use the breast tumor or all of the breast tissue removed when coding SSF6? |
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. Site Specific Factor 6 in the breast scheme describes the relationship of invasive and in situ tumor in the tumor size coded. Code SSF6 for the same tumor used to code tumor size. For this example, code SSF6 for the 1 cm tumor. In this case, the entire tumor is reported as invasive; use code 000 [Entire tumor reported as invasive]. |
2006 | |
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20061033 | Reportability--Brain and CNS: Is benign neural tissue compatible with a glioneuronal hamartoma of the cerebellopontine angle reportable? |
No. A glioneuronal hamartoma is not neoplastic and not reportable. See page 2 of the 2004 SEER Program Coding and Staging manual for the list of reportable brain/CNS tumors. There is no ICD-O-3 code for hamartoma. |
2006 |
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