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.
Histology/Polyp--Colon: Which histology code is used when a colon biopsy states adenocarcinoma arising in a polyp, but the resection path states only adenocarcinoma, and does not mention arising in a polyp. See Discussion.
This scenario occurs frequently and our QC staff is divided on which code to use.
03-24-06 Rectal Polyp: Adenocarcinoma, moderately differentiated. 6-29-06 Rectum: Adenoca, MD, invades into the submucosa. No malignancy (0/15) LNs.
Use the polyp information from the biopsy and code adenocarcinoma arising in a polyp (8210, 8261 or 8263 as appropriate).
CS Lymph Nodes: Are positive right superficial inguinal lymph nodes coded to 30 (which is the case for anal canal primaries) or 31 (which is the case for anus primaries) if the primary is stated to be in the "cloacogenic zone" or is an anorectal primary?
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 30 for positive unilateral superficial inguinal lymph nodes for cloacogenic primaries. The cloacogenic zone is part of the anal canal.
Reportability: Is a tumor reported as "neoplasm" or "neoplasia" per the pathology report, which is subsequently clinically referred to as "carcinoma" reportable? See Discussion.
Example 1: Lung-Wedge resection and subsequent left lower lobe lobectomy showed papillary epithelial neoplasia. Tumor board and subsequent reports state "nonsmall cell carcinoma of lung."
Example 2: Kidney-Partial nephrectomy showed epithelial neoplasm, clear cells with low grade cytology. Subsequent urology clinic notes state that path revealed clear cell renal carcinoma.
2004 SEER manual states that "cases clinically diagnosed are reportable. If the physician treats a patient for cancer in spite of the negative biopsy, accession the case." Do we also accession the case if primary site has been resected? Would diagnostic confirmation be coded 8 (clinical diagnosis only)?
Accession the case and code Diagnostic Confirmation as 8 [clinical diagnosis only]. Accession a case with negative pathology when the clinician is aware of the negative pathology and continues to refer to the case as malignant.
Reportability/Behavior--Skin: Is an "atypical fibroxanthoma (superficial malignant fibrous histiocytoma)" with an ICDO-3 histology code of 8830 reportable with a behavior code of 3 or is it nonreportable with a behavior code of 1?
Yes, "atypical fibroxanthoma (superficial malignant fibrous histiocytoma)" is reportable. The information in parentheses provides more detail and confirms a reportable malignancy.
CS Extension--Lymphoma: In the absence of physician staging, is an "enlarged" spleen seen on CT coded as involvement of the spleen for lymphoma cases?
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.
Do not code spleen involvement when the only evidence is an enlarged spleen.
When imaging is the only diagnostic tool (no biopsy or splenectomy), spleen involvement is based on the presence of nodules and not on enlargement. Splenic enlargement alone (by physical exam or imaging) is insufficient to support involvement of spleen.
Reportability--Melanoma: Is an excisional biopsy of the skin with a diagnosis on the pathology report of "Tumoral melanosis" reportable by itself or must there be a pathologist note, such as "Note: Unless proven otherwise, tumoral melanosis should be considered as a regressed melanoma", in order for it to be reportable? See Discussion.
Skin, left upper back, exc Bx: Tumoral melanosis. Note: Unless proven otherwise, tumoral melanosis should be considered as a regressed melanoma.
If reportable, do we report a diagnosis of tumoral melanosis without a similar note?
Tumoral melanosis (TM) alone is not reportable. It is not listed in ICD-O-3. TM can be associated with a regressed melanoma, but it can also occur with other cutaneous tumors. The case is reportable if there is a diagnosis of melanoma.
Reportability--Lymphoma: Is a lymphoma diagnosed on a bone marrow biopsy reportable if the cytogenetics evaluation performed does not confirm the malignancy? See Discussion.
Bone marrow Bx: Marginal zone lymphoma/leukemia. The morphology of the lymphoma/leukemia cells and the immunophenotypic characteristics identified by flow cytometry are consistent with marginal zone lymphoma/leukemia.
Addendum Report: Cytogenetic evaluation revealed a 46,XY male karyotype. This is the normal male chromosome karyotype. Based on the limits of this methodology, no evidence of hematologic malignancy was observed in this specimen.
For cases diagnosed prior to 1/1/2010:
Yes, this case is reportable. The cytogenetic evaluation cited in the addendum report does not disprove the bone marrow biopsy diagnosis.
For cases diagnosed 2010 forward, 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 Lymph Nodes--Lung: Do modifying terms such as "borderline" affect whether lymph nodes are coded as involved when they are used in conjunction with the descriptors listed in Note 2 (i.e., mass, adenopathy or enlargement) for lung primaries? See Discussion.
Lung primary: CT states "borderline" enlarged hilar lymph nodes. Note 2 in the Lung schema under CS Lymph Nodes does not address qualifiers.
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.
Do not code the hilar lymph nodes as involved in this case. "Borderline" enlarged hilar lymph nodes do not meet the clinical criteria for enlargement.
CS Lymph Nodes--Colon: Are positive paracecal lymph nodes for cecal primaries coded to 10 [paracolic] or code 20 [cecal: anterior (prececal), posterior (retrocecal); NOS]?
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 20 [Regional lymph node(s) for specific subsites]. Paracecal means near the cecum. Paracecal lymph nodes are regional nodes for the cecum and not for other colon subsites.
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