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20061008 | Histology (Pre-2007)--Corpus uteri: How is a polyp with "endometrial carcinosarcoma (Malignant Mixed Mullerian tumor), endometrial adenocarcinoma, and some areas of high grade spindle sarcoma" coded? See Discussion. | The path report for the TAH stated the endometrium contained an endometrial polyp measuring 6x3x3cm. Within the polyp there was endometrial carcinosarcoma (Malignant Mixed Mullerian tumor), endometrial adenocarcinoma, and some areas of high grade spindle sarcoma. There is no myometrial invasion by the tumor. (The Endometrial bx before surgery was positive for Malignant Mixed Mullerian tumor.) | For tumors diagnosed prior to 2007:
Assign code 8980 [Carcinosarcoma, NOS]. According to the WHO Classification of tumors, Malignant mullerian mixed tumor is a synonym for carcinosarcoma and carcinosarcoma is now the preferred terminology rather than malignant mixed Mullerian tumor. Carcinosarcoma has both malignant epithelial and mesenchymal components. The epithelial component is usually glandular (adenocarcinoma in this case). The mesenchymal component is usually sarcoma (as in this case).
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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20061019 | CS Site Specific Factor 6--Breast: If the tumor size for the breast is unknown, and it is unknown whether the tumor is mixed in situ and invasive or "pure", how is SSF6 to be coded? See Discussion. |
The definition for SSF6 for breast changed from "Unknown if invasive and in situ components present, unknown if tumor size represents mixed tumor or a pure tumor" to an added clarification of "Clinical tumor size coded." Since the clinical tumor size is NOT coded, this does not fit.
The definition for 060 is "Invasive and in situ components present, unknown size of tumor (CS Tumor Size coded 999). Since it is unknown if the tumor is mixed, this definition does not fit either.
It seems that the revised (April 2005) definition for 888 has left a situation that cannot be coded. |
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.SSF 6 should be coded 888 in this case. SEER will make the CS task force aware of this situation. |
2006 |
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20061005 | CS Reg LN Pos/Exam: Are lymph nodes coded as positive or negative when the pathology report for a lymph node dissection performed after radiation and chemo reveals that the nodes are negative but they demonstrated previous involvement by cancer? See Discussion. | Scenario: The patient was treated with radiation and chemotherapy prior to resection for esophageal cancer. The pathology report stated, "1/3 nodes c/w treated previous ca." | 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.Record lymph nodes that are pathologically confirmed as positive in Regional Nodes Positive. Evidence of previous involvement by cancer is not recorded in this data item. In the above scenario, the lymph nodes are negative according to pathology. Clinically positive lymph nodes are coded in CS Lymph Nodes. |
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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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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20061098 | CS Extension/CS Mets: For primary sites within the peritoneum (abdominalpelvic walls) such as stomach, colon, does the presence of malignant ascites affect the coding of CS Extension or CS Mets? | 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. The Collaborative Staging system is governed by site-specific coding rules. Refer to each set of site rules rather than looking for a general answer for all sites in peritoneum. In particular, Ovary and Corpus allow malignant ascites to be coded in CS Extension, but not CS Mets at Dx. For each site, both CS Extension and CS Mets at Dx should be checked for the proper field to code malignant ascites. |
2006 | |
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20061078 | Histology (Pre-2007): How is "adenocarcinoma, diffuse type, with signet ring features" coded? | For tumors diagnosed prior to 2007:
Code 8490 [Signet ring cell carcinoma]. Histology coding Rule 7 is the only rule that applies to this diagnosis. Assign the numerically higher ICD-O-3 code.
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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20061085 | Histology (Pre-2007)--Breast: Is histology coded from the more representative specimen or should the combination code 8522/3 [Infiltrating duct and lobular carcinoma] be used for a case in which a right breast mass needle core biopsy revealed infiltrating ductal ca, grade III and the subsequent right mastectomy revealed a 2.3 cm lobular carcinoma? | For tumors diagnosed prior to 2007:
Code the histology using the final diagnosis on the pathology report of the procedure that resected the majority of the primary tumor. In this case, the mastectomy removed more of the tumor than the needle biopsy. The final diagnosis from the mastectomy is infiltrating lobular carcinoma. Code histology to 8520/3 [lobular carcinoma].
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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20061037 | Multiple Primaries/Histology--Lymphoma: If a gastric biopsy demonstrates large B cell lymphoma arising in a low grade MALT lymphoma, how many tumors should be abstracted and how should the histology field(s) be coded? See Discussion. | Final path for gastric biopsy on 12/2005 is "consistent with malignant lymphoma" and Micro says "morphologic findings consistent with MALT lymphoma and an increased proportion of large atypical cells is concerning for large cell transformation. However, since the large cells are present only focally, a definitive diagnosis of large cell lymphoma cannot be rendered" A second gastric biopsy a week later said: Final Path: Diffuse large B cell lymphoma arising in low grade MALT lymphoma. Micro says: "Compared to patient's previous biopsy...the current specimen contains a higher percentage of large atypical cells which stain positively for CD79a, a B cell marker. The morphologic and immunohistochemical findings are consistent with a large B cell lymphoma arising in a low grade MALT lymphoma." These are different primaries according to the table of single versus subsequent primaries of lymphatic and hematopoietic diseases. |
For cases diagnosed prior to 1/1/2010: This is one primary. Code as 9699 [Marginal zone B-cell lymphoma, NOS]. The first biopsy was not conclusive. The biopsy one week later was more definitive. The reports are describing a difference between specimens, not a difference in disease. According to the WHO classification, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is an extranodal lymphoma with B-cells, cells resembling monocytoid cells, small lymphocytes and scattered immunoblast and centroblast-like cells. 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. |
2006 |
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20061049 | Date of Diagnosis/Ambiguous Terminology--Lung: Would the date of a PET scan that states there is a mass in the lung which is "in the range of malignancy " be coded as the date of diagnosis or would the date of a subsequent bronchoscopy with biopsy be used for diagnosis date because it confirms a malignancy? | The date of diagnosis in this case is the date of the bronchoscopy with biopsy. "In the range of malignancy" is not one of the ambiguous terms that are reportable. Please see the list of reportable ambiguous terms on page 3 of the 2004 SEER manual. Do not accession cases based on ambiguous terms not found on the reportable list. |
2006 |
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