Histology (Pre-2007): Is an intra-abdominal mass with the histology of "squamous cell carcinoma arising in a dermoid cyst" coded to 8070/3 [Squamous cell carcinoma] or 9084/3 [Dermoid cyst with malignant transformation]?
For tumors diagnosed prior to 2007:
Code histology to 9084/3 [Dermoid cyst with malignant transformation] per the ICD-O-3. Dermoid cysts may contain a malignant component of a type typically encountered in other organs and tissues.
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.
CS Tumor Size--Lung/Breast: Explain why the SEER instructions differ from the CS Manual regarding priority order of sources to code tumor size? See Discussion.
Regarding the 2004 SEER Manual, Appendix C, Site Specific Coding Modules, Lung and Breast. The priority of sources for coding tumor size is Pathology, Operative Report, PE, imaging for breast and pathology, operative, endoscopic, and imaging for lung. This differs from the CS Manual instructions.
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.For cases diagnosed in 2007 and forward, follow the instructions in the 2007 SEER manual and the CS manual.
Reportability: Is an AIN III that arises in perianal skin, skin tags or condyloma acuminatum reportable or must an AIN III arise in the anus or anal canal in order to be reportable?
AIN III arising in perianal skin [C445] is not reportable.
AIN III [8077/2] of the anus or anal canal is reportable.
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.
CS Extension/CS Mets at Dx--Corpus uteri: Is a microscopic metastasis in a cul-de-sac implant more appropriately reflected in the CS Extension field code 80 [Further contiguous extension; cul-de-sac] or in the CS Mets at Dx field code 40 [Distant metastasis]?
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 80 [Further contiguous extension; Cul de sac] for CS extension in this case. Endometrium and ovary are exceptions to the rules that only contiguous extension is coded in Extension code 80. Only true distant metastases are coded in Mets at Dx.
CS Extension--Lung: How is extension coded if there is only one cytology done on a pleural effusion that is negative for carcinoma (but shows an exudate) and there is no clinical assessment of the pleural effusion found in the medical record? See Discussion.
CS lung extension note 6 provides instructions from the SEER manual and also from the AJCC manual. Per SEER manual, "ignore the effusion that is negative for tumor." Do we ignore the pleural effusion for the case in question because it was negative? Per 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." For the case in question, pleural fluid was examined only once and clinical judgment is not available. As a SEER registry, do we follow the SEER portion of the note and ignore the pleural effusion? Or do we code extension as involving pleural effusion because it was an exudate?
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.A single negative pleural effusion by itself does not impact the coding of extension.
The SEER note does not alter the AJCC note and the AJCC note does not alter the SEER note. They are two separate statements from two separate staging authorities. Registries follow both notes. For this case, ignore the pleural effusion because there is no clinical judgment available and there was only one cytology on the effusion.
CS Lymph Nodes--Colon: What criteria is used to distinguish between code 30 [Regional lymph nodes, NOS] and 80 [Lymph nodes, NOS] when positive lymph nodes are removed during a colon resection but the lymph node location is not stated? See Discussion.
Example 1: Descending colon excision: Metastatic adenocarcinoma in 8 of 9 lymph nodes.
Example 2: Hepatic flexure and en bloc resection of liver. Adenocarcinoma in 3 of 10 lymph nodes.
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.
Code positive nodes included with the resected specimen as regional lymph nodes, NOS when the location is not stated. See number 3.e under the general instructions for coding CS lymph nodes.
Based only on the information provided, code CS lymph nodes 30 [Regional lymph nodes, NOS] for both examples.
CS Extension--Bladder: How is extension coded if the bladder tumor involves the right ureter per cystoscopy but the TURB specimen demonstrates muscularis propria invasion?
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.
Code CS extension based on the area of deepest invasion. According to the TNM Supplement, which was used as a resource in the development of CS, "Direct invasion of the distal ureter is classified by the depth of greatest invasion in any of the involved organs." Record the greatest extent of disease using both clinical and operative/pathologic assessment.
CS Lymph Nodes--Lung: If the lymph nodes listed in codes 10 and 20 were contralateral or bilateral, and the only description was "mass", "adenopathy", or "enlargement" on mediastinoscopy or x-ray, is this field coded to 60? See Discussion.
(CS Manual page 407) Note 2: If at mediastinoscopy/x-ray, the description is "mass", "adenopathy", or "enlargement" of any lymph nodes named as regional in codes 10 and 20, assume that at least regional lymph nodes were involved.
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.
Yes. The named nodes listed in codes 10 or 20 should be coded 60 if the "mass", "adenopathy", or "enlargement" on mediastinscopy or x-ray is described as bilateral or contralateral.