Histology (Pre-2007)--Head & Neck: How is a "sinonasal undifferentiated carcinoma (SNUC)" coded?
For tumors diagnosed prior to 2007:
Code histology to 8020 [carcinoma, undifferentiated]. "Sinonasal" refers to anatomic location of primary site not histology.
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.
Behavior--Head & Neck: Should the SEER IF_Morph_3 edit be modified because it does not allow a behavior code 2 with histology 8941 [carcinoma in a pleomorphic adenoma] for a parotid primary?
Code the behavior as 2 and over-ride the edit. The edit is there to flag unusual combinations. Once you have verified that the behavior is coded correctly, over-ride the edit.
The surgeon stage of T2 is based on size of tumor, the TIS is based on behavior. Code according to pathologically confirmed TIS.
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.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Skin: How many cases are to be abstracted and how is the histology field(s) coded for cases in which a fibrosarcoma arises in or transforms from a dermatofibrosarcoma protuberans? See Discussion.
1. If the fibrosarcoma occurs after DFP, and is called metastatic, is it a recurrence or is it a new primary? Example: Pt diagnosed in 7/05 with a high grade fibrosarcoma arising in a dermatofibrosarcoma protuberans. The path indicated "The presence of high grade fibrosarcoma, the extent of the tumor necrosis and the mitotic rate are all adverse prognostic findings that indicate a significant risk for mets." The patient had a recurrence in 8/06 called a low grade fibrosarcoma mets from prev." The DFP code is 8832/3 and a fibrosarcoma code is 8810/3. Our pathologist feels that the fibrosarcoma is a more aggressive tumor so should the case be coded to the 8810/3.
2. If DFSP has areas of fibrosarcoma, should it be coded to the latter because it is more aggressive? Example: Skin and subcutaneous tissue reads: Low grade sarcoma - tumor extends to margin. Comment: "Although the predominant pattern of this tumor is consistent with dermatofibrosarcoma protuberans, focal presence of hypercellularity and increased mitotic figures suggest transformation to Grade I fibrosarcoma. This progression, although focal, carries an increased risk of mets over classic DFSP. Code to 8810/31?
For tumors diagnosed prior to 2007:
Code histology to 8832/3 [Dermatofibrosarcoma protuberans] for both cases. DFSP with transformation to fibrosarcoma and DFSP with areas of fibrosarcoma are coded to 8832/3.
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 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.
Histology (Pre-2007)--Pancreas: Is a "composite mucinous adenocarcinoma and squamous cell carcinoma" coded to 8560 [adenosquamous carcinoma] or should 8480 [mucinous adenocarcinoma] be coded rather than 8070 [squamous carcinoma] because mucinous adenocarcinoma is a higher histology code than squamous carcinoma?
For tumors diagnosed prior to 2007:
Assign code 8560 [adenosquamous carcinoma]. According to our pathologist consultant, the mix of adenocarcinoma and squamous carcinoma is adenosquamous carcinoma. Adenosquamous tumors are rare, but known, representing 3-4% of pancreatic carcinomas.
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 Extension--Lung: Can extension be coded to 10 (Tumor confined to one lung) when either an autopsy or a CT scan describes the tumor as a mass of a specified size located in one lobe of the lung without any description of extension and no available TNM provided? See Discussion.
Example 1: Lung primary within the right lower lobe described clinically as greater than 3 cm on scan but was found to be 3 cm at autopsy.
Example 2: CT scan February shows 2 cm mass in RUL.
In both cases, the only tumor description was the size of tumor without any information regarding extension.
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, assign code 10 [Tumor confined to one lung] for a mass in one lobe when none of the descriptions in codes 11 to 80 are documented.
Neoadjuvant Treatment/Date Therapy Initiated--Breast: If Tamoxifen has been used since 2000 for the treatment of hyperplasia, should it be coded as neoadjuvant treatment for a 2004 diagnosis of breast cancer?
Do not code tamoxifen given for hyperplasia as treatment for breast cancer. In this case, tamoxifen started four years before the breast cancer diagnosis -- not treatment for breast cancer.
Histology--Breast: Does "cancerization" mean invasive for a breast tumor described as "DCIS with lobular cancerization"?
No, cancerization is not a synonym for invasive. Cells of DCIS can extend not only along the duct but also into the terminal lobules. This extension is referred to as lobular cancerization.
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.
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