Reportability--Brain and CNS: Which types of neurofibromatosis are reportable to SEER? See Discussion.
Clin exam: probable neurofibromatosis, type I. On the trunk alone are >14 cafe au lait spots all at least 10mm. Both axillary regions have freckling. No palpable fibromas, spine is straight, no organomegaly. MRI of head: no abnormality.
Neurofibromatosis type I (von Recklinghausen's disease, the Elephant Man disease) is primarily tumors of the subcutaneous tissues. By itself, NF1 is not reportable. NF2 is much more likely to develop acoustic neuromas. This syndrome is reportable only when acoustic neuroma(s) is present, because the acoustic neuroma is what is reportable. This case is not reportable because none of the symptoms affect the central nervous system.
Histology (Pre-2007)--Breast: Is a "noninvasive papillary carcinoma, solid type, of the breast" coded to 8503/2 [noninfiltrating intraductal papillary carcinoma] or 8230/2 [Intraductal carcinoma, solid type]?
For tumors diagnosed prior to 2007:
Code histology to 8503/2 [Noninfiltrating intraductal papillary adenocarcinoma]. "Solid" is one of four subtypes of intraductal papillary carcinoma. The other subtypes are cribriform, micropapillary and spindle cell. ICD-O-3 does not provide codes for each intraductal papillary subtype, so code to intraductal papillary 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.
CS Tumor Size--Breast: Is the largest focus or the total area coded for tumor size in a patient presenting with "scattered foci of DCIS, largest focus measuring 0.6cm. DCIS spans a total area of 2.1cm."
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 the size of the largest focus in CS tumor size. Code the tumor size for this case as 006 (6mm or 0.6cm).
CS Site Specific Factor 4--Prostate: For apex involvement at prostatectomy, is only apical involvement found at prostatectomy included or is all histologically proven apical involvement documented in the second digit of Site Specific Factor 4? See Discussion.
Per note 1 for Site Specific Factor 3 - Pathologic Extension all histologic information is used. Biopsy information would be included when coding path extension. Would all histologic information be used for coding prostatectomy apex involvement in Site Specific Factor 4?
Example 1: Prostate biopsies of the right and left apex and right and left mid gland show adenocarcinoma. Prostatectomy shows bilateral adenocarcinoma. Apex negative for tumor.
Example 2: Prostate biopsies of right apex and mid gland show adenocarcinoma. There is no mention of apex on prostatectomy path. How is CS Site Specific Factor 4 Prostate Apex Involvement 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.
Assign the second digit of CS SSF 4 based on prostatectomy only, do not include biopsy or other histologic information in the second digit.
According to the CS Steering Committee, the clinical or biopsy of the prostate is included in the first number of the code and should not be combined with the prostatectomy code which is the second number. These were separated purposely.
Example 1: Code the second digit of SSF 4 based on the prostatectomy, 1 [no involvement of prostatic apex].
Example 2: Code the second digit of SSF 4 based on the prostatectomy, 5 [apex extension unknown].
CS Extension/CS Site Specific Factor--Breast: How is extension (localized or unknown) and SSF6 (entire tumor in situ or 888) coded for an in situ breast primary in which bone metastasis is diagnosed 4 months following the mastectomy? See Discussion.
In situ breast primary with bone mets. No mets work up prior to mastectomy done 2/04. Path: 2.5 cm mass: ductal carcinoma in situ, solid type, with comedonecrosis (no invasive carcinoma found in mastectomy specimen). Bone scan done 4/04 showed compression fractures. MRI 6/04 showed diffuse metastatic disease of the bones.
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.
First, determine whether the bone mets in this case are progression of disease. If the patient was asymptomatic at the time of the mastectomy, the bone mets are disease progression, not initial stage.
If the initial stage includes the bone mets and they are not disease progression, extension must be coded to at least 10. Code site-Specific Factor 6 to 040 [Size of entire tumor coded, size of invasive component not stated].
Reportability/In Situ--Prostate: Was there a time period when PIN III was reportable to SEER?
Per the 2004 SEER Manual, page 2, Reportable Diagnoses, Exceptions, 1.b.iii "Prostatic intraepithelial neoplasia (PIN III) of the prostate (C619). (Collection stopped effective with cases diagnosed 1/1/2001 and later.)"
CS Lymph Nodes--Breast: How is this field to be coded if the pathologist staged the case pN1a and the lymph node is stated to be negative on H&E, is .3 cm on IHC stain for pancytokeratin but on review of smears shows no malignant cells?
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 Lymph Nodes as negative [00]. The positive stain for pancytokeratin is contradicted by the statement "malignant cells are not identified." See also sinq 20010055.
2004 SEER Manual Errata/Grade--Breast: Are the codes on page 94 of the SEER manual's Breast Grading Conversion Table requiring conversion of nuclear grades 1/3 and 1/2 to code 1, 2/3 to code 2, and 2/2 and 3/3 to code 3 correct or are the codes on page C-473 in the Three-Grade System (Nuclear Grade) for breast correct that requires conversion of the same examples to codes 2, 3, and 4 respectively?
On page C-473: Delete the section titled "Three-Grade System (Nuclear Grade)" and delete the table. Use the tables on pages 94 and C-472 to code grade for breast cancer. This correction will be made in the next errata.
CS Extension/CS Mets at Dx--Pineal Gland: In Collaborative Stage, how is positive cerebral spinal fluid 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.Assign CS Mets at DX code 40 [Distant metastases] for a pineal gland primary with positive cerebral spinal fluid.