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20041072 | Histology (Pre-2007)--Colon: Must a case be specifically labeled "familial adenomatous polyposis" or is the mere presence of numerous/multiple polyps sufficient for coding the histology to FAP? | For tumors diagnosed prior to 2007:
The presence of numerous/multiple polyps is not necessarily adenomatous polyposis coli. Adenomatous polyposis is an extreme condition usually characterized by the presence of hundreds of polyps and should be identified as such either clinically or pathologically. Look for the term "Familial adenomatous polyposis," FAP or one of its synonyms: Adenomatosis of the colon and rectum [ACR] Familial adenomatous colon polyposis Familial colonic polyposis Multiple familial polyposis In the absence of these terms, the following probably indicate a diagnosis of FAP: Hundreds of adenomatous polyps throughout large intestines, and at times, throughout the digestive system Development of polyps as early as ten years of age, but more commonly at puberty History of colectomy
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. |
2004 | |
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20041033 | Histology--Hematopoietic, NOS: When the histology is described in both WHO and FAB terms, which terminology has priority to code this field? See Discussion. |
Example: Bone marrow biopsy was reported as: "Markedly hypercellular marrow aspirate with myelodysplastic alterations morphologically consistent with refractory anemia (FAB) or refractory cytopenia with multilineage dysplasia (WHO)." | For cases diagnosed prior to 1/1/2010:Give preference to the WHO terminology when both are used in the final pathology diagnosis. The WHO classification of tumors is the current standard and is recommended by the College of American Pathologists. 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. |
2004 |
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20041062 | Histology (Pre-2007): Can we ever code this field using a more specific cell type from a metastatic site specimen rather than to a less specific cell type from the primary site specimen? See Discussion. | The histology for a metastatic deposit biopsy is mucin-producing adenocarcinoma. This report states that the primary site is the stomach. It is more specific than the histology from the stomach biopsy described as adenocarcinoma, NOS. | For tumors diagnosed prior to 2007:
Code the histology for the case example to 8481/3 [mucin-producing adenocarcinoma], the more specific 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. |
2004 |
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20041030 | Histology (Pre-2007)--Lung: What is the correct histology code for this case of squamous cell carcinoma with several different variants? See Discussion. | The path report from a left pneumonectomy says: This squamous cell carcinoma had several different variants present including typical non-keratinizing squamous cell, spindled cell squamous cell, clear cell squamous cell and a small cell variant of squamous cell. I cannot find a combination code that fits; the majority of the tumor is not stated; so do you code the highest specific type mentioned - 8084 - Squamous cell, clear cell type? |
For tumors diagnosed prior to 2007:
Assign histology code 8070 [squamous cell carcinoma, NOS]. Squamous cell carcinoma, NOS includes types of squamous cell carcinoma without a specific code. This is a combination squamous tumor that does not have a unique 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. |
2004 |
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20041071 | Histology (Pre-2007)--Breast: When the histology from a lumpectomy differs from that of a core needle biopsy, should the lumpectomy histology be coded? See Discussion. | Histology - Page 85 of the SPM 2004, Histology Type Coding Instructions, #2. Use the histology stated in the final diagnosis from the pathology report. Use the pathology from the procedure that resected the majority of the primary tumor. Based on this rule, should the following case should be coded to Ductal Carcinoma (8500/31)? Core needle bx: WD Infiltrating Ductal Carcinoma with focal lobular features. Lumpectomy: WD Invasive Ductal Carcinoma. |
For tumors diagnosed prior to 2007:
Yes, code this case to 8500/31 [Well differentiated invasive ductal carcinoma]. Code the histology stated on the pathology report from the procedure removing the most tumor tissue. A lumpectomy will usually provide more tumor tissue than a core needle biopsy. First, determine which specimen contains the most TUMOR tissue -- in this case the lumpectomy. Next, apply the histology coding rules to the diagnosis on that pathology report. The rationale is that a diagnosis from a smaller specimen will be less accurate and less representative of the true histology compared to a larger tumor specimen.
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. |
2004 |
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20041046 | CS Tumor Size--Breast: When the diagnosis is inflammatory carcinoma of the breast, must the CS tumor size always be 998? See Discussion. |
I have no specific example of a situation; I am writing an edit check and wondering if there would be any exceptions to this rule. | 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.No. For inflammatory carcinoma, code the size of the tumor in CS tumor size. Use code 998 [diffuse] when the tumor is stated to be "diffuse." Page 27 in Part I of the CS manual will be corrected to define code 998 for breast as only "diffuse." The errata should be distributed in July 2004. |
2004 |
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20041011 | EOD-Clinical Extension--Prostate: Should this field be coded to 15 [Tumor identified by needle biopsy for elevated PSA] or 30 [Localized, NOS] when the only information is from a biopsy positive pathology report that includes the clinical history of "PSA elevated, DRE negative," with no mention of an ultrasound being performed? | For cases diagnosed 1998-2003: For this scenario, assign code 15 if an ultrasound was not performed, performed and negative, or when it is unknown whether or not an ultrasound was performed. Assign code 30 only if an ultrasound was performed and there is no documentation stating that it was negative or positive. Please refer to the Prostate EOD Coding Guidelines for all of the instructions pertaining to the coding of prostate EOD. |
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20041010 | Multiple Primaries--Lymphoma: How many primaries should we abstract when Single Versus Subsequent Primaries table indicates one primary but special pathological studies indicate two primaries? See Description. | The patient had a malignant lymphoma, large B cell (9680) diagnosed in 2000. In 2003, he came in and had a spleen biopsy which showed follicular lymphoma (9690). These are the same NHL, according to the table lookup. However, the pathologist states in 2003, "Special stains now show a kappa clonal lymphoma. Since the first diagnosis was a lambda monoclonal lymphoma, this is not felt to be a recurrence of the original lymphoma." | For cases diagnosed prior to 1/1/2010:Abstract the example above as two primaries. Hematologic malignancies (including lymphoma) and solid tumors are handled differently when determining the number of primaries. For hematologic malignancies, take the physician's opinion into account. Use the Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table as an aid when there is insufficient information available. For solid tumors, follow the multiple primary rules in the SEER Program Code Manual. 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. |
2004 |
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20041002 | CS Size of Tumor/CS Extension--Brain and CNS: How should these fields be coded for benign CNS tumors? | 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 as 05 [Benign or borderline brain tumors]. Code the size of the tumor if specified. Otherwise code CS Tumor Size as 999 for benign CNS tumors. |
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20041100 | Sequence Number-central/Multiple Primaries (Pre-2007): What criteria are to be used to determine which primary site carries a worse prognosis? Should we take survival into consideration? See Discussion. | In the case of two or more simultaneously diagnosed primary tumors, instructions in the SEER manual state that the tumor with the worse prognosis is to be assigned the lower sequence number. Prognosis decisions should be based on primary site, histology and extent of disease. Stage as a criteria for decision making is fairly straightforward. On the other hand, decisions based on primary site seem to be more subjective than objective. |
For tumors diagnosed prior to 2007:
Compare the combination of the primary site, histology and extent of disease for each primary, and assign the lowest sequence number to the primary with the worst prognosis. Do not use primary site or histology alone to determine prognosis in the case of assigning sequence number. Survival is a component of prognosis. If there is no difference in prognosis, assign the sequence numbers in any order.
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. |
2004 |
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