Report | Question ID | Question | Discussion | Answer | Year |
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20041064 | CS Tumor Size/CS Extension/CS TS/Ext-Eval--Breast: How do you code these fields when the tumor size and extension differ pre and post treatment with neoadjuvant Arimidex? See Discussion. | Clinically on PE 3 cm mass attached to skin with dimpling and erythema overlying the mass. Ultrasound: 2-3 cm breast mass with overlying skin thickened by US evaluation, suggesting dermal invasion. Neoadjuvant Arimidex followed by MRM. Path: 4.5 cm ductal carcinoma (no DCIS), no invasion of skin. | 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 the larger tumor size and the farthest extension documented.
Code CS Tumor Size/Extension Evaluation to 6 [Surgical resection performed, WITH pre-surgical systemic treatment...; tumor size/extension based on pathologic evidence].
Code CS Tumor Size for the example to 045 [4.5 cm].
Code CS Extension to 20 [Local skin involvement ...] based on clinical description provided. |
2004 |
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20041047 | Multiple primaries (Pre-2007)/EOD-Extension--Fallopian Tube: How many primaries are coded when endometrioid adenocarcinoma involves bilateral fallopian tubes? See Discussion. | The pathologist states "because of the intimate association with the luminal line of the fallopian tube it is felt that this represents synchronous primaries rather than mets." The SEER Code Manual only lists ovary, retinoblastomas, and Wilms Tumors under the bilateral code stated to be a single primary. | For tumors diagnosed prior to 2007:
Complete two abstracts, one for left fallopian tube and one for right fallopian tube. This case has been determined to be two primaries by the pathologist. Bilateral involvement of paired sites (other than ovary, retinoblastoma and Wilms tumor) with the same histology within two months requires a determination of whether there are one or two primaries. The pathologist in the case above has made this determination.
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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20041070 | Primary Site: What would the primary site be for carcinoma of the renal pelvis, status post transplant? Please see details below. See Discussion. | The patient has a renal pelvis urothelial carcinoma confined to the pelvis but is status post renal pelvic transplant of the same renal pelvis. | Code the primary site to renal pelvis [C659]. Code the site in which the primary tumor originated. The transplant status in this example does not affect the primary site. | 2004 |
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20041050 | Surgery of Primary Site--Rectum: How do you code a procedure described as a "transanal resection, debulking of a large rectal mass"? See Discussion. | Patient is not a surgical candidate due to "other medical conditions". Colonoscopy done for anemia and rectal bleeding. At the colonoscopy a "Transanal Resection Debulking of large rectal mass" is performed. Two specimens are sent to the lab. The first is labeled "rectal mass" and is a 2.0 cm diameter spherical fragment of tissue. The second is labeled "transanal debulking rectal mass" and is described as multiple, irregular shaped fragments of tan, rubbery tissue measuring 5.0 x 5.0 x 3.0 cm. Final path diagnosis: Debulking of rectal mass: Adenocarcinoma greater than 2 cm in size, resection margins positive for tumor. | For cases diagnosed 1998-2002, code Surgery of Primary Site to 20 [Local tumor excision, NOS]. Because the procedure was performed via colonoscopy and apparently did not involve proctectomy, the best choice is a local excision. | 2004 |
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20041037 | Multiple Primaries (Pre-2007)/Histology (Pre-2007)/Grade, Differentiation--Thyroid: How many primaries, with what histologies should be coded when a thyroidectomy reveals "anaplastic carcinoma" and "papillary carcinoma" occurring as two separate tumors? See Discussion. | Example: Thyroidectomy revealed anaplastic carcinoma of the thyroid with mets to lymph nodes. The path report stated that the thyroid specimen also contained a small papillary carcinoma. Differentiation for the papillary carcinoma was not stated. | For tumors diagnosed prior to 2007:
Accession and code as two thyroid primaries: Anaplastic carcinoma [8021/34] Papillary carcinoma [8260/39]
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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20041038 | Reportability--Bladder: Is "low grade papillary urothelial neoplasm with no evidence of invasion" reportable to SEER? | "Neoplasm" means "new growth," not malignancy. A low grade papillary urothelial NEOPLASM with no evidence of invasion [8130/1] is not reportable to SEER. However, a low grade papillary urothelial CARCINOMA with no evidence of invasion [8130/2] is reportable. | 2004 | |
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20041069 | Reportability--Brain and CNS: Is a meningioma invading the bone malignant and, therefore, SEER reportable if diagnosed prior to 2004? See Discussion. |
1. Meningothelial meningioma with prominent nuclear pleomorphism, infiltration into dura, calvarium, temporalis skeletal muscle. Microscopic: Multifocal infiltration by meningothelial tumor...extensive infiltration of trabecular spaces, extension through inner and outer calvarial layers by meningioma...mitotic activity in tumor noted but below the 4 per 10 high power field threshold for diagnosis of atypical meningioma. 2. Aggressive (invasive) transitional type meningioma, neuroimaging and histology imply extensive invasive meningioma involving bone and paraspinal soft tissues. Microscopy:...invaded bone...focal EMA positivity diagnostic of invasive transitional type meningioma... tumor invades bone. |
The two cases above are benign meningiomas and not reportable prior to 2004. According to an expert consultant, meningiomas are in the lining cells for the inner table of the skull and as such have an affinity for bone that allows them to penetrate adjacent bone without being "malignant." The WHO Nervous System Tumor Classification states malignant meningioma exibits histological features of frank malignancy far in excess of the abnormalities present in atypical meningioma (WHO grade II). Examples of the histologic features of malignant meningioma are obviously malignant cytology, or high mitotic index (20 or more mitoses per 10 high-power fields). They correspond to WHO grade III and are usually fatal. |
2004 |
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20031101 | Primary Site/Behavior Code/EOD-Extension: How would these fields be coded for "squamous cell carcinoma in situ involving papilloma -- locally aggressive but not technically invasive" found in the sphenoid sinus, soft tissue of the skull base and brain? See Description. | The managing physician has staged this pathologically as T4 N0 M0 squamous cell carcinoma of the ethmoid sinuses. The final pathology report says " Sinus, sphenoid, resection: papillary neoplasm most consistent with inverted papilloma with squamous cell carcinoma in situ, 7 cm in greatest extent, focus of probable superficial invasion (see comment). Soft tissue, skull base, excision: involved by papillary neoplasm with squamous cell carcinoma in situ (see comment). Brain, extradural, intercranial biopsy: involved by papilloma with squamous cell carcinoma in situ. COMMENT: This is a predominantly exophytic neoplasm with infolding of the tumor epithelium and in situ extension into submucosal glands. There are only focal areas suspicious for invasive squamous cell carcinoma, with probable invasion (<2mm) in one section....The histologic features are most consistent with an inverted papilloma with carcinoma in situ." When asked to comfirm if the diagnosis were in situ or superficially invasive, the pathologist responded "Squamous cell carcinoma in situ involving a papilloma. Locally aggressive but not technically invasive." |
Code site to C31.3 [sphenoid sinus]. Code the site based on the final pathology report diagnosis. In the case example, the site attributed to the managing physician appears to be an error.
Code behavior to 3 [malignant, primary site]. The SEER list of terms meaning involvement may be used to help determine behavior. The terms used by the pathologist are "probable" superficial invasion and "suspicious" for invasive squamous cell carcinoma with "probable" invasion. Interpret as invasive.
For cases diagnosed 1998-2003: Code extension to 70 [Brain] because this tumor involves the brain. |
2003 |
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20031166 | EOD-Regional Lymph Nodes--Breast: Are subpectoral nodes the same as interpectoral nodes and, therefore, regional for breast primaries? | Subpectoral lymph nodes are regional nodes for breast primaries. Subpectoral is the term generally used to describe the placement of a prosthesis during reconstruction (under/behind the pectoralis major muscle). That is the same location for interpectoral, or Rotter's, nodes. | 2003 | |
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20031087 | EOD-Extension--Lymphoma/Brain and CNS: How is this field coded for a primary brain lymphoma that is described as multi-focal? | For cases diagnosed 1998-2003: Since brain is the only site involved in this example, assign code 11 [Localized involvement of a single extralymphatic organ or site]. | 2003 |