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.
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.
Date of Diagnosis: When a 4/04 clinical impression indicates the appearance of a carcinoma that is contradicted by a negative 4/04 biopsy but is confirmed by a 5/04 resection, should the diagnosis date be coded to April or May? See Discussion.
4/04 colonscopy: irregular fungating mass that has appearance of carcinoma. 4/04 Bx: high grade dysplasia. 5/04: LAR. 5/04 Path: 3.2 X 2.5 cm mass wd adenoca with invasion of muscularis propria.
Should the diagnosis date be 4/04 based on the clinical impression during the colonoscopy OR 5/04 since the path for the bx was negative?
The date of diagnosis for the example above is 05/04 -- the date of the pathology report confirming malignacy. The biopsy in 04/04 negated the 04/04 clinical statement.
Primary Site/Histology--Lymphoma: How are these fields coded when the final diagnosis per the pathology report is, "Soft tissue and skeletal muscle, left thigh--Large B cell lymphoma with polyclonal and mature t-cells, involving the soft tissue"?
For cases diagnosed prior to 1/1/2010:Site: C492 [Soft tissue thigh]
Histology: 9680/36 [T-cell rich large B-cell lymphoma]
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.
Primary site/Histology (Pre-2007)/Behavior: What is the correct site and histology/behavior for the following diagnosis: "mucinous cystadenoma of the appendix with perforation and pseudomyxoma peritonei." This was diagnosed at e-lap for a separate adenocarcinoma of the ascending colon.
For tumors diagnosed prior to 2007:
The appropriate code for mucinous cystadenoma of the appendix with perforation and pseudomyxoma peritonei is C18.1 8470/0. It is not reportable to SEER. According to our pathologist consultant, mucinous cystadenoma is a legitimate term for such appendiceal tumors. They may implant all over the peritoneum as pseudomyxoma peritonei, especially in the face of perforation, without being histologically malignant.
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.
EOD-Lymph Nodes--Breast: When isolated tumor cells are found in an axillary lymph node, should lymph node involvement be coded to 0 [no lymph node involvement] or 1 [micrometastasis (less than or equal to 0.2 cm)]?
For cases diagnosed prior to 2004: Code the EOD-Lymph Node field to 0 [No lymph node involvement] when regional lymph nodes are negative, even if there are positive isolated tumor cells (ITC).
CS Extension--Bladder: How should this field be coded when the pathology states "papillary transitional cell carcinoma with no invasion into the submucosa or deep muscularis" but there is "focal extension of tumor into bladder diverticula"?
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 CS Extension field to 01 [Papillary transitional cell carcinoma stated to be noninvasive]. Extension into bladder diverticula does not change the code. Diverticula are pouches in the mucosa (mucous membrane).
EOD-Extension--Lung: Is this field coded to 10 [tumor confined to one lung] or 20 [Tumor involving main stem bronchus >= 2 cm from carina] when there is no mention of the mainstem bronchus and a lobectomy is performed? See Discussion.
The clinical work-up shows a mass at the left medial apex extending into the left lung. No mention of the main stem bronchus. Because a lobectomy was performed, we assume, per Note 2, that the tumor was greater than or equal to 2 cm from the carina.
For cases diagnosed 1998-2003: Code the EOD-Extension field to 10 [tumor confined to one lung] for the case example. The EOD-Extension code 20 [Tumor involving main stem bronchus >= 2 cm from carina] applies to tumors involving the main stem bronchus.
Multiple Primaries (Pre-2007)--Colon: What is the number of primaries for a case of familial polyposis with at least three separate tumors having invasive adenocarcinoma, one in the rectum? See Discussion.
A patient had a total proctocolectomy and was found to have familial polyposis. At least 3 separate tumors were identified with invasive adenocarcinoma, one of which was in the rectum. Is this 2 primaries: C18.9 with 8220/3 and C20.9 with 8140/3 or is this all one primary cancer?
For tumors diagnosed prior to 2007:
Familial polyposis is always a single primary. Code the primary site for the case example above to C199 [colon and rectum].
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.
Primary Site--Ovary/Peritoneum: Should this field be coded to ovary or peritoneum when the bulk of the tumor is in the peritoneum and there is only surface involvement of the ovary?
If it is not clear where the tumor originated, use the following criteria to distinguish ovarian primaries from peritoneal primaries.
The primary site is probably ovarian, unless:
--Ovaries have been previously removed
--Ovaries are not involved (negative)
--Ovaries have no area of involvement greater than 5mm.
Descriptions such as "bulky mass," "omental caking" probably indicate an ovarian primary.
Descriptions such as "seeding," "studding," "salting" probably indicate a peritoneal primary.
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