Report | Question ID | Question | Discussion | Answer | Year |
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20031170 | Terminology, NOS/Recurrence/Multiple Primaries (Pre-2007): Is the term "residual disease" equivalent to "recurrence"? See Description. | Example 1. Patient underwent excision and re-excision of lentigo maligna in 1998. Final path showed close but negative margins. In 1999 a biopsy of a brown patch (over the scar) in the same location was done. Pathology reported residual lentigo maligna. Is the 1999 melanoma a new primary because it was diagnosed more than two months after the first melanoma and there is no mention of recurrence? Or is the term "residual" another way of saying recurrence? Example 2. In 1999, patient underwent excisonal biopsy of intraductal carcinoma of the right breast, followed by radiation therapy. In 2000, mammogram showed calcifications in right breast. Biopsy was done with path showing residual ductal carcinoma in situ. There is no mention of recurrence. Is this one or two primaries? |
For tumors diagnosed prior to 2007:
According to our pathologist consultant, "residual" disease indicates incomplete eradication of the original disease process. Residual means that the disease process was not completely removed/eradicated in the initial therapy. Therefore cells from the original primary were never completely removed or destroyed. In each example above, this is not a recurrence per se but rather progression of disease. Do not abstract the latter diagnosis as a new primary.
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. |
2003 |
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20031117 | Multiple Primaries (Pre-2007): Are simultaneous tumors of the rectosigmoid junction and rectum counted as two primaries? See Description. |
On the same day in 1998, a patient was found to have a T3 adenocarcinoma of the rectosigmoid junction and an in situ adenocarcinoma in a villotubular adenoma in the lower rectum. These would be the same histology if they are in the same site. Are C199 and C209 the same site? They are listed in ICD-O-2 (pg. xxxvii) and in ICD-O-3 (pg. 36), but they are not listed in the SEER Program Manual on page 9 as the same site. Is this one primary or two? |
For tumors diagnosed prior to 2007: Abstract two primaries for the example above, according to the main rule on page 7 in the SPCM. Rectosigmoid junction (C19) and rectum (C20) are in different 3-digit ICD-O-3 topography code categories. Rectosigmoid junction and rectum are not included in the exceptions to the main rule and, therefore, do not appear on page 9 of the SPCM. The table on page 9 is not identical to the table in ICD-O-3. Two site combinations are listed in ICD-O-3, but not in the SEER table: C19 (rectosigmoid junction) and C20 (rectum); C40 (bones of limbs) and C41 (other bones). Abstract multiple tumors in the rectosigmoid junction and rectum as separate primaries. Abstract multiple tumors in the bones of the limbs and other bones as separate primaries. 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. |
2003 |
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20031080 | Behavior Code/EOD-Extension--Bladder: How are these fields coded for a bladder tumor in which the pathologist states, "there is no definite invasion identified" but the urologist states the case as T1? See Description. | Patient presents with four bladder tumors, described as "each measuring close to 2 cm." A specimen was taken of only one of the tumors. The tops of the tumors were fulgurated, then vaporized methodically. No obvious tumor or residual was noted on re-inspection. Pathology revealed papillary urothelial carcinoma, high grade, with no definite invasion identified. Small segments of muscularis propria were present. A comment read..."it is difficult to determine if lamina propria invasion is present due to marked necrosis and tissue fragmentation." Urologist staged this as AJCC cT2a, but based on the pathology findings changed it to cT1. The urologist insists this is invasive. |
For cases diagnosed 1998-2003: Because of the damage to the specimen from cautery and the insistence of the urologist that the tumor was invasive, code extension for this case to 15 based on the physician's TNM category of T1.
A T1 is invasive--code the behavior /3. The urologist is confident it is invasive, and will likely treat the patient accordingly. |
2003 |
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20031034 | Histology (Pre-2007)--Kidney, renal pelvis: What codes are used to represent the histologies of 1) "renal papillary (chromophil) carcinoma" and 2) "chromophil renal cell carcinoma?" |
For tumors diagnosed prior to 2007: Code "chromophil" to 8260 [papillary renal cell]. According to our pathologist consultant, in the case of chromophil, most authors regard this as more or less synonymous with papillary renal cell [8260]. "More or less" because papillary is an old term descriptive of the microscopic structure, while chromophil is newer and based on the cytology; because most of the latter are papillary the current usage assumes them to be equivalent. 1) The diagnosis "renal papillary (chromophil) carcinoma" tells us that the pathologist who wrote it was seeing both pattern and cytologic features, and is regarding papillary equivalent to chromophil; thus, code to 8260. 2) Code "chromophil renal cell carcinoma" to 8260. 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. |
2003 | |
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20031128 | Histology (Pre-2007): What code is used to represent the histology "PD infiltrating duct ca with focal sarcomatoid pleomorphic features?" | For tumors diagnosed prior to 2007:
Code histology as 8500/33 [Infiltrating duct carcinoma, poorly differentiated]. "Features" is a term from the list indicating a majority of the tumor, however; in this case "features" is modified by "focal" which does not indicate a majority of the tumor.
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. |
2003 | |
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20031072 | EOD-Pathologic Extension--Prostate: Is extracapsular extension implied by the phrase "tumor invades the fibrous tissue of the capsule"? See Description. |
The physician staged to a pathology stage of T3. It appears the physician regards the following pathology statement to be equivalent to capsular invasion on the right side: "Tumor invades the fibrous tissue of the capsule on the right side where it approaches to within 1 mm. of the surgical margin." Should pathologic extension be coded to 42[unilateral extracapsular extension]? |
Use the best information available to stage the case. In this case, the best information is the pathologist's description of the tumor extension rather than the AJCC stage. For cases diagnosed 1995-2003: Extracapsular extension is not implied by the phrase in the question. Code the capsular involvement described to 32 [invasion into but not beyond the prostatic capsule] on the basis of the pathology report. |
2003 |
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20031137 | Primary Site--Pancreas: Should tumors with the histology "islet cell carcinoma" be coded C25.4 [Islet of Langerhans] even though the tumor location is stated to be in head of pancreas? | Assign code C25.4 [Islets of Langerhans...Endocrine pancreas]. Islet cell carcinoma of the pancreas is a tumor of the endocrine pancreas. Although Islet cells are present throughout the pancreas, the best code is C25.4 to distinguish endocrine from exocrine cancers. | 2003 | |
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20031181 | EOD-Extension--Kaposi Sarcoma: Is a "markedly enlarged spleen" involvement for cases of Kaposi Sarcoma? |
For cases diagnosed 1998-2003: No. Splenomegaly is not synonymous with "extension to" or "involvement of" the spleen in Kaposi's sarcoma. Look for a definite statement of Kaposi's lesion(s) involving the spleen. |
2003 | |
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20031039 | EOD-Clinical Extension--Liver: How do the segments of the liver described by AJCC Manual correspond to the lobes of the liver described by the SEER EOD Manual? See Description. |
CT described hepatocellular ca involvement of the liver with nodules identified in segments 5 and 7. Would EOD-extension be coded to 30 [multiple tumors (one lobe)]? |
Segments 2, 3, and 4 correspond to the left lobe of the liver. Segments 5, 6, 7 and 8 correspond to the right lobe of the liver. Segment 1 is the caudate lobe, which has completely different drainage and vascularization, is separate from the larger right and left lobes. For cases diagnosed 1998-2003: Since segments 5 and 7 are both in the right lobe, assign EOD-extension code 30 for the case above, unless there is mention of vascular invasion. Be sure to record the size of the largest primary tumor. Tumor size and vascular invasion are the most important factors for AJCC 6th edition staging. |
2003 |
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20031009 | Reportability/Behavior Code--Soft Tissue: Is a final diagnosis of a forearm mass diagnosed as "Angiomatoid malignant fibrous histiocytoma [see note]" reportable? The NOTE reads "Angiomatoid malignant fibrous histiocytoma is a low grade borderline lesion with a tendency for local recurrence, but a very low potential for distant metastases." Is behavior /1 or /3? | Angiomatoid malignant fibrous histiocytoma is reportable with a behavior code of /3 according to ICD-O-3. The Final Diagnosis takes precedence over the "note." | 2003 |