Report | Question ID | Question | Discussion | Answer | Year |
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20031073 | EOD-Pathology Extension--Prostate: Is extracapsular extension implied by the phrase, "involvement of periurethral or urethral margins"? See Description. | The prostatectomy final pathology diagnosis states that the tumor involves the periurethral margin. The microscopic describes involvement of the urethral margin. | For cases diagnosed 1998-2003: Code the EOD-Extension field in the 20-34 range, which implies no extension beyond the prostate. Disregard involvement of periurethral margin or urethral margin, NOS, unless the pathologist or surgeon specifically mentions "extraprostatic urethra" involvement. | 2003 |
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20031022 | Surgery of Primary Site--Head & Neck: Is a composite resection performed for an oral cavity primary coded to 40 [Radical excision of tumor, NOS], 41 [Radical excision of tumor only], 42 [Combination of 41 with resection in continuity with mandibles (marginal, segmental, hemi-, or total resection], 43 [Combination of 41 with resection in continuity with maxilla (partial, subtotal, or total resection)]? See discussion. |
Example: Patient underwent composite resection of left soft palate, tonsillar fossa, medial pterygoid and lateral tongue for a primary of the retromolar trigone. There was no mention of an excision of the mandible; however, the procedure included the application of a mandibular reconstruction plate. |
Use surgery codes 40-43 for composite resection of an oral cavity primary. In the case example, code Site-Specific surgery as 42 [Combination of 41 WITH resection in continuity with mandible]. Even though excision of mandible was not mentioned, there was mention of a mandibular reconstruction plate. Since the retromolar trigone is ON the mandible, resection of the mandible is likely. | 2003 |
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20031024 | Surgical Fields--Head & Neck: How does one code the removal of benign submandibular and sublingual glands performed during a neck dissection for a head and neck cancer? See discussion. | Should the removal be coded as incidental in the surgical Procedure if the Other Site field? Does it make a difference if the submandibular gland is removed en toto with lymph nodes or if the gland is submitted as a separate specimen? Does it make a difference if the glands are involved? | Removal of the lower salivary glands is part of a radical neck dissection and is not recorded in Surgery of Primary Site or Surgery of Other Site. Radical neck dissection is coded under "Scope of Regional Lymph Node Surgery." It does not matter whether or not the gland is submitted as a separate specimen. It does not matter whether or not the gland is involved. |
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 | |
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20031006 | EOD/Surgery of Primary Site--Melanoma: If a melanoma primary site is other than skin, vulva, penis, or scrotum should these fields be coded using melanoma schemes? See discussion. | Should a melanoma of the cervix be coded using the melanoma or the cervix schemes for these fields? | For cases diagnosed 1998-2003: Use the EOD and surgery code schemes for cervix uteri. The EOD scheme for melanoma excludes melanoma of the cervix uteri. The surgery code scheme for skin excludes cervix uteri. | 2003 |
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20031017 | Reason for No Surgery of Primary Site: Does code 2 [Contraindicated due to other conditions; autopsy only case] or code 1 [ Cancer-directed surgery not recommended] have priority when coding this field for extensive tumors not surgically treated because of existing comorbidities? See discussion. | Example: Patient has Stage IVA carcinoma of the tongue. The physician states that patient is not felt to be a good surgical candidate secondary to multiple medical frailties. Patient is treated with beam radiation. In this case, how do we code Reason for No Site Specific Surgery? Do we use code 2 because surgery was contraindicated due to co-existing medical conditions or do we use code 1 because the tumor is very extensive and surgery would probably not be done anyway? |
SEER has not established a priority for assigning the Reason for No Surgery of Primary Site codes. Assign the code which best describes the reason surgery was not performed. Example: Assign code 2, Contraindicated due to patient risk factors. According to the physician, this is the reason that surgery was not performed. |
2003 |
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20031032 | Diagnostic Confirmation--Hematopoietic, NOS: How should diagnostic confirmation of Hematopoietic diseases be coded in the absence of positive bone marrow? See Description. | Case 1. Patient admitted 9-12-02 with diagnosis of essential thrombocythemia. Per the H&P, patient obviously has had this since January 2001. Per the clinical history: patient with elevated platelets. Path diagnosis of bone marrow biopsy done 9-20-02 showed mildly increased megakaryocytes. 10-31-02 clinical sign-out diagnosis was: essential thrombocythemia. Case 2. Patient admitted for evaluation of erythrocytosis. Assessment: Increased hematocrit only. It is most likely that patient has polycythemia vera. I think it is reasonable to initiate phlebotomy treatment. |
Code 1, Positive histology, includes diagnostic hematologic findings and peripheral blood smears when these are the basis for diagnosis. When the clinician makes a specific diagnosis and the blood work is not diagnostic, code diagnostic confirmation as 8 [Clinical diagnosis only]. The clinician is putting together all evidence, including the blood work and using his/her professional experience to diagnose the case. Case 1. The diagnosis is not based on microscopic findings. Assign code 8 [Clinical diagnosis only]. Megakaryocytes are the immature form of thrombocytes, but mildly increased megakaryocytes are not diagnostic of essential thrombocythemia. Case 2. The diagnosis is not based on microscopic findings. Assign code 8 [Clinical diagnosis only]. |
2003 |
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20031029 | Histology (Pre-2007)/Grading--Head & Neck: Can terms that commonly modify histologic types or grades be used if they are only expressed in the microscopic portion of the pathology report? See Description. | Final path diagnosis on a biopsy of the base of tongue is squamous carcinoma. The micro portion of the path report states the following: Multiple fragments of abnormal epithelium with a complex growth pattern. Many of the cells are small and poorly differentiated, interspersed with areas of well-differentiated keratinized epithelium. This is consistent with squamous cell carcinoma in situ with areas of invasive carcinoma. Do we code histology to 8070/3 or 8071/3? | For tumors diagnosed prior to 2007:
Yes, code using terms from the microscopic description if there is a definitive statement of a more specific histologic type. Code the case example as 8070/33 [Squamous cell carcinoma, NOS, poorly differentiated]. The microscopic description adds grade information, but does not make a definitive statement of a more specific histologic type. "Keratinized epithelium" is not the same as keratinizing squamous cell carcinoma (8071/3). The mention of "areas of well-differentiated keratinized epithelium" refers to "normal" tissue within the specimen, in contrast to a type of neoplastic tissue.
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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20031082 | EOD-Size of Primary Tumor: Pathologist states that the size of the tumor is difficult to measure but is greater than 3cm but less than 5cm. How would we code the tumor size? | For cases diagnosed 1998-2003:
Code the largest dimension mentioned, since that is the standard rule for coding tumor size. Keep in mind that tumor size is not used in analysis for certain sites such as stomach, colon & rectum, ovary, prostate, and urinary bladder. Tumor size is important for analysis for certain sites such as lung, bone, breast, and kidney. |
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 |