Primary Site: Can we assume the primary site for "chordoma" is soft tissue if the bone is not stated to be involved?
Default the coding of the Primary Site field for chordomas to the bone where the tumor began in the body if the primary site is not clearly stated to be soft tissue. Bone is often the primary site for chordomas.
Based on advice from pathologist consultants: This is one of those situations where we can be quite comfortable with a default, in this case to bone, not soft tissue. Chordoma is a tumor arising in the nucleus pulposis, presumably from remnants of notochord - thus its exclusive origin is in the sacrococcygeal region, spheno-occipital region, and vertebral bodies, otherwise known collectively as the axial skeleton. Any "chordoma" in soft tissue (with no relationship to axial skeleton) is probably a myxoid chondrosarcoma or parachordoma (extremely rare).
Primary Site--Head & Neck: What site code is used to represent the following head and neck primary where there is not a clear statement of primary site? See discussion.
6/29/02: PE: 2-3 cm mass in the posterior pharynx that seems to arise from the right side of back of tongue.
6/29/02 CT soft tissue of neck: 3 cm right sided oropharyngeal mass, possibly arising from right tongue mass. There is near occlusion of airway at this level.
7/3/02 Excision of oropharyngeal tumor: Palpated mass could clearly be felt coming off the right lateral tongue in approximately the mid portion of the tongue near the tonsillar base.
Code the Primary Site field to C02.9 [tongue, NOS], based on the information provided.
Multiple Primaries/Histology--Lymphoma: What is the primary site(s) for a patient who had a lymph node biopsy with the histology of "large B cell lymphoma arising in the setting of low grade B cell lymphoma c/w marginal zone B cell lymphoma with plasmacytic features"? See discussion.
This patient also had a bone marrow biopsy that demonstrated "low grade B cell lymphoma." Per the clinician, "Pt with discordant lymphoma. We will be approaching his lymphoma as two different diseases. The large B cell had cleared after chemotherapy and radiation therapy. The low grade lymphoma is incurable."
For cases diagnosed prior to 1/1/2010:
Code as two primaries with each arising in lymph nodes [C77._]. The histology for the first primary is 9699/3 [marginal zone B cell lymphoma]. The histology for the second primary is 9680/3 [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.
Multiple Primaries/Histology (Pre-2007)--Colon: Would one primary be reported when adenocarcinoma arising in a polyp NOS [8210/3] and adenocarcinoma arising in a tubulovillous adenoma [8263/3] were simultaneously diagnosed in the sigmoid colon (first 3-digits of the histology are different)?
For tumors diagnosed prior to 2007:
Code as one primary. Code the Histology field to 8263/3 [Adenocarcinoma in tubulovillous adenoma].
Count as a single primary and code the more specific term when simultaneous lesions are present and one lesion is an "NOS" term and the other is a more specific term. "Polyp" is an NOS term. Adenoma is an associated term, but is more specific (Tubulovillous adenoma is more specific than "polyp").
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.
Multiple Primaries (Pre-2007)--Bladder: Is a 1998 transitional cell carcinoma of the bladder, followed by a 2001 squamous cell carcinoma of the bladder reportable as a second primary?
For tumors diagnosed prior to 2007:
Yes. This case is reportable as a second primary. The rule in the SEER Program Code Manual says that invasive bladder cancers with histology codes 8120-8130 [papillary, transitional] are always coded as a recurrence and are an exception to the multiple primary rule. Squamous cell carcinoma [8070] is not a part of that exception.
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-Size of Primary Tumor--Cervix: When both a depth and diameter of the tumor are provided and the description of the diameter is provided in a range, how do you code the size of the primary tumor? See discussion.
Path states "microscopic focus of endocervical glands considered invasive adenoca...maximum depth of that focus measures approximately 2 mm. Maximum diameter of that focus measures 3-4 mm."
What size would be coded for this case: 999, 002, 003, or 004?
Code the EOD-Size of Primary Tumor field to 004 [4 mm]. Code the diameter dimension in the EOD-Size of Primary Tumor field and the depth dimension iin the EOD-Extension field. Code the largest number associated if a range is provided for the diameter of the invasive tumor.
If the size of the diameter had not been mentioned, the EOD-Size of Primary Tumor field would have been coded to 001 [microscopic focus or foci only], which ignores the size associated with the depth dimension of the tumor.
EOD-Extension--Colon: What code is used to represent this field for a mid-ascending colon primary that invades through muscularis propria and into subserosal fibroadipose tissue that also presents with a "separate serosal nodule" of carcinoma within cecum that is consistent with a tumor implant (cT3, N0, M1)?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 85 [Metastasis], because the nodule of carcinoma in the cecum is not contiguous with the mid-ascending primary colon tumor.
EOD-Extension/EOD-Lymph Nodes--Rectosigmoid: How do you code these fields for a scan-based clinically staged T3 N1 rectosigmoid primary in a patient who received chemotherapy and radiation prior to a resection that demonstrated invasion only into the muscularis and no positive lymph nodes?
For cases diagnosed 1998-2003:
Use the best information available, in this case, the clinical staging, to code EOD. Code the EOD-Extension field to 40 [Invasion through muscularis propria or muscularis, NOS] and the EOD Lymph Node field to 3 [Regional lymph node(s) NOS] because the case had a clinical stage of T3 N1. EOD is coded using the most extensive clinical or pathologic stage.
Histology/Date of Diagnosis--Hematopoietic, NOS: What code is used to represent histology for a June 2001 diagnosis of "myelodysplastic syndrome" followed by a September 2001 bone marrow biopsy diagnosis of "myelodysplasia evolving into an acute leukemic state"?
For cases diagnosed prior to 1/1/2010:
Code the Histology field to 9989/3 [myelodysplastic syndrome] and the Date of Diagnosis field to June 2001.
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.
EOD-Extension--Head & Neck (Tonsil): How should the EOD-Extension field be coded for bilateral tonsil involvement? See discussion.
Tonsillectomy and bilateral radical neck dissections were done. The path diagnosis was left and right tonsils: squamous cell carcinoma, bilateral tonsils with negative inked surgical margins of resection. Physical exam and operative findings did not mention any extension beyond the tonsils.
We originally coded the EOD-Extension field to 30 for a bilateral tonsil primary. The case failed the SEER Edit IF41 (Primary Site/Lat/EOD). According to that edit, if laterality is 4 then the EOD-Extension field must not be 00 through 30.
We recoded the EOD-Extension field to 99 in order to comply with the SEER edit.
For cases diagnosed 1998-2003:
Code EOD extension as 30 [Localized, NOS] and laterality as 4 [Bilateral involvement]. The next update to the SEER edits will allow this combination.
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