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For cases diagnosed 2004-2006:

Endometrioid adenocarcinoma with squamous differentiation is coded 8570 [Adenocarcinoma with squamous metaplasia].

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.

Code the histology using the pathology report from the most representative specimen, even if that histology is less specific.

For the case example above, code 8140 [adenocarcinoma, NOS].

The rationale is that a diagnosis from a smaller specimen will be less accurate and less representative of the true histology compared to a larger tumor specimen.

For cases diagnosed 1998-2003:

Code the EOD-Lymph Nodes field to 9 [Unknown], based on the information provided.

The physician's statement of an N category from a TNM may be used to determine lymph node involvement in the absence of other information. However, you cannot assume nodal involvement based on the incomplete staging information of "Stage IV" for a base of tongue primary. For this primary site, extension into the hypopharynx from this primary is equivalent to T4/Stage IV. Therefore you cannot assume the clinician's assessment of the case as Stage IV represents his assessment of lymph node involvement.

For tumors diagnosed prior to 2007:

Code the Histology field to 8830/3 [Malignant fibrous histiocytoma]. Code the Date of Diagnosis to October 1999 based on the clinician's statement of "The patient probably has malignant fibrous histiocytoma. His course has been more aggressive than that seen with an atypical fibroxanthoma." Assume that this statement means that the physician re-evaluated the clinical course and decided that the original tumor must have been malignant.

If the original slides are reviewed and the diagnosis is changed to a malignancy or if the clinician states that the first occurrence was obviously malignant, backdate the date of diagnosis to the first occurrence.

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.

For tumors diagnosed prior to 2007:

Example 1: Code the Histology and Grade, Differentiation fields to 8140/39 [adenocarcinoma, NOS, grade not stated]. Because there was no microscopic examination of tissue from the primary site, the histology may be coded from the microscopic examination of the tissue from a metastatic site. Do not code grade from a metastatic site regardless of whether the involvement of the metastatic site is by direct extension or by discontinuous metastases.

Example 2: Code the Histology and Grade, Differentiation fields to 8046/33 [non-small cell carcinoma, poorly differentiated]. Because there is a microscopic examination of tissue from the primary site, that information should be used to code histology rather than a cytology of a metastatic site.

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.

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.

The piece of bone was likely removed to access the maxillary sinus and would not be a separate organ. Use the "All Other Sites" surgery coding schemes to code this primary. For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 40 [Total surgical removal of primary site]. Code the Surgical Procedure of Other Site field to 2 [Non-primary surgical procedure to other regional sites]. The maxillectomy was not performed in continuity to the turbinectomy and should be coded in this field rather than the Surgery of Primary Site field.

For tumors diagnosed prior to 2007:

Code the Date of Diagnosis to March. Code the Histology field to 8500/3 [Infiltrating duct carcinoma]. Histology can be upgraded from a clinical histology to a pathological histology anytime.

For cases diagnosed 1998-2003, in coding extension, you need to assess whether there has been progression of disease or not. If progression of disease is verified, do not code extension using the surgical information from November. Code the extension and tumor size based on the mammogram and physical examination at the time of the mammogram, if available.

If no progression of disease is verified, use surgical information to code extension and tumor size.

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.

For tumors diagnosed prior to 2007:

Report this case as two primaries, left and right kidneys. According to our pathologist consultant, "The description sounds like bilateral multiple primaries. Multicentricity in the same kidney occurs in about 4% of all cases, and bilaterality in 0.5 to 3% (Atlas of Tumor Pathology, Tumors of the Kidney, Bladder, and Related Urinary Structures)."

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.