Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20021056 | Histology (Pre-2007)/Terminology: Are "pattern", "architecture", and "architectural pattern" terms that indicate a majority of tumor? |
For tumors diagnosed 2004 to 2006: The terminology "Architectural pattern: ____________," when used in the final pathology diagnosis, indicates a subtype that can be coded. This type of format in a pathology report is based on a College of American Pathologists (CAP) protocol. Disregard "pattern" and "architecture" when not used in accordance with the CAP protocol. See www.cap.org for cancer protocols. 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. |
2002 | |
|
20021199 | Primary Site/Surgery of Primary Site--Lymphoma: What codes are used in these fields when both regional lymph nodes and an extra-nodal site are involved with lymphoma and there is not a clear statement from the clinician as to the primary site? See discussion. |
In our registry, we code the primary site for such cases to the extra-lymphatic site if there is one extra-nodal site involved with disease and the patient does not have disseminated involvement of multiple extra-nodal sites. Is this correct? Example: A patient with a submandibular lymphoma and involved nodes undergoes a salivary gland excision and a modified radical neck dissection yielding 100 nodes. |
For cases diagnosed prior to 1/1/2010:Code the Primary Site to C08.0 [submandibular gland] and use the surgery code schemes that apply to that site (Parotid and Other Unspecified Glands). Physiologically, lymphoma cells in regional lymph nodes do not "back-flow" into the extralymphatic organ to involve it secondarily. As a result, the primary site is usually the extralymphatic organ with regional lymph node involvement. Do not be afraid to code an extralymphatic site as primary when that site and its regional nodes are involved. If the lymph nodes are not regional to the extra-nodal involved site and the primary site cannot be determined, code the primary site to C77.9 [Lymph node, NOS]. 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. |
2002 |
|
20020058 | 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. |
2002 | |
|
20021200 | Date of Diagnosis: How do you code this field when the pathologic confirmation is delayed for 2 months because the clinician decides to "watch and see what happens" to a CT identified mass thought to be either a "metastasis from a previously diagnosed malignancy or a new primary"? | Code the Date of Diagnosis field to the date of the scan. This is the earliest date that a recognized medical practitioner said the patient had cancer. The diagnosis on the CT scan was a malignancy. The only question was whether the mass on the scan was metastatic or a primary. | 2002 | |
|
20021154 | Primary Site: What code is used to represent the primary site for a "teratocarcinoma with features of embryonal carcinoma" removed from the thigh muscle in a patient with x-ray negative testicles? See discussion. |
The case was reviewed by AFIP and called "extratesticular." Per our pathology consultant, the site should be coded to unknown because it is very doubtful that the tumor was primary in the soft tissue of the thigh. According to him, such tumors don't originate exclusively in the testes, but tend to occur along the central axis such as the mediastinum or retroperitoneum. If an extratesticular tumor arises in either of these areas, the primary site should be code to the mediastinum or the peritoneum rather than to unknown. Lesions primary in the testicle may also undergo maturation with fibrosis and involution. This process often leaves little evidence of the original tumor in the testis. |
Code the Primary Site field to C809 [unknown] for this case. The thigh tumor is a metastatic site. |
2002 |
|
20021062 | Histology (Pre-2007)--Breast: What code is used to represent histology for "invasive ductal carcinoma with squamous differentiation"? Is "squamous differentiation" synonymous with "squamous metaplasia"? | For tumors diagnosed prior to 2007:
Code the Histology field to 8570/3 [Adenocarcinoma with squamous metaplasia]. Our pathology consultant agrees that squamous metaplasia is synonymous with squamous differentiation.
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. |
2002 | |
|
20021111 | Histology/Grade, Differentiation--Lymphoma/Leukemia: Do you agree with coding a diagnosis of Nasal NK/T cell lymphoma to 9719/38? | For cases diagnosed prior to 1/1/2010:Yes. Code the Grade, Differentiation field to 8 [NK cell] rather than 5 [T-cell]. Code the Histologic Type to 9719/38 [NK/T-cell lymphoma, nasal and nasal-type with Cell indicator of NK (8)]. 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. |
2002 | |
|
20021152 | 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). |
2002 | |
|
20021006 | EOD-Extension--Hematopoietic, NOS: If a solitary plasmacytoma originates in the right tonsil and extends to the left tonsil, vallecula and hypopharynx, is extension still coded to 10 [localized disease, solitary plasmacytoma only]? | For cases diagnosed 1998-2003:
Code the EOD-Extension field to 10 [localized disease, solitary plasmacytoma only] for all cases of solitary plasmacytoma. |
2002 | |
|
20021132 | EOD-Extension: The medical record lacks a clear statement that metastatic workup was complete. A metastatic deposit is identified within 4 months of diagnosis and while the patient is undergoing first course of treatment. How do you code the EOD-Extension field? |
For cases diagnosed 1998-2003: In coding the EOD-Extension field, ignore metastasis that is discovered after the initial workup is completed regardless of the timeframe from diagnosis date until the date the metastatic deposit was discovered. The metastasis is progression of disease. Any of the following represents progression of disease. Do not code the subsequently identified metastatic involvement in the EOD: 1) The metastatic workup was complete and treatment started before the procedure was done that found the metastatic involvement. 2) A procedure, such as a scan, was negative initially and a repeat of that procedure is now positive. 3) The treatment plan is developed for a localized disease process. If you are unable to determine whether the newly discovered metastasis represents progression or is part of the initial workup, regard the metastasis as progression. Do not code the metastasis in the EOD-Extension field. |
2002 |