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.
Histology (Pre-2007)--Lung: How is a poorly differentiated non-small cell carcinoma with "squamoid differentiation" coded?
For tumors diagnosed prior to 2007:
Squamoid and squamous are synonymous. Squamoid is non-standard terminology. It means "squamous like" and is a synonym of squamous.
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.
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.
EOD-Size of Primary Tumor--Lung: Can tumor size of 002 [Malignant cells present in bronchopulmonary secretions] be used when there is a lung mass seen but the diagnosis is from a positive bronchopulmonary secretion?
For cases diagnosed 1998-2003:
EOD-Size of Primary Tumor code 002 [Malignant cells present in bronchopulmonary secretions] is used only when there is no visible primary lung tumor and bronchopulmonary secretions are positive for lung malignancy.
Even if the diagnosis was made by cytology of broncho-pulmonary secretions, if there is a visible mass, code the size of the mass if known, code 999 if size is unknown.
EOD-Lymph Nodes--Breast: Are micrometastases in the lymph nodes, found only on immunohistochemical staining, coded as positive lymph nodes?
For cases diagnosed 1998-2003: Do not code as positive lymph nodes that have micrometastases diagnosed ONLY on immunohistochemistry. By traditional diagnostic methods, these are still negative lymph nodes.
Summary Stage and EOD ignore the IHC positive micrometastases for cases diagnosed through 2003. The collaborative staging system that begins with 2004 cases and is based on the sixth edition of TNM addresses this issue.
Histology (Pre-2007)--Breast: Is a "noninvasive papillary carcinoma, solid type, of the breast" coded to 8503/2 [noninfiltrating intraductal papillary carcinoma] or 8230/2 [Intraductal carcinoma, solid type]?
For tumors diagnosed prior to 2007:
Code histology to 8503/2 [Noninfiltrating intraductal papillary adenocarcinoma]. "Solid" is one of four subtypes of intraductal papillary carcinoma. The other subtypes are cribriform, micropapillary and spindle cell. ICD-O-3 does not provide codes for each intraductal papillary subtype, so code to intraductal papillary carcinoma.
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.
First-Course of Cancer-Directed Therapy Fields/Hematopoietic, NOS: How do you code treatment for a myelodysplastic syndrome when a patient is admitted to receive a "second transfusion 7 months after diagnosis"?
The first course of treatment for these hematopoietic primaries lasts until there is a treatment change. For the case you cite the second transfusion (7 months after diagnosis) would be first course treatment. Code the Other Cancer-Directed Therapy Field to 1 [Other cancer-directed therapy].
Reportability--Heme & Lymphoid Neoplasms: Are either heparin-induced thrombocytopenia or heparin-induced thrombocytopenia that becomes refractory thrombocytopenia reportable?
Heparin-induced thrombocytopenia is not reportable.
If the diagnosis is changed to refractory thrombocytopenia, then this case is reportable.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.