CS Extension--Bladder: How should this field be coded for a high grade urothelial carcinoma with "focal micropapillary features and invasion of lamina propria, with a note stating there is invasive carcinoma focally involving thin muscle bundles...difficult to distinguish whether muscularis propria or muscularis mucosae"?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Assign CS Extension code 15 [Invasive tumor confined to subepithelial connective tissue (tunica propria, lamina propria, submucosa, stroma)]. The information provided confirms invasion of the lamina propria (code 15) but is not definitive enough to assign a code higher than 15.
Histology (Pre-2007)--Lung: Does 8070 [squamous cell carcinoma], 8560 [adenosquamous carcinoma] or 8255 [adenocarcinoma with mixed subtypes] best represent this field for a lung biopsy described as a "poorly differentiated non-small cell carcinoma with squamous and glandular features with focal mucin positivity per mucin stain"?
For tumors diagnosed prior to 2007:
Assign code 8560/33 [Adenosquamous carcinoma, poorly differentiated]. "Glandular" carcinoma is a synonym for adenocarcinoma. Mixed adenocarcinoma and squamous carcinoma is coded to 8560. Do not use code 8255 [Adenocarcinoma with mixed subtypes] when a more specific complex code is available.
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--Heme & Lymphoid Neoplasms: How is histology coded for a pathologic diagnosis of "B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt lymphoma" that was clinically referred to as a "double hit lymphoma"?
Code histology to 9680/3 [diffuse large B-cell lymphoma (DLBCL)]. Per the Alternate Names section in the Heme DB, B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma is one of the synonyms for for DLBCL.
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.
Multiple primaries--Lymphoma: Is a splenectomy done for non-Hodgkin lymphoma diffuse large B-cell of the spleen a composite histology and a single primary if a perihilar lymph node with Hodgkin lymphoma classic type is found at the time of this surgery?
For cases diagnosed prior to 1/1/2010:This is two primaries -- Non-Hodgkin lymphoma (NHL) in the spleen and Hodgkin lymphoma (HD) in a lymph node.
Composite lymphoma is NHL and HD both in a single lymph node.
For cases diagnosed 1/1/10 and later, 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.
Common variable immunodeficiency (acquired hypogammaglobulinemia) is not a reportable condition.
Common variable immunodeficiency represents a group of approximately 150 primary immunodeficiencies that have a common set of symptoms but different underlying causes, both benign and malignant.
The case is not reportable unless this immunodeficiency diagnosis is accompanied by a diagnosis of a cancer or a reportable hematopoietic or lymphoid neoplasm.
See Appendix F: Non-Reportable List for Hematopoietic Diseases.
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.
MP/H Rules--Breast: What histology code is used for lobular carcinoma, pleomorphic type?
For cases diagnosed 2007 or later, use rule H14 and code the histology 8520 [lobular carcinoma]. 8520 is the only ICD-O-3 code for lobular carcinoma. There are no codes for specific lobular types.
Primary site--Heme & Lymphoid Neoplasms: Is a peripheral blood equivalent to bone marrow biopsy for the purposes of Rule PH26 and code the primary site to C421 [Bone marrow] for a marginal zone lymphoma found in peripheral blood when there was no additional workup (e.g., scans, etc.) for this case?
Code the primary site to C421 [bone marrow]. Our hematopoietic specialty physicians state that involvement of peripheral blood is equivalent to bone marrow involvement because the marrow produces blood. In the absence of any other involvement, per Module 7 (Coding primary sites for lymphomas) Rule PH26, it states to code the primary site to bone marrow when the only involvement is bone marrow.
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.
Primary Site--Bladder: What subsite is used for fundus of the bladder?
As of November 2005, Code fundus of bladder to C678 [overlapping lesion of bladder]. Opinions vary regarding the definition of bladder "fundus." However, according to our pathologist consultant, fundus includes posterior, anterior and lateral walls and dome. Fundus does not include the trigone.
A correction to page C-595 of the 2004 SEER manual will be included in the next errata.
Histology (Pre-2007)--Breast: What code is used to represent the histology "Ductal carcinoma in situ; 6 mm focus of invasion is a pure mucinous carcinoma that appears to have arisen in the background of encysted papillary carcinoma."
Code to mucinous (8480) since that is the only clearly invasive component of this diagnosis.
According to our pathologist consultant, "Encysted papillary carcinoma is the same thing as intracystic papillry carcinoma, which I think of as an intraductal papillary carcinoma which has greatly expanded the duct to form a cyst-like structure. It generally behaves in an in-situ rather than an invasive fashion. The only clearly invasive component is the mucinous carcinoma, which is what I would code."
MP/H Rules/Histology--Thyroid: Regarding rule H15, is the mixed code 8340 [Papillary carcinoma, follicular variant] used when there are subtypes of these histologies described, such as a tumor diagnosed with follicular and papillary microcarcinoma or should 8341 [Papillary microcarcinoma] be used?
For cases diagnosed 2007 or later:
For coding purposes, this is a papillary and follicular combination that would be coded to the combination code 8340/3 [Papillary carcinoma, follicular variant].
For thyroid cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult, usually less than 1 cm. in diameter.
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