MP/H Rules/Histology--Endometrium: What is the correct histology code for an endometrial cancer described as "Adenocarcinoma with areas of squamous differentiation?"
Assign 8570/3 to adenocarcinoma with squamous differentiation of the endometrium. The most recent WHO classification does not list "adenocarcinoma" for tumors of the uterine corpus. WHO does state that "endometroid carcinoma of the usual type is a glandular neoplasm..." Further, WHO states "Endometroid carcinoma typically displays a glandular or villoglandular architecture..." Based on the WHO classification, the use of the term "adenocarcinoma" in this context can be interpreted as endometroid carcinoma.
EOD-Lymph Nodes--Head & Neck: When a physician provides only "Stage IV" (i.e., an abbreviated stage) for a right posterior tongue primary with lateral extension into the oropharynx and hypopharynx, can you assume "palpable" level 2, 3 and 5 lymph nodes are involved?
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.
Histology--Heme & Lymphoid Neoplasms: How is this field coded when the final diagnosis for excisional biopsy of two cervical lymph nodes shows classical Hodgkin lymphoma, histologic subtype cannot be determined, but the COMMENT section of the report indicates there are features of both lymphocyte rich and nodular sclerosis subtypes?
Per Rule PH28, code histology to 9650/3 [Classical Hodgkin lymphoma]. This rule states to code the non-specific (NOS) histology when the diagnosis is one non-specific (NOS) histology and two or more specific histologies.
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. http://seer.cancer.gov/seertools/hemelymph.
EOD-Clinical Extension--Prostate: How is this field coded when biopsies of the prostatic apex are positive and the physician clinically stages the case as T1c?
For cases diagnosed 1998-2003:
Code clinical extension to 33 [arising in the prostatic apex] when a biopsy of the prostatic apex is positive for malignancy, with no further evidence of involvement. If biopsies of both the apex and another site within the prostate (for example right lobe) are positive and there is no mention that the malignancy arose in the apex, code extension to 34 [extending into the prostatic apex].
Idiopathic thrombocytic purpura (ITP) is not a synonym for refractory thrombocytopenia (RT). ITP is not a reportable disease. See Appendix F.
Under the Alternate Names section in the Heme DB, the only synonym for refractory thrombocytopenia is "RT." ITP is not listed as a synonym for refractory thrombocytopenia.
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.
CS Lymph Nodes--Breast: What code should be used for the the following? There is no mention of LNS clinically; the patient has neoadjuvant therapy; and the LNS are matted pathologically.
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.Use the information from the pathologic evaluation to code CS Lymph nodes.
In the nodes evaluation field, assign code 6 [Regional lymph nodes removed for examination with pre-surgical systemic treatment or radiation and lymph node evaluation based on pathologic evidence]. See CS Lymph Nodes note 4.
Reportability--GIST: The 2014 SEER Program Coding and Staging Manual and the answer to SINQ 20100014 appear to conflict with respect to reporting GIST cases. The manual states (p.5, exception 1) that we are to accession the case if the patient is treated for cancer. However, the patient in Example #7 in the SINQ discussion is receiving chemotherapy, but is deemed not reportable. This is a problematic issue in our area, as pathologists prefer using the NCCN “Risk Stratification of Primary GIST by Mitotic Index, Size and Site” table rather than stating whether the tumor is benign or malignant. Although they tell us that moderate or high risk should receive treatment, they will not characterize them as malignant.
Determining reportability for GIST is problematic because of the reluctance of pathologists to use the term "malignant" for GIST cases. If you can document the pathologist's terminology and case characteristics (e.g. treatment) that correspond to "malignant" for your registry as part of the registry's policies and procedures, you can report those cases as malignant.
The exception cited above in the SEER manual pertains to a clinical diagnosis with a negative pathology report. Normally, the negative pathology report would override the clinical diagnosis and the case would not be reportable. However, if the patient is treated for a malignancy in spite of the negative pathology, report the case.
Histology (Pre-2007): Is 8524 [lobular mixed with other carcinoma] or 8490 [signet ring cell carcinoma] used to represent a diagnosis of "infiltrating lobular with signet ring features?"
For tumors diagnosed prior to January 1, 2004:
According to our pathologist consultant, for this specific case, code to 8490 [Signet ring cell carcinoma].
Our pathologist states: "Signet ring cell carcinoma is most often a variant of lobular carcinoma (as it appears to be in this case - it is less frequently a variant of ductal), and I think it's appropriate to code it as such. Coding to lobular would also be ok, though that would lose the special feature of the signet ring cells. I would rather not code to 8524, since it is not really a mix of lobular and something else."
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.
CS Tumor Size--Breast: Is the largest focus or the total area coded for tumor size in a patient presenting with "scattered foci of DCIS, largest focus measuring 0.6cm. DCIS spans a total area of 2.1cm."
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.
Code the size of the largest focus in CS tumor size. Code the tumor size for this case as 006 (6mm or 0.6cm).
An official website of the United States government
Home