CS Lymph Nodes/CS Site Specific Factor--Breast: When there are no lymph nodes removed and none palpable for an inflammatory breast cancer and the physician stages the case Nx, is the CS Lymph Node field code to 00 [None, no regional lymph nodes involved] or 99 [Unknown, not stated] and would SSF 4 and 5 be coded to 000 [Regional lymph nodes negative...] or 888 [Not applicable]?
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 CS Lymph Nodes 00 [clinically negative]. See note 3 for CS Lymph Nodes.
EOD-Size of Primary Tumor--Colon: When an adenocarcinoma is stated to be arising in an adenoma and the "tumor size" stated in the final pathologic diagnosis is the same size as the mass described in the gross description, should we assume that the entire polyp has been totally/near totally replaced by tumor and code the tumor size stated in the final path diagnosis?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field as stated by the pathologist in the final pathologic diagnosis. If the size of the tumor is the same as the size of the polyp, assume the polyp was completely replaced by tumor.
EOD-Extension--Head & Neck: How much information is needed for a head and neck primary in order to code extension to localized versus unknown? What code is used to represent this field when the only information for a buccal cavity primary is a positive aspiration of the buccal mass?
For cases diagnosed 1998-2003:
Code the EOD-Extension to 99 [Unknown] for this case until more information is received. The available information does not describe the primary site and there is a complete lack of staging information.
Head and neck cancers spread early and often to nodes. Do not code the EOD-Extension to localized when the information is as limited as it is for this example.
Histology (Pre-2007): Is an intra-abdominal mass with the histology of "squamous cell carcinoma arising in a dermoid cyst" coded to 8070/3 [Squamous cell carcinoma] or 9084/3 [Dermoid cyst with malignant transformation]?
For tumors diagnosed prior to 2007:
Code histology to 9084/3 [Dermoid cyst with malignant transformation] per the ICD-O-3. Dermoid cysts may contain a malignant component of a type typically encountered in other organs and tissues.
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.
Ambiguous Terminology/Reportability: Is the phrase "indicative of cancer" SEER reportable?
No. The phrase "indicative of cancer" alone is not a definitive cancer diagnosis. The word "indicative" is not on the list of ambiguous terms that is equivalent to a diagnosis of cancer.
EOD-Lymph Nodes--Lung: What code is used to represent this field when the only information is a description of:
1. "hilar mass"
2. "mediastinal mass"
3. "enlarged" or "greater than 1 cm" used to describe any of the lymph nodes listed under code 2 in the EOD Lymph Nodes field?
For cases diagnosed 1998-2003:
Code EOD-Lymph Nodes fields as follows for the examples given:
1) 9 [Unknown; not stated] for a "hilar mass"
2) 2 [Mediastinal] for a "mediastinal mass"
3) 2 [Mediastinal] for "enlarged" or "greater than 1 cm," if used to describe any of the named lymph nodes listed under code 2 in the EOD-Lymph Nodes field.
Behavior--Breast: Is behavior for encapsulated papillary carcinoma (EPC) of the breast coded as noninvasive or invasive?
The pathologist has the final say on behavior. Code behavior based on the pathologist's final diagnosis. See Rule F in ICD-O-3.
According the WHO Classification of Breast Tumors, encapsulated papillary carcinoma of the breast is in situ, /2. Encapsulated papillary carcinoma with invasion is assigned /3. WHO describes "frank invasive carcinoma" for this histology as "neoplastic epithelial elements infiltrate beyond the fibrous capsule of encapsulated papillary carcinomas." WHO cautions that true infiltration should be "differentiated from entrapment of neoplastic epithelial cells in the fibrous capsule and from epithelial displacement into the biopsy site, which is frequently encountered following needle-core procedures of papillary lesions."
Histology--Brain and CNS: How is histology to be coded for a pituicytoma WHO grade I, of the pituitary?
Assign code 9380/1 [glioma, borderline].
According to our pathologist consultant, the term pituicytoma is restricted to low-grade glial neoplasms of the neurohypophysis or infundibulum. The best category currently available for these is glioma.
The term "coagulable state" is not reportable. This is not a a neoplasm. The term means capable of coagulating or capable of becoming thick. There are neoplasms, such as polycythemia vera, in which the blood becomes thick; however, you must have an actual reportable diagnosis in order to accession the case.
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--Heme & Lymphoid Neoplasms: Is C448 [overlapping lesion of skin] or C449 [skin, NOS] the appropriate site code for a 2008 diagnosis of mycosis fungoides involving over 40 percent of the skin surface, including both upper and lower extremities and trunk?
Code the primary site to C449 [skin, NOS]. The code C448 should be used when there is a single overlapping lesion that includes all the disease. The patient has extensive skin coverage involving multiple skin subsites (upper and lower extremities and the trunk), but it is unlikely there is ONE plaque (one lesion) overlapping all these different skin subsites. The disease has more likely presented as multiple plaques (lesions) in these different areas.