MP/H Rules/Histology--Appendix: What is the histology for an appendix resection diagnosis of "Malignant neoplasm of the appendix with the following features: Histologic type: Adenocarcinoma ex goblet cell carcinoid with mucin production (adenocarcinoma arising from goblet cell carcinoid)"? Is this histology best coded to a mixed adenocarcinoma/carcinoid tumor (8244/3)?
Code histology to combined carcinoid and adenocarcinoma (8244/3). The tumor is a mix of adenocarcinoma and carcinoid.
Reportability/Primary Site--Head & Neck: If a wedge resection/shield resection is performed on the lower lip for SCCA and the path report refers to "lip, NOS" with no mention of vermilion border, is this case reportable?
Review the operative and pathology reports, and the physical exam for mention of "mucosal surface" (reportable) or "skin" (not reportable). If neither are mentioned, lip, NOS is reportable per the ICD-O-3 code of C009.
EOD-Extension--Colon: How is this field coded for an appendical primary when the appendix has ruptured and intrapentoneal fluid is positive?
For cases diagnosed 1998-2003: Code EOD extension as 85 [Metastasis]. Positive intraperitoneal fluid is equivalent to distant metastasis (implantation) for colon, including appendix, primaries.
Update to current manual/Mets at diagnosis fields--Lymphoma: Are distant metastases possible for a lymphoma with a primary site of lymph nodes? The instructions in the SEER manual tell us to assign code 8 in each of the Mets at Dx fields for a lymphoma originating in lymph nodes.
This is a correction to the SEER manual. Lymphomas originating in lymph nodes (C77) could have distant metastases to any site except lymph nodes. The following corrections to the manual apply now and will appear in the next version of the manual.
Remove C770-C779 from the instruction for assigning code 8 on the following pages.
Page 135 Mets at Dx--Bone
Page 137 Mets at Dx--Brain
Page 139 Mets at Dx--Liver
Page 141 Mets at Dx--Lung
Page 145 Mets at Dx--Other
Example
Biopsy of axillary lymph node: Diffuse Large B-Cell lymphoma. Lymph nodes involved above and below the diaphragm, multiple nodules seen in lung, lesions in liver. Bone marrow biopsy positive for DLBLC. Per Hematopoietic manual, primary site would be C778 for multiple lymph node regions involved.
CS Extension--Cervix: How are "positive pelvic washings" coded for a cervical primary?
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.
According to the CS Steering Committee, positive pelvic washings for primary cervical cancer are not part of the staging criteria in the collaborative staging system (nor in TNM and FIGO). Document positive pelvic washings in a text field. The CS steering committee will add a statement to CS extension to clarify this for cervix uteri.
Code histology to 9691/3 [Follicular lymphoma, grade 2]. Nodular lymphoma is an obsolete term once used to describe follicular lymphoma. (See Appendix A, Table A3)
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.
Behavior--Breast: Should the behavior change to /3, invasive, to get a case to clear edits? The histology of this breast case is ductal carcinoma in situ (DCIS), 8500/2. Lymph nodes are positive for micro-mets (0.2 mm-2 mm). SEER Summary Stage: 3, regional lymph nodes positive. This creates an edit for SEER Summary Stage due to the behavior code of /2, in situ.
Code the behavior to /3, not just to pass edits, but because this is an invasive case based on the positive lymph nodes.
For most cases, behavior is based on the primary tumor, but in situations like this where an invasive component cannot be found and there are positive lymph nodes, the /3 behavior is assigned based on the positive lymph nodes.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: For cases diagnosed in 2005, if a specimen contains an invasive 4.5 cm lobular carcinoma of the right breast and also has a tiny focus of intraepidermal tumors cells [Paget disease of nipple], how many cases should be abstracted and how should the histology field(s) be coded?
For tumors diagnosed prior to 2007:
There are two primaries in this example:
1. Invasive lobular carcinoma [8520/3]
2. In situ Paget disease of nipple [8540/2].
There is no combination code for lobular carcinoma and Paget disease.
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)--Lung: What code is used to represent the histology "mucin-producing bronchoalveolar carcinoma?" Is mucin-producing synonymous with mucinous?
For tumors diagnosed prior to 2007:
Code histology as 8253 [Bronchiolo-alveolar carcinoma, mucinous]. Mucin-producing bronchoalveolar carcinoma is best classified in ICD-O-3 as Bronchiolo-alveolar carcinoma, mucinous.
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 Site Specific Factor--Breast: If the tumor is described as being a 1 cm poorly differentiated pleomorphic lobular carcinoma with scattered LCIS in breast tissue, for SSF6, do we use the breast tumor or all of the breast tissue removed when coding SSF6?
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.
Site Specific Factor 6 in the breast scheme describes the relationship of invasive and in situ tumor in the tumor size coded. Code SSF6 for the same tumor used to code tumor size.
For this example, code SSF6 for the 1 cm tumor. In this case, the entire tumor is reported as invasive; use code 000 [Entire tumor reported as invasive].
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