Report | Question ID | Question | Discussion | Answer | Year |
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20041071 | Histology (Pre-2007)--Breast: When the histology from a lumpectomy differs from that of a core needle biopsy, should the lumpectomy histology be coded? See Discussion. | Histology - Page 85 of the SPM 2004, Histology Type Coding Instructions, #2. Use the histology stated in the final diagnosis from the pathology report. Use the pathology from the procedure that resected the majority of the primary tumor. Based on this rule, should the following case should be coded to Ductal Carcinoma (8500/31)? Core needle bx: WD Infiltrating Ductal Carcinoma with focal lobular features. Lumpectomy: WD Invasive Ductal Carcinoma. |
For tumors diagnosed prior to 2007:
Yes, code this case to 8500/31 [Well differentiated invasive ductal carcinoma]. Code the histology stated on the pathology report from the procedure removing the most tumor tissue. A lumpectomy will usually provide more tumor tissue than a core needle biopsy. First, determine which specimen contains the most TUMOR tissue -- in this case the lumpectomy. Next, apply the histology coding rules to the diagnosis on that pathology report. The rationale is that a diagnosis from a smaller specimen will be less accurate and less representative of the true histology compared to a larger tumor specimen.
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. |
2004 |
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20041072 | Histology (Pre-2007)--Colon: Must a case be specifically labeled "familial adenomatous polyposis" or is the mere presence of numerous/multiple polyps sufficient for coding the histology to FAP? | For tumors diagnosed prior to 2007:
The presence of numerous/multiple polyps is not necessarily adenomatous polyposis coli. Adenomatous polyposis is an extreme condition usually characterized by the presence of hundreds of polyps and should be identified as such either clinically or pathologically. Look for the term "Familial adenomatous polyposis," FAP or one of its synonyms: Adenomatosis of the colon and rectum [ACR] Familial adenomatous colon polyposis Familial colonic polyposis Multiple familial polyposis In the absence of these terms, the following probably indicate a diagnosis of FAP: Hundreds of adenomatous polyps throughout large intestines, and at times, throughout the digestive system Development of polyps as early as ten years of age, but more commonly at puberty History of colectomy
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. |
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20041073 | Primary Site/Histology--Lymphoma: How are these fields coded when the final diagnosis per the pathology report is, "Soft tissue and skeletal muscle, left thigh--Large B cell lymphoma with polyclonal and mature t-cells, involving the soft tissue"? | For cases diagnosed prior to 1/1/2010:Site: C492 [Soft tissue thigh] Histology: 9680/36 [T-cell rich large B-cell lymphoma] For cases diagnosed 2010 forward, 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. |
2004 | |
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20041074 | Histology (Pre-2007)--Colon: Is the histology coded as adenocarcinoma arising in a polyp when the final diagnosis on the pathology report is adenocarcinoma but the colonoscopy report associated with the path states that the surgeon performed a polypectomy? See Discussion. | Histology: 3/04 Colonoscopy with polypectomy of a sessile appearing polyp. Path report: Final Dx: Adenocarcinoma; Micro: Adenocarcinoma apparently arising from the mucosa...noted to invade the muscularis mucosa into the submucosa. | For tumors diagnosed prior to 2007
Code this case to adenocarcinoma [8140]. The best source for histology is the final diagnosis on the path report from the procedure that removed the most tumor tissue. When there is a conflict, the path diagnosis has higher priority than the colonoscopy diagnosis for coding histology.
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. |
2004 |
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20041075 | CS Tumor Size: Can we take the size of a "polypoid" mass? See Discussion. | 3/04 Colonoscopy: 4 cm semi-circumferential friable mass in sigmoid colon. Path: Tubulovillous adenoma indeterminate for malignancy. 4/04 Sigmoid Colectomy: 5 x 4 polypoid mass: WD Adenocarcinoma arising in a tubulovillous adenoma. Define "Polypoid". Size of "polypoid" mass. Would the size be coded to 050 or 999? |
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.If the pathology report confirms that the entire polyp is malignant, code the size of the polyp/polypoid mass. If the pathology report does not confirm that the entire polyp is malignant, code 999. Code tumor size as 999 [Unknown] for the example above. Do not code the size of the polypoid mass in this example. The size given above is the size of the polypoid mass, not the size of the malignancy. Polypoid means "Like a polyp. |
2004 |
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20041076 | CS Extension--Colon: What is the difference between codes 46 [Adherent to other organs or structures, but no microscopic tumor found in adhesion(s)] and 57 [Adherent to other organs or structures, NOS]? See Discussion. | Code 46 reads "Adherent to other organs or sturcture, but no microscopic tumor found in adhesion(s)". Would these examples be coded to 46? Example 1: 7/04 Op findings: mass was adherent to duodenum without obvious invasion. Path: margins negative (no mention of duodenum). Case staged to pT3. Example 2: Op findings: large mass involving cecum adherent to peritoneum & retroperitoneum. Path: invasion of pericolic soft tissue; margins negative (no metion of peritoneum & retroperitoneum). Case staged to pT3. |
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 46: Attached to other organ (on imaging or surgical observation); pathology says no invasion of the other organ. Code 57: Attached to other organ; pathology is positive for invasion of other organ, or pathology does not specify whether there is invasion of the other organ. Example 1: Code extension to 46 [Adherent to other organs or sturcture, but no microscopic tumor found in adhesion(s)]. The tumor was attached to the duodenum, but not invading Example 2: Code extension to 46 [Adherent to other organs or structure, but no microscopic tumor found in adhesion(s)]. The tumor was attached to peritoneum & retroperitoneum, but not invading based on negative margins and no peritoneum or retroperitoneum specimen submitted to pathologist. |
2004 |
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20041077 | CS Site Specific Factor 1--Colon: If the registrar did not support the CEA code recorded with the appropriate text documentation, should the central registry accept the registrars coding or change the value to 999? | 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.Accept your registrars' codes at your discretion. It is encouraged, but not required, to enter text for CS data elements. These cases do not automatically default to code 999. |
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20041078 | Ambiguous Terminology: Is the expression "has the markings of a malignancy" a clinically reportable term? See Discussion. |
12/02 Baseline mammogram: spiculated mass with associated marked retraction located in UOQ lt breast. This has the markings of malignancy. Several microcalcifications in outer aspect of rt breast. BI-RADS 5 higly suggestive of malignancy. |
Do not accession cases using only the term "has the markings of malignancy." This term is not on the list of ambiguous terms that are reportable. If the term does not appear on either the reportable or not reportable list, the term is not diagnostic of cancer. Do not accession the case. Please see SINQ 20010094 in reference to BI-RADS terminology. |
2004 |
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20041079 | CS Mets at Dx/CS Mets Eval--Colon: Would the metastasis field be coded to 00 [No; none] and the evaluation field be coded to 1 [No path exam of metastatic tissue performed.] when the source of information is from the operative findings for the following 6 different cases? 1) Liver normal; 2) No evidence of metastatic disease; mesentery normal, 3) Small ascites; no liver metastasis, mass adherent to duodenum without obvious invasion, 4) No mets or local invasion, 5) No evidence of carcinomatosis, peritoneal studding or malignant effusion and 6) Tumor adherent to lateral sidewall (path negative); no evidence of metastatic implants. | 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. The CS Mets Eval code refers to the method used to evaluate the site farthest from the primary site. The correct code may not be the highest eval code. For example 1 above, if the liver is the site farthest from the colon primary that was evaluated for distant mets, code the CS Mets Eval code to the method used to evaluate liver. Code surgical evaluation as 1. Assuming this is all of the information about possible distant metastatic sites for the examples above, code CS Mets at DX as 00, and CS Mets Eval as 1 for each. Please note: imaging of farther sites should also be included when CS Mets at DX is coded. For example, if there was also a negative chest X-ray, the CS Mets at DX field would be 00 but the CS Mets Eval field would be 0 because the CXR documents that there are no mets beyond the immediate area of the tumor. |
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20041080 | Behavior Code/CS Extension--Brain and CNS: How are these fields coded when the final diagnosis on pathology indicates that an atypical meningioma invades the brain and the bone flap specimen indicates extensive invasion through the full thickness of the calvarium? See Discussion. |
FDx on the path is: A. Rt frontotemporal brain tumor: Atypical meningioma, WHO grade II (out of III). B. Arachnoid tissue: Atypical meningioma with small focus of invasion into superficial brain and focal perivascular spread. C. Bone flap: Atypical meningioma with extensive invasion through full thickness of the calvarium. Comment: Although this tumor shows a small focus of brain invasion, it should be considered a grade II (out of III) meningioma based on its histologic atypia (cellularity, sheeting of tumor cells and prominent nucleoli), elevated Ki-67 index and low mitotic rate. |
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.For tumors diagnosed prior to 2004, the example above is a benign meningioma and not reportable to SEER. For tumors diagnosed 2004 or later, code the behavior as 1 [Borderline malignancy]. Code CS Extension as 05 [Benign or borderline brain tumors]. According to expert consultant, meningiomas are in the lining cells for the inner table of the skull and as such have an affinity for bone that allows them to penetrate adjacent bone without being "malignant. |
2004 |