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Report Produced: 10/31/2024 21:25 PM

Report Question ID Question Discussion Answer Year
20061032 Behavior--Head & Neck: Should the SEER IF_Morph_3 edit be modified because it does not allow a behavior code 2 with histology 8941 [carcinoma in a pleomorphic adenoma] for a parotid primary?

Code the behavior as 2 and over-ride the edit. The edit is there to flag unusual combinations. Once you have verified that the behavior is coded correctly, over-ride the edit.

The surgeon stage of T2 is based on size of tumor, the TIS is based on behavior. Code according to pathologically confirmed TIS.

 2006
20061033

Reportability--Brain and CNS: Is benign neural tissue compatible with a glioneuronal hamartoma of the cerebellopontine angle reportable?

No. A glioneuronal hamartoma is not neoplastic and not reportable. See page 2 of the 2004 SEER Program Coding and Staging manual for the list of reportable brain/CNS tumors. There is no ICD-O-3 code for hamartoma.

 2006
20061034 Primary Site--Unknown & ill-defined site: Is the primary site code C809 [Unknown primary site] preferred over the use of a site code for an organ system (e.g., biliary tract, NOS) or a specific primary site (e.g., colon, NOS) when these are "favored" but other potential sites "cannot be excluded"? See Discussion.

Case 1 - CT: Mult pulm nodules, bilat pleural effusions; paraaortic, paracaval, celiac lymphadenopathy. Lytic lesions L4&L5.

Bx L3: Met pd adenoca. Based on the histopathologic features and the results of the immunostains, cholangiocarcinoma is regarded as the most likely primary. However, other possible primaries include pancreas, stomach, and (remotely) lung.

Should primary be coded as C26.9, digestive organ, NOS?

Case 2 - CT: Mult liver masses. Liver Bx: Mod diff adenoca. The most likely primary sites include cholangiocarcinoma, stomach and pancreas.

FDx per attending: Met adenocarcinoma to the liver, probably biliary origin.

What primary site code do we use?

Case 3 - Admitting Dx: Unknown primary with mets to lungs, liver and cerebellar area. Liver Bx: Met adenoca. The combination of morphological and immunohistochemical staining favor a colon primary. However other possibilities include cholangiocarcinoma and pancreatic ca.

Should we code site as C18.9 or C26.9?

Code the primary site according to the physician's opinion. An ill-defined site code or an NOS code for the organ system is preferred over C809 [Unknown primary site] whenever possible. Code C809 only when there is not enough information to use an ill-defined or NOS code.

Case 1 and Case 2 - Assign code C249 [Biliary tract, NOS]. Based on the available information, the physicians believe these are most likely biliary primaries.

Case 3 - Assign code C189 [Colon]. According to the available information, the physician believes this is most likely a colon primary.

 2006
20061036 CS Extension--Lymphoma: For lymphoma cases, can extension be coded to 80 [Nodular involvement of lungs] based on imaging or operative findings when there is no positive statement of involvement? See Discussion.

Specifically, CS Ext code 80 includes nodular involvement of the lungs. The CT report for this patient states that the lungs are nodular. Is that enough to use code 80? Can the liver be coded as involved based on the operative findings?

Scenario: The patient was diagnosed with lymphoma. The CT showed pulmonary nodules. The pt had an exploratory laparotomy with a positive mesenteric LN bx and a positive ileocecectomy. The operative findings included a nodular liver. No staging was done by the oncologist and he has the pt on CHOP-R.

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.

Extension code 80 can be assigned based on imaging or operative findings as in the lymphoma case described above. The fact that this extension was not based on pathological evidence is captured in the evaluation code. Assign CS/TS Ext-Eval code 0 [No staging laparotomy done. No autopsy evidence used (clinical)].

 2006
20061037 Multiple Primaries/Histology--Lymphoma: If a gastric biopsy demonstrates large B cell lymphoma arising in a low grade MALT lymphoma, how many tumors should be abstracted and how should the histology field(s) be coded? See Discussion.

Final path for gastric biopsy on 12/2005 is "consistent with malignant lymphoma" and Micro says "morphologic findings consistent with MALT lymphoma and an increased proportion of large atypical cells is concerning for large cell transformation. However, since the large cells are present only focally, a definitive diagnosis of large cell lymphoma cannot be rendered"

A second gastric biopsy a week later said: Final Path: Diffuse large B cell lymphoma arising in low grade MALT lymphoma. Micro says: "Compared to patient's previous biopsy...the current specimen contains a higher percentage of large atypical cells which stain positively for CD79a, a B cell marker. The morphologic and immunohistochemical findings are consistent with a large B cell lymphoma arising in a low grade MALT lymphoma."

These are different primaries according to the table of single versus subsequent primaries of lymphatic and hematopoietic diseases.

For cases diagnosed prior to 1/1/2010:

This is one primary. Code as 9699 [Marginal zone B-cell lymphoma, NOS].

The first biopsy was not conclusive. The biopsy one week later was more definitive. The reports are describing a difference between specimens, not a difference in disease.

According to the WHO classification, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is an extranodal lymphoma with B-cells, cells resembling monocytoid cells, small lymphocytes and scattered immunoblast and centroblast-like cells.

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.

 2006
20061038 Treatment, NOS: Is Bromocriptine coded to hormone or "other" treatment for a pituitary primary that is not surgically treated? Yes, code bromocriptine as hormone treatment for pituitary adenoma, as it suppresses the production of prolactin that causes the adenoma to grow. 2006
20061039 CS Tumor Size/CS Site Specific Factor--Breast: Should the tumor size be coded to 1.5 cm or 2.5 cm and SSF6 coded to 020 or 030 respectively for a tumor with invasive and in situ components described as being a 2.5 cm tumor with a "greater than" 1.5 cm invasive portion? See Discussion. Should tumor size be coded to 1.5 cm and SSF6 coded to 020 [Invasive and in situ components present, size of invasive component stated and coded in CS Tumor Size] or should the tumor size be 2.5 cm with SSF6 coded to 030 [Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated and in situ described as minimal (less than 25%)]?

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 tumor size 992 [stated as greater than 1 cm] and SSF6 code 020.

The September 2006 revision to the CS Tumor Size table now lists the 992-995 range codes as "greater than ___ cm."

It is better to code the invasive size than the entire size of the tumor. In the TNM mapping, this would more accurately portray the tumor as T1c rather than T2.

 2006
20061040 Reportability--Anus: Is a final diagnosis on a pathology report of "squamous cell carcinoma of the anus, NOS" assumed to be a skin of anus primary or a primary of the anus? Squamous cell carcinoma of the anus is reportable unless known or stated to be skin of anus. 2006
20061041 CS Site Specific Factor--Prostate: How is SSF 6 coded for this site when there is only one Gleason number documented and the number is less than 5 (e.g., Gleasons 3)?

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 999 [unknown or no information]. Note 1 was revised in September 2006 to clarify this situation.

Note 1 states "If only one number is given and it is less than or equal to 5, code the total score to 999, unknown or no

information.

 2006
20061042 First Course Treatment--Lymphoma: Should the use of proton pump inhibitors be coded as treatment for lymphoma primaries in patients with H Pylori? No, do not code proton pump inhibitors as treatment. These are used for gastric acid suppression. Proton pump inhibitors are used to treat symptoms, not the lymphoma itself. 2006