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Report Produced: 09/14/2024 16:18 PM

Report Question ID Question Discussion Answer Year
20071006 Primary Site: Is an "angiosarcoma" stated as arising in the skin of the breast and treated with a mastectomy, coded to the primary site of skin or breast?

Code the primary site as skin of breast when skin of breast is documented as the site of origin.

According to the WHO classification of soft tissue tumors, the majority of angiosarcomas "develop as cutaneous tumors...less than one quarter present as a deep soft tissue mass."

 2007
20071007 MP/H Rules/Histology: In the absence of a tissue diagnosis, should the histology field be coded based on the findings of a suspicious cytology or a CT scan that clinically confirmed the diagnosis? See Discussion. Cytology (brushings at ERCP) which are highly suspicious of adenocarcinoma. A CT of the abdomen performed the next day shows a mass, most likely Klatskin tumor. Can the histology be coded to Klatskin tumor [8162/3] based on the CT findings?

For cases diagnosed 2007 or later, code the histology to 8162/3 [Klatskin tumor] using the histology from the CT. This case is confirmed clinically based on the CT. It cannot be accessioned based on suspicious cytology.

Rule H8 in the 2007 Histology Coding Rules for Other Sites provides instructions for coding histology when the pathology report and cytology report are not available.

 2007
20071008 Histology (Pre-2007)--Breast: How is "invasive lobular carcinoma with signet ring cell features (95%) and ductal features (5%)" coded for a single tumor diagnosed prior to 2007?

For cases diagnosed 1/1/04-12/31/06, code histology to 8524 [Lobular mixed with other types of carcinoma]. Assuming there is no mention of in situ, Histology Coding Rule 3 applies: Use a mixed histology code if one exists

For cases diagnosed 2007-2014, 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.

 2007
20071009 MP/H Rules/Multiple Primaries/Laterality--Brain and CNS: How many primaries are to be abstracted and how is laterality to be coded for two meningiomas, one occurring at the midline and the other in the right termporal region? See Discussion. MRI of the brain shows two meningiomas: One is stated to be 'midline' (laterality code 9) and one is stated to be in the 'right' temporal region. The rules state if same site (C700), same histology & laterality is same side or one side unknown, then abstract as single primary. Based on this, the MRI findings would be one primary, but how should laterality be coded? For cases diagnosed 2007 or later, abstract two primaries. The lateralities of both meningiomas are known. Right (code 1) and midline (code 9) are different lateralities. 2007
20071010 MP/H Rules/Histology--Prostate: While cases of "acinar adenocarcinoma" of the prostate are required to be abstracted with the histology code 8140/3 [adenocarcinoma, NOS] for cases diagnosed 1/1/07 or later, can 8550/3 [acinar adenocarcinoma] be used for cases diagnosed prior to 1/1/07? See Discussion. The SEER Multiple Primary and Histology manual, effective with 2007 forward diagnosis dates, indicates that this histology should be coded to 8140/3 [adenocarcinoma, NOS]. Does this contradict ICD-O-3? Can acinar adenocarcinoma be coded for other primary sites?

For cases diagnosed 2007 or later, code acinar adenocarcinoma of the prostate as 8140/3.

Prior to diagnosis year 2007, code 8550/3 [acinar adenocarcinoma] may be used for prostate cases and for acinar adenocarcinoma of other sites, such as pancreas.

 2007
20071011 Multiple Primaries (Pre-2007)--Breast: How many primaries are to be abstracted when each of multiple breast "re-excisions" performed more than two months apart in 2006 demonstrate intraductal carcinoma and there is no mention of "recurrence"? See Discussion.

Right Breast

06/27/2002 exc bx, DCIS. Margins involved.

09/24/2002 re-exc, several foci of intraductal ca. Margins involved.

10/15/2002 re-exc, microfocus of DCIS

Radiation treatment started 11/18/2002.

Is this 1, possibly 2, or maybe 3 breast primaries because of the 2 month rule and no statement of "recurrence"? Based on SINQ #20000478, this would be at least 2, but possible 3 primaries. Based on SINQ #20021143, this would be 1 primary if the case were diagnosed from 1998-2003. The excisions appear to represent wider excisions of the same tumor.

For cases diagnosed prior to 2013:

For tumors diagnosed prior to 2007, this is one primary, assuming these are wider excisions of the same tumor.

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.

 2007
20071012 Reportability--Melanoma: Is a skin excision final diagnosis of "melanocytic tumor with uncertain malignant potential" reportable if the path COMMENT states the initial shave biopsy diagnosis was "melanocytic tumor with uncertain malignant potential [minimal deviation melanoma]"? See Discussion.

SKIN, RIGHT FOOT, EXCISION: CHRONIC SCARIFICATION WITH RESIDUAL ATYPICAL MELANOCYTES IN THE DERMIS IDENTIFIED, BUT COMPLETELY EXCISED.

Comment: The prior outside biopsy report indicates that the lesion was a melanocytic tumor of uncertain malignant potential (minimal deviation melanoma) measuring at least 2.5 mm in depth. There was apparently no in situ component. Special stains performed here are similar, with positive reactivity for Melan A and S-100. The cells are atypical, but there are reactive changes, making it impossible to accurately assess the true nature of the lesion in this biopsy. If this is a minimal deviation melanoma, it would be classified as a T3 (T3a since there is no description in the outside report of ulceration) lesion. The atypical melanocytes extend to a depth of 1.1 mm in this 2 mm deep biopsy, but are completely excised, both at the deep margin and at all of the peripheral margins (closest margin is superior, with clearance of 7 mm).

PATH FROM INITIAL BIOPSY: Diagnosis: Rt dorsal foot, shave biopsy: Melanocytic tumor of uncertain malignant potential (see comment). Tumor depth at least 2.5mm Deep margin involved. Comment: As a primary lesion, I would favor that this represents a melanocytic tumor with indeterminate biologic potential also known as minimal deviation melanoma. The lesion does extend to the deep margin and wider excision is recommended.

 This case is not reportable. Based on the information provided, there is no definitive diagnosis of malignancy. 2007
20071015 CS Lymph Nodes/CS Mets at Dx--Melanoma: How are these fields coded if a sentinel lymph node biopsy reveals no malignancy but there is an aggregate of melanoma cells in the lumen of a large vein immediately adjacent to the lymph nodes?

This question was answered by the CoC:

Do not count this as regional metastatic disease since there is no evidence it is an established tumor. Stage this as a N0.

 2007
20071016 MP/H Rules/Multiple Primaries--Bladder: The new multiple primary rule M7 states that tumors diagnosed more than three years apart are multiple primaries. Does this apply to in situ bladder tumors that occur more than three years apart and to an in situ tumor that occurs three years after an invasive tumor?

For cases diagnosed 2007 or later, use the MP/H rules in order. Rule M6 comes before rule M7.

M6 states that bladder tumors with certain histologies are a single primary. It is a single primary regardless of timing if there is any combination of:

  • papillary carcinoma [8050]

  • transitional cell carcinoma [8120-8124]

  • papillary transitional cell carcinoma [8130-8131]

    • Rule M7 applies to bladder tumors with histologies other than those listed above. If you have such a case, rule M7 applies to in-situ tumors and to an in situ three years after an invasive.

    		 2007
    		20071017 CS Extension--Prostate: Can the phrase "hard, fixed prostate" be interpreted as clinical extracapsular extension and coded to 50 [extension or fixation to other structures]? See Discussion.

    Patient had a "hard, fixed prostate" with needle core bx positive for Gleason grade 4+5=9 adenocarcinoma extensively involving gland. PSA was 87.5. Lymphadenectomy showed 3 positive pelvic/obturator lymph nodes. No prostatectomy was done and no physician TNM staging documented.

    Do we need a specific clinical description of other organs to which the prostate is fixed in order to code CS Clinical Extension 50, or does the statement "hard, fixed prostate" qualify? If not, how would we code extension for this seemingly advanced cancer?

    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.Assign extension code 50 [extension or fixation to adjacent structures] based on the term "fixed." Fixation to a particular structure(s) does not have to be specified in order to use code 50.

    Do not use the statement "hard" to determine CS extension.

    		 2007