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Report Produced: 09/28/2024 03:27 AM

Report Question ID Question Discussion Answer Year
20021101 Histology (Pre-2007)/Grade, Differentiation--All Sites: How do we code these fields for a tumor that is predominantly a "well differentiated liposarcoma" [8851/31] that has a less predominent type of "dedifferentiated liposarcoma" [8858/33]? If we code the predominant cell type [8851/3] and the worst grade [3], the case will not pass edits because well-differentiated liposarcoma requires a differentiation code of 1. See discussion. Example: Dedifferentiated liposarcoma, with the following features: size 22 cm, FNCLCC grade 3 of 3 [high grade]. Path comment: The tumor consists of predominantly well-differentiated sclerosing subtype liposarcoma and areas of high grade spindle cell (non-lipogenic) sarcoma. The area of high grade spindle cell sarcoma measured up to 7.5 cm.

For tumors diagnosed prior to 2007:

Code the Histology field to 8858/33 [Dedifferentiated liposarcoma, grade 3]. The pathologist gives a final designation of Dedifferentiated liposarcoma and then provides further details in the comment that do not negate the final designation.

Grade is usually coded independent of the cell type. There are a few Catch-22 situations, like this one, in which the grade is built into the name of the cell type.

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.

 2002
20021100 Primary Site: How do we code the primary site for a malignancy that occurs in parenchyma located in an ectopic site? See discussion.

1. Patient presented with a subcutaneous nodule in right axilla. Pathologic impression by initial and reviewing pathologists is that the lesion represents a breast adenocarcinoma arising in ectopic mammary parenchyma. Subsequent breast biopsies were negative.

2. Patient presented with right branchial cleft cyst. The pathologist states the cyst is a primary thyroid adenocarcinoma arising in an ectopic focus of thyroid tissue. The subsequent total thyroidectomy is negative.

Code the primary site to the location of the malignancy.

1. Code the Primary Site field to C76.1 [Axilla NOS].

2. Code the Primary Site field to C10.4 [Branchial cleft].

 2002
20021099 Reportability/Histology (Pre-2007)--Pancreas: Are the following pancreatic tumors with mention of "low grade malignant potential/borderline" reportable to SEER? If so, what histology and behavior codes should be used? See discussion.

1. AFIP diagnosis: Pancreas, tail, resection: Mucinous cystadenocarcinoma (mucinous cystic neoplasm) of low grade malignant potential. Comment: There are no reliable histomorphologic features which can separate these neoplasms into benign and malignant tumors, and so we consider them all to be low grade malignant tumors.

2. Whipple resection: Intraductal papillary mucinous tumor of the pancreas with extensive low grade and multifocal high grade ductal dysplasia (so-called borderline tumor and carcinoma in-situ).

For tumors diagnosed prior to 2007:

Both tumors are reportable to SEER.

1. Code the Histology and Behavior Code fields to 8470/3 [Mucinous cystadenocarcinoma, NOS].

2. Code the Histology and Behavior Code fields to 8453/2 [Intraductal papillary-mucinous carcinoma, non-invasive].

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.

 2002
20021098 Histology (Pre-2007)--All Sites: What code is used to represent the histology with a final diagnosis of adenocarcinoma, signet ring type when the comment suggests a "mixed histologic pattern"? See discussion. The following is the comment from the pathology report: "The histologic features reveal a tumor with a mixed histologic pattern. A diffuse infiltrate of signet ring cells and a second pattern of amphophilic polygonal cells. The latter elements suggest neuroendocrine differentiation, but IHC stains fail to reveal endocrine attributes in these cells."

For tumors diagnosed prior to 2007:

Code the Histology field to 8490/3 [Signet ring cell adenocarcinoma]. Code the specific subtype when the diagnosis says "generic carcinoma, something type." Neuroendocrine differentiation was suspected, but not supported by the IHC stains. A combination code is not appropriate for this example.

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.

 2002
20021096 Grade, Differentiation--Bladder: What codes are used to represent this field for the four bladder cases described in the discussion section that have a combination of grades mentioned in the pathology reports? See discussion.

1) Final path diagnosis: papillary transitional cell carcinoma, high grade. Micro description states: High grade, poorly differentiated carcinoma.

2) Well to moderately differentiated papillary transitional cell carcinoma, grade 1-2/3.

3) Urothelial carcinoma, high grade (poorly differentiated, grade 3 of 3).

4) High grade papillary urothelial carcinoma (papillary transitional cell carcinoma, grade 3 out of 4).

For cases diagnosed January 2004 and forward:

1) Grade 4. High grade is coded 4. Code the grade stated in the final diagnosis.

2) Grade 3. Grade 1-2/3 is coded 3. Use the three-grade conversion table in the 2004 SEER manual.

3) Grade 4. Grade 3 of 3 is coded 4. Use the three-grade conversion table in the 2004 SEER manual.

4) Grade 3. "Grade 3 out of 4" is coded 3 and is more precise than "high grade."

 2002
20021094 EOD-Extension/EOD-Lymph Nodes--Testis: If the patient received chemo, should "bulky retroperitoneal adenopathy" be coded as involved lymph nodes in the EOD lymph node involvement field for a testicular primary treated with an orchiectomy that rendered a path diagnosis of "seminoma confined to the testicle"? See discussion. Per an orchiectomy path diagnosis a seminoma was confined to the testicle. The only other workup, other than a scrotal ultrasound, was a staging CT scan that revealed bulky retroperitoneal adenopathy in abdomen and pelvis, as well as mediastinal adenopathy. There was also a peripheral pulmonary nodule. No final clinical diagnosis or stage was provided in the chart. Following the orchiectomy the patient was treated with chemo. Should we also have coded distant site lung involvement?

For cases diagnosed 1998-2003, code the EOD-Lymph Nodes field to 9 [unknown] because "adenopathy" is not used to code lymph node involvement. The physician varied from the usual treatment for a localized testicular carcinoma, which is an orchiectomy. The physician proceeded immediately to chemotherapy as further treatment. It is not clear whether the decision to treat with chemo was based on the nodes and/or lung being involved.

Search the record for the physician's opinion regarding distant metastasis. Do not code distant involvement based on a peripheral pulmonary nodule seen on CT without further proof. If no further information is available, code the EOD-Extension field to 99.

 2002
20021093 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.

 2002
20021092 Histology/Primary Site--CLL/SLL: How should these fields be coded for a "chronic lymphocytic leukemia/small lymphocytic lymphoma" [CLL/SLL] diagnosed on a lymph node biopsy that is referred to by the clinician as CLL? See discussion. Does the clinician's reference to this disease as CLL change the SEER rule to code to SLL if the disease arises in a lymph node or solid tissue?

For cases diagnosed prior to 1/1/2010:Code the Histology field to 9670/3 [Malignant lymphoma, small lymphocytic, NOS] and the Primary Site field to C77._ [lymph nodes] when CLL/SLL is diagnosed in lymph node or solid tissue, even if the clinician refers to CLL. When CLL/SLL is diagnosed in the blood, code as leukemia.

Refer to clarification #6 on the ICD-O-3 Errata and Clarifications. "...if disease is diagnosed only in the blood or bone marrow, code the primary site to C42.1, bone marrow and assign the leukemia morphology code. If the diagnosis is made on any other tissue (typically lymph nodes, lymphatic structures, breast, and stomach), code to the tissue involved and assign the lymphoma morphology. If the diagnosis is made on both blood or bone marrow and a tissue biopsy, code the tissue involved and assign the lymphoma morphology."

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.

 2002
20021091

Reportability--Hematopoietic, NOS: Are the terms "thrombocytosis, NOS" and "thrombocythemia, NOS" non-reportable to SEER? See discussion.

Our understanding from SEER about how to classify these types of clinical impressions for the 2001 and later reportable blood diseases is as follows: If we cannot prove that it is malignant, then we should be conservative and exclude the case for reporting to SEER.

For cases diagnosed prior to 1/1/2010:The terms "thrombocytosis, NOS" and "thrombocythemia, NOS" are not reportable to SEER.

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.

 2002
20021090 Primary Site--Ovary/Peritoneum: How should the Primary Site field be coded when no resection is done and it is uncertain whether the primary site is in the ovary or the peritoneum? See discussion. CT: ascites, omental cake and peritoneal studding. H&P impression: probable ovarian or peritoneal primary. Repeat CT: no enlarged adnexal mass seen to suggest ca of ovary, but possibility couldn't be ruled out. Omental bx: Metastatic ca. Comment: "IHC stains have been performed and are not typical of ovarian ca, although do not exclude an ovarian primary." After the bx, there were two clinical diagnoses written a month apart with no evidence of further work-up between those dates. The first diagnosis was "ovarian ca". The second was "Peritoneal carcinomatosis 2 month ago; Primary is unknown, possibly ovarian."

Use the best information available to identify the primary site. In this case, it is the physician's clinical assessment. Code the Primary Site to C56.9 [Ovary] for this example because the ovary is indicated to be the primary site according to the physicians involved.

When there is no surgical procedure involving the removal of the ovaries, code the Primary Site based on the clinical assessment of the disease location. If the disease is only noted to be in the peritoneum, code site to peritoneum, NOS. If the disease is seen clinically in both the ovary and the peritoneum, code site to ovary.

 2002