| Report | Question ID | Question | Discussion | Answer | Year |
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20091089 | Histology--Hematopoietic: How is histology coded for a "chronic lymphocytic leukemia with plasmacytic differentiation"? | For cases diagnosed prior to 1/1/2010:Assign histology code 9823/3 [Chronic lymphocytic leukemia]. Plasmacytic differentiation does not indicate a plasma cell or plasmacytic leukemia. For cases diagnosed 1/1/10 and later, 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. |
2009 | |
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20091020 | MP/H Rules/Histology--Breast: How do you code histology for a breast tumor when the comment section of the pathology report compares the current resected specimen with a previous needle biopsy? See Discussion. | A single tumor is described on the breast needle biopsy as "infiltrating lobular carcinoma and ductal carcinoma in situ" and on the lumpectomy specimen as "infiltrating duct carcinoma." Per the COMMENT section on the pathology report: "Tumor resection was compared to previous needle biopsy. The appropriate designation is probably a terminal duct/lobular lesion." | For cases diagnosed 2007 or later, assign code 8522 [Infiltrating duct and lobular carcinoma] according to Breast MP/H rule H16. The comment on the lumpectomy pathology report takes both the lumpectomy information and the biopsy information into consideration. "Probable" is an ambiguous term used to code histology. | 2009 |
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20091030 | MP/H Rules/Multiple Primaries--Thyroid: How many primaries should be coded if there is a clinical diagnosis of recurrent thyroid carcinoma in 3/08 in a patient with a history of thyroid carcinoma diagnosed in 1995 with a 2002 clinical recurrence? See Discussion. | Thyroid carcinoma diagnosed in 11/95 and treated with total thyroidectomy (although path report only mentions the left lobe) and ablation. Elevated thyroglobulin level in 11/02, stated to have recurrent carcinoma and again treated with ablation. History on this case states patient had a near total thyroidectomy at diagnosis. Patient is seen again at a third hospital 3/08. Diagnosis again is recurrent carcinoma apparently because of a thyroid mass that is palpable. No treatment was performed and patient expired 4/08. Is this a new primary because of MP/H rule M10? | For cases diagnosed 2007 or later: The pathology report takes precedence over the other information when there is a discrepancy. Based on the information available, only the left thyroid lobe was removed 11/95.
Use the 2007 MP/H rules to evaluate new tumors. If the 3/08 diagnosis represents a new tumor, use the MP/H rules. If the diagnosis in 3/08 is not new tumor, the MP/H rules do not apply.
For this case, a new tumor in 3/08 would be a new primary using rule M10 for Other Sites. |
2009 |
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20091045 | CS Tumor Size/CS Site Specific Factor--Breast: When tumor size is unknown, but it is known that both in situ and invasive components are present, how should CS Tumor Size and SSF6 be coded? See Discussion. | We coded CS Tumor Size 990 and SSF 6 to 060 for a case in which no tumor size was mentioned and the breast core biopsy identified microinvasive infiltrating lobular carcinoma and lobular carcinoma insitu. The lumpectomy identified no residual tumor. SEER edit 218 states we must have CS Tumor Size as 999 if the CS SSF 6 is 060. Yet the tumor size code of 990 (Microinvasion; microscopic focus or foci only, no size given; described as less than 1 mm) would more accurately reflect this case. Even in a situation where there was microinvasion described as less than 1mm, the edit will not allow one to code CS Tumor Size to 990 with the CS SSF 6 as 060. Should these types of cases have CS Tumor Size coded 999 or should the edit be adjusted to allow for this combination? | 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 990 [Microinvasion; microscopic focus or foci only, no size given; described as less than 1 mm] and CS SSF6 050 [Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated AND proportions of in situ and invasive not known].
This combination of codes captures the information available for this case. |
2009 |
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20091115 | MP/H Rules/Multiple primaries - - Melanoma: How many primaries are reported when a patient presents with a malignant melanoma (NOS) and a separate lentigo maligna, both on right chest? See Discussion. | MP/H rule M5 states that melanomas with ICD-O-3 histology codes that are different at the third number are multiple primaries. However, the 2007 MP/H fundamentals Webcast session on melanoma rules states that this is not two histologic types. Lentigo maligna is a growth pattern, not a histologic type. Will clarification be included in the next MP/H rules revision? |
For cases diagnosed 2007 or later, two primaries are to be reported for this case. Rule M5 applies because there is a difference in the histology codes at the third digit.
Clarifications regarding histologic types of melanoma will be added to the rules when they are revised. |
2009 |
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20091014 | MP/H Rules/Histology--Melanoma: Please clarify what we should code when we see the term 'spitz or spitzoid' in association with melanomas. See Discussion. |
Path reports often diagnose "melanoma with spitzoid features." There is no code for this in ICD-O-3. Would it be melanoma NOS with a specific type for MP/H rule H9 (with features of...), or would we stop at H3? Could the matrix principle apply, changing 8770/0 (one of the synonyms is Spitz nevus) to 8770/3 (although no Spitz synonyms are specifically listed under this code)? What if the path report says "melanoma arising in a Spitz nevus"? |
For cases diagnosed 2007 - 2020 Assign code 8720/3 [Malignant melanoma] for melanoma with Spitzoid features, Spitzoid variant of nevoid melanoma, melanoma arising in Spitz nevus, or Spitzoid melanoma. The WHO Classification of Tumors groups these with Nevoid melanomas and codes them to 8720/3. According to WHO, "Nevoid melanoma is a subtype of malignant melanoma of the skin that is distinctive in that the primary lesion mimics many of the architectural features of a common compound or intradermal nevus ... or a Spitz nevus... These lesions are defined not as atypical nevi, but as melanomas because they involve the dermis and have the potential for metastasis." |
2009 |
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20091092 | MP/H Rules/Histology--Lung: How should Diagnosis Date, Diagnostic Confirmation and Histology be coded for the LEFT lung mass in the following case? PET shows a 3 cm mass in the left lung and a 2.9 cm mass in the right lung. No reportable terminology in PET. The right mass is biopsied and shows adenocarcinoma. The left mass is not biopsied. Based on rule M6, this should be reported as two primaries. No additional information in medical record. Patient expired. |
For cases diagnosed 2007 or later: For date of diagnosis, use the date of the PET scan for both primaries. For the left tumor, assign diagnostic confirmation code 8 [Clinical diagnosis only] and assign histology code 8000/3 [malignant neoplasm]. The left lung mass is reported as a separate primary because there is one tumor in each lung. According to Rule M6, when there is one tumor in the left lung and one tumor in the right lung, each tumor is a separate primary. Tumor and mass are equivalent terms for purposes of the multiple primary rules. |
2009 | |
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20091061 | Multiplicity Counter--Head & Neck: How is this field coded when a patient has carcinoma in the same location as a previous primary but it is unknown if there was a disease-free interval? See Discussion. | Patient was diagnosed with squamous cell carcinoma, single tumor of the right true vocal cord in May 2008. Tumor was treated with radiation therapy and chemotherapy. Excision of right vocal cord mass in February 2009 shows squamous cell carcinoma. | Assign code 01 [one tumor only] for the example provided (see discussion). Given the information provided, there is no reason to suspect that the February 2009 diagnosis represents new tumor; therefore, it does not affect the multiplicity counter. It appears that this was the treatment plan for the original diagnosis in May 2008: radiation and chemo followed by excision of the mass. | 2009 |
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20091055 | Date therapy initiated/Systemic/Surgery Sequence--Breast: How are these fields coded when a patient has chemotherapy after a sentinel lymph node biopsy and has a lumpectomy after completing chemotherapy? See Discussion. | On 4-10-08 a patient underwent sentinel lymph node biopsies. This was followed by chemotherapy which started on 4-15-08. The patient subsequently underwent a lumpectomy on 11-10-2008. | For this case, code Date Therapy Initiated to the date of the sentinel lymph node biopsy [04102008]. Assign code 3 [Systemic therapy after surgery] in Systemic/Surgery Sequence. |
2009 |
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20091025 | MP/H Rules/Multiple primaries--Urinary: How should we handle urinary tract tumors diagnosed before the MP rules went into effect when determining the number of primaries to report primaries? How do you apply rules M5, M6 and M8 when an invasive bladder tumor and other urinary site tumors occur before and after the effective date of these rules? See Discussion. |
Example: Patient with a prior in situ carcinoma of the bladder in 11/89, left ureter papillary transition cell carcinoma in situ diagnosed in 5/05, left renal pelvis papillary transition cell carcinoma in situ diagnosed in 8/07 and invasive bladder carcinoma diagnosed in 3/08. When an invasive bladder tumor and other urinary site tumors occur, do you stop with the bladder at rule M5 and M6 never reaching M8? |
For cases diagnosed 2007 or later: Use the 2007 MP/H rules for urinary sites to assess diagnoses made in 2007-2014. Use the multiple tumors module to compare a diagnosis in 2007-2014 to an earlier diagnosis. For the example above, start by comparing the left renal pelvis diagnosis in 8/07 to the earlier left ureter primary diagnosed 5/05. Start with rule M3. Stop at rule M8. The 8/07 renal pelvis diagnosis is not a new primary. Next, compare the 3/08 bladder tumor to the earlier left ureter primary diagnosed 5/05. Start with rule M3. Stop at rule M5. The 3/08 bladder tumor is a new primary because it is an invasive diagnosis following an in situ diagnosis. Use only the more recent of the two earlier urinary diagnoses for comparison. Do not compare the 2007 and later diagnoses to the 11/89 in situ bladder primary in this case. |
2009 |
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