Histology (Pre-2007): What codes are used to represent the histology "mucinous adenocarcinoma arising in a villous adenoma" and "mucinous adenocarcinoma arising in a villous glandular polyp"? See discussion.
Should histology be coded to 8480/3 [mucinous adenocarcinoma] or 8261/3[adenocarcinoma arising a villous adenoma] or 8263/3 [adenocarcinoma in a villoglandular adenoma]?
For tumors diagnosed prior to 2007:
Code the Histology field to 8480/3 [mucinous adenocarcinoma] using rule D in the Coding Complex Morphology Diagnoses: "Code the morphology with the highest code."
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.
EOD Fields--Lymphoma: Was MALT Lymphoma [9715/3 (ICD-O-2) and 9699/3 (ICD-O-3)] inadvertently excluded from SEER EOD manual, top of page 180?
For cases diagnosed 1998-2003:
Yes. Use the scheme on page 180 for MALT lymphoma. The ICD-O-2 morphology code 9715 was omitted in error. It should have been added when the EOD was printed in 1998.
Diagnostic Confirmation--Testis: How do you code this field when a testicular mass is confirmed to be cancer on physical exam and testicular antigen, but the orchiectomy specimen was negative and yet the final signout diagnosis on the medical record was "testicular cancer"?
Code the Diagnostic Confirmation field to 5 [Positive laboratory test/marker study] because the disease was confirmed both clinically and by a positive marker. Code 8 [Clinical diagnosis only] is used when the diagnosis is based on information other than that coded in 5, 6, or 7 [positive lab test/marker study, visualization, and radiography or other imaging techniques]. Code 8 is rarely used.
Grade, Differentiation--Lymphoma/Leukemia: What code is used to represent this field when the phenotype is combined B cell and T cell?
For cases diagnosed prior to 1/1/2010:Code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable]. There is no combination code for B cell and T cell. There is also no hierarchy established for choosing one code over the other. Therefore coding such a case as a pure B cell or a pure T cell would misrepresent the phenotype.
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.
1) If Van Nuys nuclear grade 2 is the only grade given for an in situ breast primary, would it be coded as a 3-component system (e.g., 2/3 = 3)?
2) Is there a way of determining grade if only the total Van Nuys Prognostic index score is given (e.g., score 7/9)?
1. Code Van Nuys grade 2 as code 2 [Grade 2] in the Grade, Differentiation field.
2. Code Van Nuys score of 7 as 9 [Cell type not determined, not stated or not applicable] in the Grade, Differentiation field.
Currently, there is no conversion from the total Van Nuys score to grade because "grade" represents only one of the three Van Nuys factors that make up the total score. The other factors are tumor size and margin. The grade represents from 1 to 3 points within the total Van Nuys score. The total score can be between 3 and 9.
Histology (Pre-2007)--Breast: What code is used to represent the histology for a single lesion with "metaplastic carcinoma" and the majority of tumor has sarcomatoid appearance? Squamous cell carcinoma and high grade intraductal carcinoma are also present. Is the term "sarcomatoid" equivalent to sarcoma?
For tumors diagnosed prior to 2007:
For cases diagnosed on or after 1/1/2001: Code the Histology field to 8575/3 [metaplastic carcinoma]. Sarcomatoid is not coded as sarcoma.
The terms metaplastic carcinoma, squamous cell carcinoma and intraductal carcinoma are used, but only the metaplastic and squamous cell carcinomas are invasive. Metaplastic, loosely defined, means tissue that is not normal.
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.
Reportability--Myelodysplastic Syndrome: How we handle cases of myelodysplastic syndromes identified in 2001 casefinding documents that are determined to have an "unknown diagnosis" date after review of the patient's hospital medical record?
Myelodysplastic syndrome cases with unknown dates of diagnosis identified in pre-2001 casefinding documents should not be accessioned and are not SEER reportable.
For cases identified in 2001 casefinding documents, when the diagnosis date cannot be confirmed using the medical records typically accessed by the registrar or central registry staff, do not accession these cases; they are not SEER reportable. This default applies only to those cases identified in 2001 casefinding documents.
For cases identified in 2002 or later casefinding documents, the attending physician should be contacted and asked to clarify the diagnosis date for cases identified with unknown dates of diagnosis. Clarifying the diagnosis date is necessary to determine whether the case is reportable and whether it should be accessioned.
EOD-Extension--Lymphoma: Would a lymphoma involving mesenteric and retroperitoneal nodes (both site code C77.2) be coded to extension 10 [Involvement of a single lymph node region; Stage I], based on the fact that while more than one "chain" is involved only one "region" is involved?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 20 [Involvement of two or more lymph node regions on the same side of diaphram]. The AJCC lists mesenteric as a core nodal region, but does not list retroperitoneal lymph nodes as a part of this region, so retroperitoneal is a separate region.
The EOD staging scheme for lymphoma uses lymph node REGIONS as the criteria for assigning the extension code. Use the AJCC Cancer Staging Manual as the definitive source for classifying lymph node regions, not the ICD-O-3. If it is a separate LN region per the AJCC, it is coded in the EOD as a separate region.
According to the AJCC curator, the nodal regions are defined in Kaplan's book on Hodgkin disease. Bilateral cervical, or axillary, or hilar, or pelvic, or inguinal nodes count as two regions. Mediastinal and para-aortic lymph nodes count as one region regardless of laterality as they are centrally located. A large mediastinal mass constitutes one region involved regardless of the size.
Surgery of Primary Site--Skin: For skin primaries diagnosed 1998-2002, what is the difference between code 40 [Wide excision or re-excision of lesion or minor (local) amputation, NOS] and 50 [Radical excision of a lesion, NOS]?
Codes 40 and 50 are not in the scheme for 2003 forward. See history for coding cases diagnosed 1998-2002.
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