SEER Inquiry System - Search

For cases diagnosed prior to 1/1/2010:If the physician clearly states that this is a new primary, submit it as a new primary. Otherwise, use the Single versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table.

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.

Default the coding of the Primary Site field for chordomas to the bone where the tumor began in the body if the primary site is not clearly stated to be soft tissue. Bone is often the primary site for chordomas.

Based on advice from pathologist consultants: This is one of those situations where we can be quite comfortable with a default, in this case to bone, not soft tissue. Chordoma is a tumor arising in the nucleus pulposis, presumably from remnants of notochord - thus its exclusive origin is in the sacrococcygeal region, spheno-occipital region, and vertebral bodies, otherwise known collectively as the axial skeleton. Any "chordoma" in soft tissue (with no relationship to axial skeleton) is probably a myxoid chondrosarcoma or parachordoma (extremely rare).

This answer pertains to cases prior to 2014. For cases diagnosed 2014 and forward, see http://seer.cancer.gov/tools/grade/

Do not use FIGO grade to code differentiation.

FIGO grade is something completely different from FIGO stage. FIGO stage is used to code EOD. FIGO grade is based on the percentage of non-squamous (i.e., solid) portions of the tumor and corresponds roughly to a three grade differentiation system: grade I, well differentiated (=<5% solid component); grade II, moderately differentiated (>5 - 50% solid); and grade III, poorly differentiated (> 50% solid). SEER is evaluating whether the ICD-O-3 6th digit differentiation codes (four grade categories) accurately represent the FIGO grade. For the time being, do not code FIGO grade.

For a diagnosis that includes commonly used differentiation term with a FIGO grade, such as "Moderately differentiated, FIGO grade II," disregard the FIGO grade and code the Grade, Differentiation field according to the term "Moderately differentiated."

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."

For cases diagnosed 1998-2003:

In coding the EOD-Extension field, ignore metastasis that is discovered after the initial workup is completed regardless of the timeframe from diagnosis date until the date the metastatic deposit was discovered. The metastasis is progression of disease.

Any of the following represents progression of disease. Do not code the subsequently identified metastatic involvement in the EOD:

1) The metastatic workup was complete and treatment started before the procedure was done that found the metastatic involvement.

2) A procedure, such as a scan, was negative initially and a repeat of that procedure is now positive.

3) The treatment plan is developed for a localized disease process.

If you are unable to determine whether the newly discovered metastasis represents progression or is part of the initial workup, regard the metastasis as progression. Do not code the metastasis in the EOD-Extension field.

For tumors diagnosed prior to 2007:

Assign histology code 8210 [adenocarcinoma in a tubular adenoma] and behavior code 2 [in situ]. "In situ" is specified by the pathologist.

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.

For tumors diagnosed prior to 2007:

Report this case as two primaries, left and right kidneys. According to our pathologist consultant, "The description sounds like bilateral multiple primaries. Multicentricity in the same kidney occurs in about 4% of all cases, and bilaterality in 0.5 to 3% (Atlas of Tumor Pathology, Tumors of the Kidney, Bladder, and Related Urinary Structures)."

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.

For cases diagnosed 1998-2003:

Code the EOD-Extension field to 10 [confined to pancreas] because a scan supported the finding of no extension beyond the pancreas.

If the abstractor reviewing the medical record has scans, op reports, and/or pathology reports stating that the tumor is confined to the pancreas, code extension to 10 [confined to pancreas].

However, if the medical record only provides a patient history from a physician stating that the patient had localized pancreas, code extension to 30 [localized, NOS]. The NOS codes are used only when there is not enough information to code the specific codes (in this case, 10 or 20).

Code the Primary Site field to C809 [unknown] for this case. The thigh tumor is a metastatic site.