Multiple Primaries (Pre-2007)--Soft Tissue: Does SEER agree that one primary of the soft tissues of pelvis [C49.5] should be reported when a pathologic diagnosis for bilateral herniorrhaphies is "right and left inguinal hernias with low grade spindle cell sarcoma"?
For tumors diagnosed prior to 2007:
Yes. This is one primary and should be coded to C49.5 [Connective, subcutaneous and other soft tissue of pelvis]. According to Rule A in ICD-O-3, the type of tumor ("sarcoma") indicates origin from a particular tissue, resulting in the primary site code of C49.5 [Inguinal region, NOS] for this sarcoma.
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-Lymph Nodes--Breast: How do you code this field when the gross description on the pathology report states "nodal tissue is matted" but only 1/18 lymph nodes is found to contain micrometastatsis per the microscopic description of the report?
For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 1 [Micrometastasis] because the matted nodal tissue was found to contain only one node with micrometastasis when examined microscopically. Coding priority is given to the microscopic description over the gross description.
EOD-Pathologic Review of Number of Regional Lymph Nodes Examined: What code is used to represent this field when a path report from a lymph node biopsy or dissection describes lymph node "portions" or "fragments"? See discussion.
1) Lymph nodes, right pelvic dissection: No evidence of malignancy in 4 portions of lymph node examined. (Should we code the number examined as 01, 04, or 97?)
2) Lymph nodes, left pelvic dissection: 5 fragments of lymph nodes show no evidence of malignancy. (Should we code the number examined as 05 or 97?)
3) Biopsy of right neck mass: Malignancy in fragments of lymph nodes. The following month, pt had a right modified lymph node dissection: 16/32 lymph nodes are positive for malignancy. (Should we code the number examined as 32, 33, 97, 98?)
For cases diagnosed 1998-2003:
The total number of lymph nodes examined is recorded in EOD-Num of Reg LN Examined. If the number of actual lymph nodes represented by the "fragments" or "portions" cannot be determined, assign code 96, 97, or 98 as appropriate.
1) Based on the terminology "four portions of lymph node (singular)" code to 01 despite "dissection" terminology.
2) Code to 97 based on "fragments of lymph nodes (pleural)" terminology and procedure identified as dissection.
3) Code to 97 based on statement of "fragments of lymph nodes (pleural)" for biopsy plus dissection.
EOD-Extension--Kidney: If a "tumor thrombus" in a renal vein is discontinuous from the primary tumor in the kidney, is it still coded to 60 [Tumor thrombus in a renal vein, NOS], rather than 85 [Metastasis]?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 60 [Tumor thrombus in a renal vein, NOS]. A thrombus can be a bolus of tumor cells within a large vein that may or may not still be connected/contiguous with the primary tumor. However, both a discontinuous and contiguous thrombus are coded to 60.
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].
Histology (Pre-2007)/Grade, Differentiation--All Sites: When the original pathology reports diagnosis indicates a grade and the review of slides (ROS) pathology report does not give a grade, can you code the histologic type from the ROS and the grade from the original pathology report? See discussion.
For example, if the original diagnosis is "poorly differentiated carcinoma" and the ROS diagnosis is "squamous cell carcinoma," would the morphology code be 8070/33?
For tumors diagnosed prior to 2007:
Yes. Code the Histology and Grade, Differentiation fields to 8070/33 [poorly differentiated squamous cell carcinoma]. Code the higher grade when different grades are specified for the same specimen and code the more specific morphology (i.e., squamous cell carcinoma rather than carcinoma, NOS).
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.
Multiple Primaries--Hematopoietic, NOS: When the SEER Single versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table indicates that a disease is not a new primary, but a pathologist or clinician states that it is a new primary, do we use the physician information or the table?
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.
Grade, Differentiation--Breast: How do we code grade for a breast primary diagnosis of "Low grade invasive duct, modified Bloom-Richardson grade II/III (tubule formation 2, nuclear grade 1, mitotic rate 1)"? This appears to add up to a Bloom-Richardson score of 4, which does not fit with a Bloom-Richardson II/III.
Code the Grade, Differentiation field to 1 [grade I] using the information from the BR score.
For cases diagnosed 1998-2003: Grade or differentiation information from breast pathology reports is used in the following priority order:
1. Terminology (well, moderately, poorly)
2. Histologic grade (grade I, grade II)
3. BR scores
4. BR grade
5. Nuclear grade
On the hierarchical list for coding breast grade, the first two priorities do not apply to this case, but the third (Bloom-Richardson scores) does. Add the BR information (2+1+1) for a total score of 4, which translates to BR low grade (code 1). The statement of "II/III" may be a typo that should state I/III.
Histology: What code is used to represent the histology "endometrioid adenocarcinoma, villoglandular type"?
Assign code 8262/3 [Villous adenocarcinoma].
According to the WHO Classification of Tumours, Breast and Female Genital Organs (2003), villoglandular is one of four variants of endometroid adenocarcinoma. The corresponding ICD-O-3 code according to WHO is 8262/3.
Histology/Grade, Differentiation--Lymphoma: What code is used to represent the histology "high grade malignant lymphoma with features of so called blastic NK cell cutaneous lymphoma [hematodermic lymphoma]" found on punch biopsy?
For cases diagnosed prior to 1/1/2010:Code the Histology field to 9709/3 [cutaneous lymphoma, NOS]. Code the Grade, Differentiation field to 8 [NK cell].
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.
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