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20031140 | Primary site--Unknown & ill-defined site/Kidney: How should this field be coded when humeral metastases are compatible with renal cell carcinoma pathologically, no kidney lesion is found clinically and the physician's signout diagnosis is "no primary found, as of now unknown"? See Description. | Path states "biopsy of humerus, mets sarcomatoid carcinoma consistent with renal cell carcinoma." Material was sent to Mayo Clinic for consult & they state "with focus of clear cells, agree that a likely primary is renal cell carcinoma." Abdominal CT showed no abnormality in kidneys. When the registrar abstracted the case she spoke to the managing physician who told her that "no specific site was found and it was, as of now, unknown." This was stated about three months after dx. Can we code as a renal primary based on pathologic information or should we code unknown based on CT and physician's statement? | Code this case to C64.9 [Kidney, NOS]. ICD-O-3 rule H states that the topography code attached to a morphology term may be used when the topographic site is not given in the diagnosis. Topography code C64.9 is attached to morphology code 8312/3 [Renal cell carcinoma] in ICD-O-3. |
2003 |
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20031092 | Histology (Pre-2007)/Multiple Primaries (Pre-2007)--Breast: How is the histology of invasive small cell carcinoma of lobular histogenesis coded? Could high grade ductal carcinoma in situ, comedo type be a recurrence of ductal carcinoma diagnosed 18 years earlier? Is "invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type" one or two primaries? See Description. |
A patient was diagnosed in 1984 with 1st breast primary, histology was ductal carcinoma, T1N0, LIQ left breast. In 2002 a mass was found on mammogram, MRM with axillary sampling performed. Histology was invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type, nuclear grade 3/3, T2N1, UOQ left breast. Is the ductal carcinoma in situ recurrent disease from the 1st primary? Does it go with the lobular histogenesis, i.e., lobular carcinoma and DCIS histology code 8522/3 or is the ductal in situ a 3rd primary? | For tumors diagnosed prior to 2007:
According to our pathologist consultant: Invasive small cell carcinoma of lobular histogenesis appears to be an unusual histology for a breast primary. Code it as such 8041 [Small cell carcinoma, NOS]. The 2002 lesion is most likely a new primary since the previous lesion was 18 years ago, in a different quadrant, and invasive. A comedo DCIS would probably not be asymtomatic for 18 years; an unlikely "recurrence" of an earlier ducal carcinoma. Code "invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type" as two primaries. Code the small cell as a separate primary (8041/3), and the DCIS separately (8501/2).
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. |
2003 |
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20031040 | First Course Treatment/Radiation Therapy/Immunotherapy--Thyroid: For this primary, do we code I-131 as a Radio-isotope as well as a Biological Response Modifier? See Description. | (SEER Book 8 lists I-131 as a Biological Response Modifier.) Immunoglobulin is listed as immunotherapy agent in the CCR manual also coded as immunotherapy. Are there two different types of I-131, immunoglobulin and sodium iodide? | Code Radioactive Iodine, Sodium Iodide 131-I, as radiation (code 3, Radioisotopes). Sodium Iodide is listed as an ancillary drug in SEER Book 8, page 45. The listing on page 63 refers to Antiferritin antibody, or AntiCEA. Both of these were under clinical investigation when Book 8 was written. They are no longer active and this change will be made when Book 8 is revised. |
2003 |
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20031076 | EOD-Size of Primary Tumor--Prostate: Is this field coded to the size of a hypoechoic mass identified on a TRUS when there is no tumor size from the prostatectomy specimen? | For cases diagnosed 1998-2003: Ultrasound measurement of a malignancy can be used to code EOD-Size of Primary Tumor. Information on tumor size taken from imaging/radiographic techniques has low priority, just above physical examination. | 2003 | |
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20031191 | EOD-Clinical Extension--Prostate: How is this field coded when biopsies of the prostatic apex are positive and the physician clinically stages the case as T1c? | For cases diagnosed 1998-2003:
Code clinical extension to 33 [arising in the prostatic apex] when a biopsy of the prostatic apex is positive for malignancy, with no further evidence of involvement. If biopsies of both the apex and another site within the prostate (for example right lobe) are positive and there is no mention that the malignancy arose in the apex, code extension to 34 [extending into the prostatic apex]. |
2003 | |
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20031145 | EOD-Extension--Head & Neck: Is this field coded 10 [Invasive tumor confined to one of the following subsites: interior wall, one lateral wall, posterior wall] or 30 [Localized, NOS] for tonsillar primary when there is no mention of involvement of surrounding structures? See Description. | Site is stated to be "left tonsil" and was coded to site C099. "The lesion is admixed in tonsillar tissue." No surrounding structures are stated to be involved. Is it logical to assume that since code C099 includes the palantine tonsils and the palatine tonsils are on the lateral wall and since no other areas are stated to be involved that extension code 10 [confined to one lateral wall] would be more appropriate than code 30 [localized NOS]? | For cases diagnosed 1998-2003: Code EOD-extension for the case example to 10 [Invasive tumor confined to one of the following subsites: anterior wall, one lateral wall, posterior wall]. The tonsil lies in a pocket on the wall (tonsillar fossa), so you know it is confined to the wall. | 2003 |
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20031113 | Primary site/Surgery of Primary Site/Surgical Procedure of Other Site--Unknown & ill-defined site: How are these fields coded for this type of primary site when a tumor excision and lymph node dissection is performed? See Description. | Patient had a left parotidectomy w/ neck dissection in 02/2003. Findings showed a 10x5cm neck mass over the angle of the mandible as well as a 1.5 cm level 4 mass. Path showed invasive mod diff squamous cell ca. with posterior soft tissue margin positive for tumor; small portion of salivary gland had no tumor. Metastatic SCCa in 5 of 34 lymph nodes of neck dissection; no tumor in parotid lymph nodes. Pathology report says this could be a parotid carcinoma because the bulk of the disease is in the parotid, but it could also be metastatic...correlate with clinical findings. Doctor calls this unknown primary of the head and neck. Is this C80.9 or C76.0? | For cases diagnosed 1998-2003: The data item "Surgery of Primary Site" is intended to record only surgeries of the primary site. If the primary site is unknown or ill-defined, it is impossible to determine whether or not a particular surgery was performed on the primary site. "Surgical Procedure of Other Site" collects much less specific information; however, this is the correct data item to record surgery performed when the primary site is unknown or ill-defined. For the case example, code the primary site as C76.0 [Head, face or neck, NOS]. Code Surgery of Primary Site as 98 [All unknown and ill-defined disease sites, with or without surgical treatment]. Code Surgical Procedure of Other Site as 1 [Non-primary surgical procedure performed]. |
2003 |
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20031057 | Grade, Differentiation--Bladder: How is this field coded for a five grade system? See Description. | Example: Invasive, high grade transitional cell carcinoma (Grade 4-5/5) | For this example, code grade as 4 based on the term "High grade." If "high grade" was not stated, the grade would be coded as 9, not determined. There is no SEER translation between the ICD-O grades and a five grade system for bladder. None of the pathololgist experts we querried knew of a five grade system for bladder. | 2003 |
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20031073 | EOD-Pathology Extension--Prostate: Is extracapsular extension implied by the phrase, "involvement of periurethral or urethral margins"? See Description. | The prostatectomy final pathology diagnosis states that the tumor involves the periurethral margin. The microscopic describes involvement of the urethral margin. | For cases diagnosed 1998-2003: Code the EOD-Extension field in the 20-34 range, which implies no extension beyond the prostate. Disregard involvement of periurethral margin or urethral margin, NOS, unless the pathologist or surgeon specifically mentions "extraprostatic urethra" involvement. | 2003 |
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20031150 | Histology (Pre-2007)--Breast: Should the histology "non-invasive papillary carcinoma" along with the comment "solid intraductal papillary proliferation includes cytologically atypical cells with scattered mitotic figures" be coded to 8503/2 [intraductal papillary carcinoma] or 8050/2 [papillary carcinoma in situ]? | For tumors diagnosed prior to 2007:
The best histology code for this breast case is 8503/2 [Noninfiltrating intraductal papillary carcinoma]. According to the WHO Classification of Tumors for Breast, Papillary carcinoma, non-invasive is a synonym for Intraductal papillary carcinoma. Further, code a more specific histologic type when found in the microscopic description, according to the SEER Program Code manual.
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. |
2003 |
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