Behavior--Head & Neck: Should the SEER IF_Morph_3 edit be modified because it does not allow a behavior code 2 with histology 8941 [carcinoma in a pleomorphic adenoma] for a parotid primary?
Code the behavior as 2 and over-ride the edit. The edit is there to flag unusual combinations. Once you have verified that the behavior is coded correctly, over-ride the edit.
The surgeon stage of T2 is based on size of tumor, the TIS is based on behavior. Code according to pathologically confirmed TIS.
Ambiguous Terminology--Breast: Is a stereotactic biopsy that is "focally suspicious for DCIS" reportable if it is followed by a negative excisional biopsy? See Discussion.
Per the 2004 SEER manual page 4, 1.a, the case is reportable based on the ambiguous term "suspicious" for DCIS.
Per the 2004 SEER manual page 4, 1.c, use these terms when screening diagnoses on pathology reports, operative reports, scans, mammograms, and other diagnostic testing other than tumor markers.
Note: If the ambiguous diagnosis is proven to be not reportable by biopsy, cytology, or physician's statement, do not accession the case.
Do not accession this case. The needle localization excisional biopsy was performed to further evaluate the suspicious finding found on stereotactic biopsy. The suspicious diagnosis was proven to be false.
CS Extension--Lung: How is extension coded if there is only one cytology done on a pleural effusion that is negative for carcinoma (but shows an exudate) and there is no clinical assessment of the pleural effusion found in the medical record? See Discussion.
CS lung extension note 6 provides instructions from the SEER manual and also from the AJCC manual. Per SEER manual, "ignore the effusion that is negative for tumor." Do we ignore the pleural effusion for the case in question because it was negative? Per AJCC manual, "most pleural effusions associated with lung cancers are due to tumor. However, there are a few patients in whom multiple cytopathologic examinations of pleural fluid are negative for tumor. In these cases, fluid is non-bloody and is not an exudate. When these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element." For the case in question, pleural fluid was examined only once and clinical judgment is not available. As a SEER registry, do we follow the SEER portion of the note and ignore the pleural effusion? Or do we code extension as involving pleural effusion because it was an exudate?
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.A single negative pleural effusion by itself does not impact the coding of extension.
The SEER note does not alter the AJCC note and the AJCC note does not alter the SEER note. They are two separate statements from two separate staging authorities. Registries follow both notes. For this case, ignore the pleural effusion because there is no clinical judgment available and there was only one cytology on the effusion.
Histology (Pre-2007): Is histology for an anorectal biopsy of "Cloacogenic carcinoma (squamous cell carcinoma with basaloid features)" coded to 8124/3 [Cloacogenic carcinoma] or 8083/3 [Basaloid squamous cell carcinoma]?
For tumors diagnosed prior to 2007:
Code histology to 8124/3 [Cloacogenic carcinoma]. These are squamous cell carcinomas of basaloid type that are found in the cloacogenic (transitional) zone of the anal canal.
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.
CS Lymph Nodes: Are positive right superficial inguinal lymph nodes coded to 30 (which is the case for anal canal primaries) or 31 (which is the case for anus primaries) if the primary is stated to be in the "cloacogenic zone" or is an anorectal primary?
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.Assign code 30 for positive unilateral superficial inguinal lymph nodes for cloacogenic primaries. The cloacogenic zone is part of the anal canal.
Reportability--Hematopoietic, NOS: Is a "refractory cytopenia with excess blasts" discovered on a bone marrow biopsy reportable?
For cases diagnosed prior to 1/1/2010:
Refractory cytopenia with excess blasts (RCEB) is reportable. RCEB is the same disease process as refractory anemia with excess blasts, except there is more than one type of blood cell that is low (red, white, platelets).
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.
Diagnostic Confirmation: How is this field coded for a case with a cytology that is suspicious for ductal carcinoma and the clinical diagnosis is carcinoma? See Discussion.
SINQ 20031152 states that histology for this type of case is to be coded per the clinical diagnosis of "carcinoma." Does it follow then that Diagnostic Confirmation is to be coded 8 (clinical diagnosis only)? Would we code Diagnostic Confirmation differently if the clinician stated that the diagnosis of malignancy was confirmed by the suspicious cytology?
Code diagnostic confirmation as 8 [clincial diagnosis] when there is a suspicious cytology and a physician's clinical diagnosis. Do not accession cases with only suspicious cytology.
Code diagnostic confirmation as 8 when the clinician's diagnosis of malignancy is confirmed by the suspicious cytology. It is still a clinical diagnosis made by the physician using the information available for the case.
Reportability--Melanoma: Is the following reportable? See Discussion.
PATH: Skin, Lt back exc bx: compound nevus with severe cytoarchitectural atypia and regression. Comment: due to overlap of morphology between MM and nevi with severe atypia, and since there's evidence of regression, consideration for re-excision may be considered if clinically indicated.
The final diagnosis, compound nevus with severe atypia, is not reportable. This diagnosis is not listed in ICD-O-3.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: For cases diagnosed in 2005, if a specimen contains an invasive 4.5 cm lobular carcinoma of the right breast and also has a tiny focus of intraepidermal tumors cells [Paget disease of nipple], how many cases should be abstracted and how should the histology field(s) be coded?
For tumors diagnosed prior to 2007:
There are two primaries in this example:
1. Invasive lobular carcinoma [8520/3]
2. In situ Paget disease of nipple [8540/2].
There is no combination code for lobular carcinoma and Paget disease.
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.
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