Multiple Primaries (Pre-2007)--Breast: When a breast cancer is treated with less than a total mastectomy and more than 2 months later a tumor of the same histology is diagnosed in the same breast with no statement of "recurrence," is this a new primary?
For tumors diagnosed prior to 2007:
Count as 2 primaries when a subsequent malignant breast tumor is diagnosed more than 2 months later unless stated to be a recurrence. For cases diagnosed after 1/1/94, an in situ followed by an invasive breast cancer is counted as two primaries even if stated to be a recurrence.
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-Extension--Corpus Uteri: What code is used to represent this field for a corpus primary (sounding 8 cm or less in length) treated with radiation prior to a hysterectomy that pathologically showed superficial myometrial invasion? Is it possible that the invasion could have been more extensive prior to the radiation treatment?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 12 [Myometrium, inner half] which represents the extension you know. In this particular case, there was no clinical evidence of extension outside the corpus. As long as the surgery was not performed because of disease progression, use information from the surgery to code EOD extension.
Diagnostic Confirmation--Prostate: How do we code this field when there is an elevated PSA, no other work-up and there is a clinical diagnosis of adenocarcinoma?
Code the Diagnostic Confirmation field to 5 [positive laboratory test/marker study] to indicate the diagnosis is based upon an abnormal PSA tumor marker if the physician uses the PSA as a basis for diagnosing prostate cancer.
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.
Grade, Differentiation--Lymphoma/Leukemia: What code is used to represent this field for a lymph node biopsy that reveals "well differentiated lymphocytic lymphoma" and a bone marrow biopsy that reveals "chronic lymphocytic leukemia/well differentiated lymphocytic lymphoma"?
For cases diagnosed prior to 1/1/2010:
Code the Grade, Differentiation field to 1 [Grade 1] for both of these cases because there is no mention of T-cell, B-cell, null cell, or NK cell involvement. Both cases have a pathologic description of well differentiated, not the descriptors "high grade," "low grade," or "intermediate grade" which must be ignored when coding grade for lymphomas.
For lymphomas, you cannot code the descriptions "high grade," "low grade," and "intermediate grade" in the Grade, Differentiation field because these terms refer to categories in the Working Formulation and not to histologic grade. However, you can code terms such as "well differentiated", "moderately differentiated" and "poorly differentiated" for lymphoma histologies.
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--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.
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-Extension--Pancreas: How do you code extension when a mass is described on exploratory laparotomy as compressing the duodenum, arising in the head of the pancreas, "extending around" the superior mesenteric vein and artery, and "encasing" the portahepatis?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 40 [extension to peripancreatic tissue, NOS]. Neither of the terms "extending around" nor "encasing" are interpreted as involvement with tumor by SEER.
EOD-Lymph Nodes/EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined--Lung: How do you code these fields for clinically positive lymph nodes when the result of neoadjuvant treatment is that the lymph nodes are pathologically negative? See discussion.
The pt presents with "mediastinal adenopathy" for a lung primary and was treated with pre-operative radiation therapy. After two months, he was treated with surgery. The 10 lymph nodes removed were all negative. How does SEER code these three EOD fields?
Will an error be triggered in SEER Edits if you code lymph nodes as clinically positive in the EOD lymph node involvement field and yet pathologically negative in the number of regional nodes positive and number of regional nodes examined fields?
For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 2 [Mediastinal, NOS]. Code the EOD-Regional Lymph Nodes Positive and Examined fields to 00/10. You will not have a problem with the SEER Edits. The EOD field is coded using clinical and pathologic information. All information gathered within four months of the date of diagnosis (in the absence of disease progression) or through completion of surgery(ies) can be used to code EOD. The clinically positive nodes justify the radiation therapy.