Report | Question ID | Question | Discussion | Answer | Year |
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20081041 | MP/H Rules/Histology--Thyroid: How many primaries are to be reported and what histology is to be coded for an anaplastic/undifferentiated thyroid carcinoma with sarcomatoid transformation likely arising in association with a papillary thyroid carcinoma? Thyroid contains one tumor: 12.5 cm in greatest dimension...almost completely replaces entire thryroid gland. | For cases diagnosed 2007 or later: This is a single primary using rule M2; a single tumor is always a single primary. The histology code for this case is 8260/3 [Papillary carcinoma of thyroid]. Begin with Histology Coding rule H8. Stop at rule H17 and code the histology with the numerically higher ICD-O-3 code. |
2008 | |
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20081002 | Primary site: What is the correct primary site code for angiosarcoma of the spleen with mets to bone marrow C42.2 vs C49x? See Discussion. | Robbins Pathology states the following about liver angiosarcomas: Hepatic angiosarcomas are rare but of interest because they are associated with distinct carcinogens, including arsenic (exposure to arsenical pesticides), Thorocast (a radioactive contrast medium previously widely used in radiology), and polyvinyl chloride (PVC) (widely used in plastics). The increased frequency of angiosarcomas among works in the PVC industry is one of the truly well-documented instances of chemical carcinogenesis in humans. With all these agents, there is a very long latent period of many years between exposure and the development of tumors.
Could the same apply to the spleen? |
Code C422 [Spleen] as the primary site for angiosarcoma of spleen with metastasis to bone marrow. | 2008 |
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20081126 | MP/H Rules--Brain and CNS: Are stigmata of neurofibromatosis in the brain reportable neurofibromatosis lesions? See Discussion. |
Reference: SINQ 20051108; SINQ 20061018 Three year old patient with history of neurofibromatosis 1. 3/05 MRI of the brain showed right optic nerve glioma. It also showed heterogeneous high t2 signal in the middle cerebellar peduncles and near the genu of the internal capsules bilaterally are stigmata of neurofibromatosis type I. 3/08 MRI showed new mass suspicious for glioma in the hypothalamus. Clinical diagnosis is benign glioma secondary to diagnosis of neurofibromatosis. How many primaries are to be accessioned for this patient? Should the matrix principle be invoked for the second glioma? Should the behavior code for the glioma be 0? |
For cases diagnosed 2007 through 2017 Accession NF (9540/1) when there is CNS tumor -- a glioma or some other intracranial/intraspinal tumor. Stigmata of NF are reportable when the stigmata themselves are reportable tumors. For example, glioma, or another intracranial/intraspinal tumor. Do not report sitgmata that are only termed "stigmata seen on MRI," for example, without other reportable terminology. Do NOT accession NF (9540/1) when there is only peripheral nerve/nervous system involvement. Accession the neurofibromatosis itself only once per patient. Accession any initial neoplasm in the CNS separately. Abstract and code any subsequent CNS neoplasms according to the multiple primary brain rules. Accession three primaries for the case described above.
--> Optic nerve gliomas associated with NF are pilocytic astrocytomas. Code pilocytic astrocytoma as 9421/3 in North America. For cases diagnosed 2018 or later See the 2018 Solid Tumor Rules for Non-Malignant CNS tumors. |
2008 |
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20081121 | Multiple primaries/Histology--Lymphoma: How many primaries should be abstracted and how should the histology field(s) be coded in this situation? How would the bone marrow involvement by only NHL be handled? Composite lymphoma (9596) as defined by SEER and ICD-O is NHL and HD in one node which fits the final impression on the removed cervical node. See Discussion. |
Patient presented with cervical, supraclavicular & superior mediastinal lymphadenopathy. A cervical node was excised for pathological review. The final impression on that node was Composite lymphoma characterized by (1) Nodular Lymphocyte Predominant Hodgkin Lymphoma [HD] (2) CLL/SLL [NHL]. Then, a bone marrow aspirate/bx was performed revealing CLL/SLL [NHL]. | For cases diagnosed prior to 1/1/2010:This is a single primary. The histology code is 9596/3 [composite Hodgkin and non-Hodgkin lymphoma]. According to the Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table, 9596/3 followed by 9670/3 is one primary. For cases diagnosed 1/1/10 and later, 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. |
2008 |
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20081129 | MP/H Rules--Breast: What histology code should be used with invasive papillary carcinoma with cribriform carcinoma component? There is also DCIS adjacent to the invasive tumor, predominant cribriform and focal papillary patterns. This is a single breast tumor. See Discussion. | Registry staff is divided between 8523 and 8255. | For cases diagnosed 2007 or later: First apply rule H9, code the invasive. To determine the code for the invasive histology, start with rule H10 and stop at rule H15. Code the histology 8503 [papillary]. Papillary (8503) and cribriform (8201) are listed in Table 1 as specific duct types, but in this case they are invasive. Table 1 and Table 2 will be clarified in the next version of the MP/H rules. |
2008 |
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20081093 | CS Extension: How is CS Ext coded for the following? Rretroperitoneal primary Cystic mucinous tumor with intraepithelial carcinoma There is no CS Extension code for intraepithelial ca in the retroperitoneal scheme. |
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.According to the American College of Surgeons I & R system, assign code 10 [confined to site of origin] for intraepithelial carcinoma of the retroperitoneum. |
2008 | |
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20081066 | Multiplicity Counter/Type of Multiple Tumors--Breast: How should these fields be coded when path shows a 1.2 cm infiltrating carcinoma with lobular features and several foci of infiltrating lobular carcinoma [7 foci described as multifocal], 1 large focus, and numerous foci of LCIS and CIS with lobular and ductal features? Should we count the foci or separate tumor nodules, ignore them, or code unknown values for these fields? See Discussion. | Scenario: 10/17/07: Right axilla soft tissue bx - infiltrating mammary ca with lobular features arising within apparent breast tissue present within axilla. Tumor size 1.2 cm. 11/3/07: Right breast, reexcision lumpectomy - Several foci of infiltrating lobular CA. (2) foci & (5) foci within specimen (multifocal). (1) large focus also present. No lymphovascular invasion identified. Numerous foci LCIS. Pleomorphic LCIS & CIS with lobular and ductal features. Margins free of invasion however margins diffusely involved with LCIS.
When do you count foci or separate tumor nodules, when do you ignore them, and when do you code unknown values for these fields? Coding instruction 3b states, "When the tumor is multifocal or multicentric and the foci of tumor are not measured, code as 99." Instruction 4b states, "Use code 01 when there is a single tumor with separate foci of tumor." Finally, instruction 6b states, "Use code 99 when the tumor is described as multifocal or multicentric and the number of tumors is not given," which seems to imply that if we know the number of tumors, we would code that number. |
Multiplicity Counter: Use instruction 4b. Since there is one measured tumor and the foci were not measured, code the multiplicity counter 01 [One tumor only]. Type of Multiple Tumors: Code Type of multiple tumors 00 [Single tumor]. |
2008 |
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20081068 | Scope Regional LN Surgery--Melanoma: How is this field coded when there is no primary skin lesion and the only disease present is one axillary lymph node that reveals melanoma? See Discussion. | According to SINQ 20061045, the CS Lymph Node field is coded to 80. | Code scope of regional LN surgery 4 [1 to 3 regional lymph nodes removed] for this case. One lymph node was removed. For this case, the axillary lymph node is coded as regional for the CS Lymph Node field. Therefore, include this lymph node is also coded in the Scope of Regional LN Surgery field. | 2008 |
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20081013 | First course treatment--Prostate: If a patient has a prostatectomy and the margins are positive, then several months later radiation is given because the PSA levels never decreased or have risen, is the radiation coded as first course of treatment or subsequent treatment? |
Record the radiation as first course of treatment even though it was delayed for several months. Radiation is highly effective when there is a small or microscopic amount of tissue left at the margin following prostatectomy. In most regions, radiation therapy is the standard of care for positive margins at prostatectomy. |
2008 | |
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20081123 | Reportability--Brain: Is angiocentric glioma, WHO grade 1 of the right frontal lobe reportable? If so, how is histology to be coded? | Angiocentric glioma is reportable. The best histology code currently available is 9380/1 [glioma, NOS; uncertain behavior]. According to the WHO Classification of Central Nervous System Tumours, Angiocentric glioma has a behavior of /1. WHO defines it as an epilepsy-associated stable or slowly growing cerebral tumour primarily affecting children and young adults; histopathologicaly characterized by an angiocentric pattern of growth, monomorphous bipolar cells and features of ependymal differentiation. |
2008 |