Report | Question ID | Question | Discussion | Answer | Year |
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20081008 | Surgery of Primary Site--Breast: How is this field coded when a re-excision follows a prior mastectomy? | Code the most extensive surgery in Surgery of Primary Site. This is a cumulative field. Assign the appropriate code including all surgeries of the primary site performed during the first course of treatment. The correct code for mastectomy followed by re-excision will depend on the extent of the re-excision. For example, if the re-excision removed muscle, code radical mastectomy. |
2008 | |
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20081136 | CS Extension--Corpus uteri: Can a suspicious cytology be used to code extension? See Discussion. | Endometrial primary confirmed by biopsy on 10/26/06. Pelvic washing on 11/14/06 was 'suspicious for malignancy.' Resection path the same day stated the primary tumor invades the inner 1/3 of the myometrium.
Can we use the pelvic washing cytology & code CS extension 61 or should CS extension be coded 12? |
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 extension code 61 [cancer cells in peritoneal washings] for the case described above. "Suspicious" is listed as a term indicating involvement. There is no exception noted for cytology reports. See page 122 of the 2007 SEER manual. |
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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20081114 | Reportability--Brain and CNS: Is hygroma reportable? See Discussion. |
Benign brain guidelines indicate that named tumors that have been assigned an ICD-O-3 code are reportable. However, per I&R: "Most cystic hygromas (9173/0) are fetal malformations and occur in patients less than two years old. If this patient was an adult, they are primarily treated with surgery. Hygroma (used in a general sense) is a response to trauma (i.e., subdural hematoma) and as such, is not a "new growth" and would not be reportable either as a cyst or as a neoplasm. Unless the patient had some sort of operation, I'd hesitate to include the case as a reportable benign tumor." How is the cancer registrar to distinguish between reportable and non-reportable hygromas? Example: Brain MRI showed diffuse cerebral volume loss and incidental bilateral frontal subdural hygromas (histology code 9173/0). Reference: I&R 14825 |
Hygromas are not reportable. This instruction will be added to the next revision of the benign brain rules. According to an expert in the field, hygromas are not neoplastic. Hygromas are cystic dilations of a localized subarachnoid or subdural accumulation of clear fluid related to an excess accumulation of CSF, typically related to an old hemorrhage that somehow prevents reabsorption of CSF. |
2008 |
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20081113 | Reportability--Brain and CNS: Is a cavernoma reportable as a benign brain tumor? See Discussion. |
Cavernous hemangiomas are typically described as vascular malformations in the brain. Per a search of the literature, cavernoma, cavernous hemangioma and cavernous malformation are all synonymous. There is some controversy as to whether cavernomas are vascular malformations or tumors. Cavernous hemangioma (9121/0) has been assigned a code in the ICD-O-3. The other terms are not even listed. Benign brain guidelines indicate that named tumors that have been assigned an ICD-O-3 code are reportable. Would we report a lesion that is labeled cavernous hemangioma but not one that is labeled carvernoma? Are cavernous malformations of the brain to be reported as benign brain tumors? The MP/H guidelines for benign brain tumors do not include blood vessel tumors in chart 1. Are the following tumors reportable? If so, what is the primary site? Example 1: Patient admitted for resection. Clinical diagnosis is left temporal cavernous hemangioma. Path diagnosis is cerebral cortex and white matter showing cavernoma. Example 2: Patient admitted for resection with clinical diagnosis of parietal cavernous hemangioma. Path shows A-V malformation. Example 3: Patient had T4 spinal tumor removed. Path showed cavernous angioma. Reference: I&R 18109 and 23460 |
Cavernoma is a reportable benign brain tumor. According to our pathologist consultant, cavernoma is synonymous with cavernous hemangioma. Examples 1. Reportable. Primary site - C710 [cerebrum] 2. Not reportable. Path dx disproves clinical diagnosis. 3. Not reportable. Not a brain tumor. |
2008 |
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20081115 | CS Extension--Brain and CNS: How is this field coded for a malignant tumor presenting as a confluent lesion over right parietal, posterior frontal and thalamic regions? | 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 CS extension code 40 [Tumor crosses the midline; Tumor involves contralateral hemisphere; Tumor involves corpus callosum (including splenium)] The thalamus is located between the corpus callosum and the cerebellum and brain stem. A supratentorial tumor extending to the thalamus involves the corpus callosum (extension code 40) but has not yet reached the cerebellum or brain stem. Code 40 applies, but code 50 or any higher code is not applicable in this case. |
2008 | |
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20081100 | MP/H Rules/Histology--Rectum: When not specifically mentioned as part of the histology, is the adenoma a second histologic type, or just a further physical description of the tumor? See Discussion. |
Rectal tumor resection (APR) path report final dx: "mucinous carcinoma, see comment". The comment is the CAP-format tumor summary, which states "histologic type: adenocarcinoma with extensive mucin production (mucinous or colloid carcinoma). Additional pathologic findings: adenomas - tumor arises in a tubulovillous adenoma". If you follow the rules and only use the final dx, you would code a different histology than if you use the 'additional path findings.' |
For cases diagnosed 2007 or later Other Sites histology rule H12 applies in this case. Assign histology code 8263 [adenocarcinoma in tubulovillous adenoma]. Use information from the CAP protocol and from comments associated with the final diagnosis to code histology. The fact that the malignancy arose in a polyp can be taken from anywhere in the medical record; not limited to the final diagnosis. Based on the information provided for this case, the histology is adenocarcinoma with extensive mucin production (mucinous or colloid carcinoma) arising in a tubulovillous adenoma. |
2008 |
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20081017 | Ambiguous terminology/Reportability--Leukemia: Is a 'suspicious peripheral blood smear' the same as a suspicious cytology? See Discussion. | The final diagnosis on the path report for a peripheral blood smear is stated to be "suspicious for malignancy." The microscopic description states that the "lymphoid population raises the concern of chronic lymphocytic leukemia." Nothing further was done. Is this a reportable case? If so, should it be coded as a leukemia or a malignancy NOS? | For cases diagnosed prior to 1/1/2010:Do not accession a leukemia case based only on a "suspicious" peripheral blood smear. If a confirmed diagnosis, clinical confirmation or further information becomes available later, accession the case at that time. 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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20081077 | MP/H Rules--Ovary: How do you code histology for a diagnosis of "clear cell CA, predominately cystic." | For cases diagnosed 2007 or later, assign histology code 8310 [Clear cell carcinoma]. Cystic describes the appearance of the tumor. Clear cell is the histologic type. Code clear cell carcinoma 8310/3. Rule H11 applies. | 2008 | |
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20081004 | First course treatment/Histology--Lymphoma: What treatment, if any, is coded for a patient with methotrexate induced lymphoma when the treatment plan is to take the patient off methotrexate? Also, is there a specific histology for drug induced lymphoma? See Discussion. | Diffuse Large B-cell Lymphoma of soft palate & nasal septum, methotrexate induced, in 5/07. Patient was taken off methotrexate with complete resolution of disease. No other treatment was given. Patient was on methotrexate for treatment of rheumatoid arthritis. | For cases diagnosed prior to 1/1/2010:Treatment: Code the treatment fields to 00 [not done] in this case. Document the discontinuation of methotrexate for rheumatoid arthritis in a text field. Histology: Assign code 9680/36 [Malignant lymphoma, large B-cell, diffuse, NOS]. There is no specific histology code for therapy-related lymphoma. 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 |