Radiation Therapy--Breast: If hospital records indicate that a mammocyte intracavitary radiation therapy device was placed in the breast, but there is no follow-up documentation of radiation actually being given, should we code radiation 2 (implants) or 8 (recommended, unknown if given)?
Assign code 8 [recommended, unknown if administered]. Check this case periodically, and others coded 8. Update if further information becomes available.
MP/H Rules--Corpus uteri: How is histology coded for an endometrial tumor described as an "endometrioid adenocarcinoma with prominent squamous metaplasia"?
For cases diagnosed 2007 or later:
Endometrioid adenocarcinoma with squamous metaplasia is coded 8570 [Adenocarcinoma with squamous metaplasia]. This falls under the Histology Coding Rules for Other Sites, rule H17. The code for Endometroid adenocarcinoma is 8380. The code for Adenocarcinoma with squamous metaplasia is 8570. The histology with the numerically higher ICD-O-3 code is Adenocarcinoma with squamous metaplasia -- 8570.
Histology--Pancreas: What is the correct code for "non-secretory pancreatic endocrine tumor" with positive lymph nodes on excision indicating a malignant tumor? Pathologist indicated it was not an exocrine tumor.
Code as islet cell carcinoma [8150/3].
There are several cell types in the islets, and each produces a different hormone. The custom has been to name the tumors by their hormone production e.g. insulinoma, glucagonoma, etc. Occasional tumors do not produce any hormone (at least one that can be determined or measured). These tumors are called non-functioning endocrine tumors. Most of the endocrine tumors in the pancreas are islet cell tumors.
Reportability--Lung: Is carcinoid tumorlet of the lung a reportable disease? See Discussion.
The literature on this is rather ambiguous as to whether these tumorlets (defined as <0.5 cm) are benign, such as atypical hyperplasia, or actual carcinoid tumors.
Carcinoid tumorlets are not reportable. The histology can be similar to typical carcinoids; however, they are <5 mm in diameter and are benign/nonreportable.
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.
MP/H Rules: Does the presence of metastases affect the application of the MP/H rules? See Discussion.
Single lung tumors presenting in each lung but the patient also presents with bone mets? Would rule M6 apply? Or do the bone mets represent additional tumors?
For cases diagnosed 2007 or later, the MP/H rules do not apply to metastases. Ignore metastases when applying the rules.
For the case above, use rule M6 and abstract as two primaries (right lung and left lung). The bone mets are ignored.
Primary site/Histology: Does SEER accept the site/type combination of lymph nodes (C77.0-C77.9) with the histology of either 9823 (B-cell chronic lymphocytic leukemia/small cell lymphocytic lymphoma) or 9827 (Adult T-cell leukemia/lymphoma)? See Discussion.
There is a discrepancy between the SEER Site/Type table and the CS histology codes under Lymph Nodes.
For cases diagnosed prior to 1/1/2010:These are not "impossible" site/histology edits. You can override them. However, if the lymph nodes are involved and a lymphoma histology is available, the lymphoma histology should be coded rather than leukemia histology. For example, assign histology code 9670 (Malignant lymphoma, small B lymphocytic, NOS) instead of 9823 (B-cell chronic lymphocytic leukemia/small cell lymphocytic lymphoma) if the disease is identified in the lymph nodes.
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.
MPH Rules/Behavior--Breast: Would a positive right axillary node following DCIS of the right breast indicate the presence of a new primary? See Discussion.
How would you abstract the information from 2007? A patient with a strong family history of breast cancer had bilateral simple mastectomies in 2000, after a suspicious mammogram. Results showed DCIS in the rt breast; no malignancy in the left breast. Now in 2007, the patient has a right axillary lymph node removed - positive for carcinoma of breast origin. Comment says, "recurrent breast carcinoma in rt axillary node from patient's known history of DCIS." Is this a new primary? Is this a diagnosis date in 2007? Is the site C509 and laterality right side?
For cases diagnosed 2007 or later:
A metastasis was diagnosed in 2007. The 2007 MP/H rules do not apply to metastases.
Change the behavior code of the 2000 diagnosis. The breast cancer diagnosed in 2000 must have been invasive based on the metastasis in 2007.
Reportability/Date of diagnosis--Liver: Does the final diagnosis of a scan have higher priority than the findings in the discussion in the body of the report? See Discussion.
A patient with liver cancer becomes transplant eligible when the tumor is 2 cm in size. Frequently, liver tumors will be watched (no biopsy) for months until they meet the 2 cm size criteria. In the meantime, multiple scans will describe the tumor using variations of ambiguous terms that drift in and out of reportablility. One day the tumor is labeled "presumed hepatocellular carcinoma." Weeks later it is back to "worrisome for hepatoma." A single scan will use different terms in different sections of the report.
Example case: Abdominal CT reveals a 1 cm liver lesion. Per the discussion portion of the scan, the lesion is consistent with hepatocellular carcinoma. Per final diagnosis: 1 cm liver lesion, possibly hepatocellular carcinoma. Is this report diagnostic of cancer? Would the date of this report be the date of diagnosis? (Patient did receive a liver transplant for hepatocellular carcinoma months later.)
When a reportable ambiguous term is used in one part of a report or the medical record and a non-reportable ambiguous term is used in another part of the report or the medical record, accept the reportable term and accession the case.
The example above is reportable. "Consistent with" is a reportable ambiguous term. Accept "consistent with" over the non-reportable term "possibly."
The date of this report would be the date of diagnosis if this is the earliest report using reportable terminology.
MPH rules--Rectum: How is the number of primaries to be determined when a treatment plan has been completed, but it is not possible to determine whether there was a disease-free interval between occurrences? See Discussion.
Patient diagnosed with adenocarcinoma of the rectum in March 2006, underwent chemo and radiation therapy as treatment. Patient seen in April 2007 for surveillance colonoscopy. HPI stated patient underwent chemorad with good results. Colonoscopy showed "persistent" disease. Abdominal perineal resection was done in May 2007. Path showed adenocarcinoma of the rectum.
Keeping in mind that we are not to use a clinical statement for determining recurrences, is the April 2007 occurrence counted as a new primary?
For cases diagnosed 2007 or later:
Do not abstract the 2007 events as a new primary. "Persistent disease" indicates there was never a disease free interval.
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