Multiple Primaries (Pre-2007)--Bladder/Prostatic Urethra: When invasive TCC of the bladder and TCC in-situ of the prostatic urethra are diagnosed at the same time, are they reportable as two primaries? See discussion.
There is no direct extension of tumor from the bladder to the urethra. According to the SEER rules for determining separate primaries, bladder (C67) and urethra (C68) are separate sites. However, it seems that TCC in the bladder and urethra should be reported as a single primary.
For tumors diagnosed prior to 2007:
This is one primary. Mucosal spread of in situ cancer from a hollow organ (bladder) into another hollow organ (prostatic urethra) is coded as a single primary.
This type of mucosal spread of tumor is sometimes referred to as "intramucosal extension" or " in situ component extending to." Mucosal spread can also be expressed as a statement of an invasive component in one organ with adjacent or associated in situ carcinoma in a contiguous organ with the same type of epithelium.
This case represents an invasive bladder tumor with in situ extension to the prostatic urethra. A tumor that is breaking down can be invasive in the center with in situ cancer at its margins. Occasionally, the in situ margin can move into a contiguous organ with the same type of epithelium.
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.
Histology (Pre-2007)--Prostate: What code is used to represent the histology "prostatic duct carcinoma"? See discussion.
Should the histology be coded to duct carcinoma [8500/3] or endometrioid carcinoma [8380/3]? Prostatic duct carcinoma is defined as endometrioid carcinoma; however, sometimes the pathology report describes the histology as being only "prostatic duct carcinoma."
For tumors diagnosed prior to 2007:
If there is no mention of endometrioid carcinoma in the microscopic description, code the Histology field to 8500/3 [duct carcinoma]. If "endometrioid carcinoma" is mentioned in either the final diagnosis or in the microscopic description, code the Histology field to 8380/3 [endometrioid carcinoma].
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.
Multiple Primaries (Pre-2007)--Bladder: Should an invasive malignancy following an in situ malignancy by more than two months be a new primary? Why? See discussion.
Example: An in situ bladder case was diagnosed and treated. Three months later another TURB diagnosed an invasive bladder carcinoma. Is the invasive case reportable to SEER as a new primary?
For tumors diagnosed prior to 2007:
Yes. These are two primaries.
In situ cancers are not included in SEER incidence rates. Incidence rates must correlate with mortality rates.
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 Fields--Lymphoma: Was MALT Lymphoma [9715/3 (ICD-O-2) and 9699/3 (ICD-O-3)] inadvertently excluded from SEER EOD manual, top of page 180?
For cases diagnosed 1998-2003:
Yes. Use the scheme on page 180 for MALT lymphoma. The ICD-O-2 morphology code 9715 was omitted in error. It should have been added when the EOD was printed in 1998.
1) If Van Nuys nuclear grade 2 is the only grade given for an in situ breast primary, would it be coded as a 3-component system (e.g., 2/3 = 3)?
2) Is there a way of determining grade if only the total Van Nuys Prognostic index score is given (e.g., score 7/9)?
1. Code Van Nuys grade 2 as code 2 [Grade 2] in the Grade, Differentiation field.
2. Code Van Nuys score of 7 as 9 [Cell type not determined, not stated or not applicable] in the Grade, Differentiation field.
Currently, there is no conversion from the total Van Nuys score to grade because "grade" represents only one of the three Van Nuys factors that make up the total score. The other factors are tumor size and margin. The grade represents from 1 to 3 points within the total Van Nuys score. The total score can be between 3 and 9.
Surgery of Primary Site--Skin: For skin primaries diagnosed 1998-2002, what is the difference between code 40 [Wide excision or re-excision of lesion or minor (local) amputation, NOS] and 50 [Radical excision of a lesion, NOS]?
Codes 40 and 50 are not in the scheme for 2003 forward. See history for coding cases diagnosed 1998-2002.
Scope of Regional Lymph Node Surgery/EOD Fields: When a patient has two simultaneously diagnosed primaries, and a regional lymph node dissection intended for one of the primaries removes nodes that are also regional for the other primary, is the information from the lymph node dissection coded for both primaries?
For cases diagnosed 1998-2003:
If the lymph nodes are negative, the status of nodes that are regional for both sites would be used to code the EOD and Site-Specific Surgery fields for both sites.
If any of the lymph nodes are positive use the histology from the lymph nodes to determine how the EOD and Site-Specific Surgery will be coded. For example: If prostate cancer is an incidental finding when a cystoprostatectomy and pelvic lymph node dissection are done to treat a bladder cancer, and all of the positive lymph nodes reflect the histology of the prostate primary (adenocarcinoma), code the nodes as positive for the prostate primary and negative for the bladder primary.
Reportability--Myelodysplastic Syndrome: How we handle cases of myelodysplastic syndromes identified in 2001 casefinding documents that are determined to have an "unknown diagnosis" date after review of the patient's hospital medical record?
Myelodysplastic syndrome cases with unknown dates of diagnosis identified in pre-2001 casefinding documents should not be accessioned and are not SEER reportable.
For cases identified in 2001 casefinding documents, when the diagnosis date cannot be confirmed using the medical records typically accessed by the registrar or central registry staff, do not accession these cases; they are not SEER reportable. This default applies only to those cases identified in 2001 casefinding documents.
For cases identified in 2002 or later casefinding documents, the attending physician should be contacted and asked to clarify the diagnosis date for cases identified with unknown dates of diagnosis. Clarifying the diagnosis date is necessary to determine whether the case is reportable and whether it should be accessioned.
EOD-Size of Primary Tumor--Corpus Uteri: If both the width and depth of the tumor are provided, do we code the largest dimension in the tumor size field? If the width dimension is not provided, can we code the depth of the tumor in the tumor size field? See discussion.
Example: An endometrial primary is described as having, "a soft lobulated tumor diffusely involving the entire endometrium, extending 2.0 cm into the myometrium."
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 999 [unknown] for this case because this field is supposed to reflect the dimension for tumor width and not tumor depth. Tumor depth is coded in the EOD-Extension field.
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