MP/H Rules/Histology--Ovary: How is histology coded for "serous carcinoma, papillary invasive pattern"?
For cases diagnosed 2007 or later, code the histology 8441/3 [Serous carcinoma, NOS]. Use the Other Sites rules. Start with rule H8 and stop at rule H11. "Pattern" is not one of the terms used to identify a specific type (See H16), so papillary is ignored.
CS Extension--Extramedullary Plasmacytoma: Under what circumstance would CS extension code 80 be used in a case of extramedullary plasmacytoma?
For cases diagnosed prior to 1/1/2010, 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 80 [Systemic disease] for extramedullary plasmacytoma involving more than one site. Use code 80 when extramedullary plasmacytoma is NOT single, solitary, unifocal, isolated, mono-ostotic or localized. Code 80 can also be used when the bone marrow is involved but the plasma cells are <10%.
Do not apply EOD instructions to CS.
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/Multiple primaries-Brain: Does a glioblastoma multiforme following a low grade glioma (oligodendroglioma) represent a new primary? See Discussion.
In 2/08 patient underwent resection of tumor of right frontal lobe. Path diagnosis showed a low grade glioma, favor low grade oligodendroglioma (WHO grade II). In 02/09 biopsy of a left thalamic mass showed glioblastoma mutiforme. Per rule M6 glioblastoma multiforme following a glial tumor is a single primary. Per path diagnosis, the first tumor represented a low grade glioma. However, oligodendroglioma is not on the glial branch of chart 1 in the MP/H rules.
For cases diagnosed 2007 or later, glioblastoma multiforme following oligodendroglioma are multiple primaries according to rule M8. Rule M6 does not apply. M6 applies only to glial tumors as listed in chart 1. Chart 1 is based on the WHO classification. The WHO classification separates oligodendroglial tumors from glial tumors.
MP/H Rules/Multiple primaries--Brain: Does a patient diagnosed with anaplastic astrocytoma of the left temporal lobe in 2000 followed by a diagnosis of oligoastrocytoma of the right frontal lobe in 2007 have a single primary per rule M7 or multiple primaries per rule M8? See Discussion.
MP/H rule M7 states that tumors with ICD-O-3 histologies on the same branch in chart 1 are a single primary. Chart 1 shows that both of the histologies for our sample case are located on the glial branch. However, the glial tumor branch has three secondary branches. Does rule M7 apply to secondary branches? Anaplastic astrocytoma [9402] is classified under the secondary branch for astrocytic tumors. Oligoastrocytoma [9382] is classified under the secondary branch for mixed glioma. Does rule M7 or does rule M8 apply for this case? Does this case represent one or two primaries?
For cases diagnosed 2007 or later, Rule M8 applies. There are two primaries.
Anaplastic astrocytoma and oligoastrocytoma (mixed glioma) are on separate branches in Chart 1. They are both gliomas, but one is a mixed glioma and the other is an astrocytic tumor.
Primary site--Bladder: What is the correct subsite for "interureteric ridge"? See Discussion.
Description: 4 mm nodule at base of bladder near interureteric ridge.
For this case, assign code C670 [Trigone of bladder]. The description for this case states that the tumor location is the base of the bladder. Base is a synonym for trigone.
The interureteric ridge (or interureteric crest, or interureteric fold) is a fold of mucous membrane extending accross the bladder between the two ureteric orifices. The trigone is located below the interureteric ridge.
MP/H Rules/Histology--Breast: What histology is coded for a tumor diagnosed as "intraductal papillary carcinoma (neuroendocrine differentiation)"? See Discussion.
Final diagnosis states: Right breast, excisional bx with findings most consistent with intraductal papillary carcinoma (neuroendocrine DCIS). The path micro states: the morphologic features are those of a neuroendrocrine-type tumor & IHC stains confirm neuroendocrine differentiation.
For cases diagnosed 2007 or later, assign code 8503/2 [Intraductal papillary carcinoma] using Breast rule H2. Code the histology from the final diagnosis.
There is no code for neuroendocrine DCIS in ICD-O-3.
CS Tumor Size/CS Site Specific Factor--Breast: When tumor size is unknown, but it is known that both in situ and invasive components are present, how should CS Tumor Size and SSF6 be coded? See Discussion.
We coded CS Tumor Size 990 and SSF 6 to 060 for a case in which no tumor size was mentioned and the breast core biopsy identified microinvasive infiltrating lobular carcinoma and lobular carcinoma insitu. The lumpectomy identified no residual tumor. SEER edit 218 states we must have CS Tumor Size as 999 if the CS SSF 6 is 060. Yet the tumor size code of 990 (Microinvasion; microscopic focus or foci only, no size given; described as less than 1 mm) would more accurately reflect this case. Even in a situation where there was microinvasion described as less than 1mm, the edit will not allow one to code CS Tumor Size to 990 with the CS SSF 6 as 060. Should these types of cases have CS Tumor Size coded 999 or should the edit be adjusted to allow for this combination?
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.Code CS tumor size 990 [Microinvasion; microscopic focus or foci only, no size given; described as less than 1 mm] and CS SSF6 050 [Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated AND proportions of in situ and invasive not known].
This combination of codes captures the information available for this case.
Primary site--Lung: What primary site code is used for bronchus intermedius?
Assign code C340 [main bronchus].
The bronchus intermedius is the lower part of the main bronchus on the right side. The bronchus intermedius begins just below the point where the upper lobe bronchus branches off from the main bronchus. The bronchus intermedius branches into the middle lobe bronchus and the lower lobe bronchus.
MP/H Rules/Multiple primaries--Brain and CNS: How many primaries are to be accessioned for a patient with Neurofibromatosis 2 (NF2) who presents with meningiomas on the left and right side of the brain and multiple meningiomas of the spinal cord? See Discussion.
We have a patient with NF2 who also has meningiomas diagnosed on the left and right side of the brain as well as multiple meningiomas of the spinal cord. Are the meningiomas all one primary (separate from the NF2): C70.9 and 9530/1?
For cases diagnosed 2007 or later, this is four primaries.
Report NF2 because it occurs with reportable neoplasms. Note: Report NF only once per patient.
Per MP/H Benign CNS Rule M4, the meningiomas of the meninges/brain (C70.0) and meninges/CNS (C70.1) are multiple primaries. Code the meningiomas of the spine to the histology to 9530/1 [Multiple meningiomas] (Rule H6) because there are multiple tumors in the spine.
Per Rule M5, the meningiomas of the right and left side of the brain are multiple primaries. Code of each to the histology 9530/0 [Meningioma, NOS] per Rule H2 because they are separate primaries (assuming there is one tumor on each side of the brain).
Reportability--Anal canal: Are squamous cell carcinomas arising in a condyloma of the rectum reportable or should we assume that the site is skin of anus or perianal area and not reportable?
Squamous cell carcinoma arising in a rectal condyloma is reportable. Do not assume the site is skin of anus or perianal.
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