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Report Produced: 10/01/2024 07:20 AM

Report Question ID Question Discussion Answer Year
20091122 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. 2009
20091046 CS Lymph Nodes/CS Site Specific Factor--Melanoma: When CS Lymph Nodes is coded 13, 14 or 15 (codes used when satellite nodule(s) or in-transit metastases are present), why must CS SSF 3 be coded 000 (No lymph node metastasis)? See Discussion.

3/11/05 Consult - PE: huge exophytic lesion right lower leg (mushroom-type lesion), 6cm. Below that lesion is another ulcerative lesion 2cm. Right upper arm lesion w/ satellite nodule. Note from physician states malignant melanoma on right lower leg metastatic to the left arm/shoulder. No scans done so there is no assessment of the lymph nodes.

We coded CS LNS to 13, which captures the satellite nodule, CS SSF3 = 999 and CS Reg Nodes Eval = 0. SEER Edit 216 requires the SSF3 to be 000. SSF 3 is coded 999 as there is no information about the clinical status of lymph nodes.

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.When CS lymph nodes is coded 13-15, SSF 3 must be coded 000. Follow the instruction in the SSF 3 Note: Use code 000, No lymph node metastases, if ... there are satellite nodules or in-transit metastases, but no regional lymph node metastases, i.e., CS Lymph Nodes is coded 13-15.

For this case, assign CS lymph node code 15 [Satellite nodule(s) or in-transit metastases greater than 2cm from primary tumor WITHOUT regional lymph node involvement or involvement of regional nodes not stated]. The arm lesion is more than 2cm from the leg lesion.

 2009
20091095 CS Site Specific Factor--Prostate: Please clarify how SEER registries should use code 040 for Site-Specific Factor 3 on prostate cases. See Discussion. The 6/11/09 NAACCR Webinar on prostate cancer pointed out that SSF 3 code 040 refers the registrar to Note 4, which states "when the apical, distal urethral, bladder base, or bladder neck margins are involved and there is no extracapsular extension, use code 040." The webinar went on to say that code 040 ONLY applies to these specific margins, and that if other margins are involved (for example, the 'right lateral margin'), we should not use code 040. Is this consistent with SEER's interpretation of Note 4? Are we to ignore involvement of margins other than those specified in Note 4, and consequently code SSF 3 within the 000-032 range? Would this also apply to code 048 (extracapsular extension and margins involved)?

Yes, SEER agrees. Code SSF3, code 040 per page C-740 of 2007 SEER manual exactly as stated in Note 4. According to the Inquiry and Response System of the CoC, Note 4 lists specific margins that were once thought to have a prognostic impact. Code 040 in SSF3 should be used only when those margins are involved.

Note 4 pertains to code 040, not to code 048.

2009
20091051 MP/H Rules/HistologyCorpus Uteri: How should histology be coded for a "carcinosarcoma with high grade sarcomatous component within a polyp, with greater component of endometrioid carcinoma and foci papillary serous carcinoma within polyp"? For cases diagnosed 2007 or later, assign code 8980/3 [Carcinosarcoma] according to rule H17. Rule H12 does not apply since the final diagnosis is not "adenocarcinoma." 2009
20091105

Multiple Primaries--Hematopoietic: How many primaries and which histologies should be reported for a case presenting with a 2005 diagnosis of CLL/SLL, 2006 clinical diagnosis of MDS and a 2008 diagnosis of AML? See Discussion.

2005 diagnosis of CLL/SLL (9670) with lymph node involvement, treated with FCR. 2006 clinical diagnosis of MDS secondary to chemo (9987) with CLL/SLL in remission. 2008 biopsy reveals AML (9861). Per Seer Hematopoietic Table, 9987 & 9861 are a single primary. In 6/2008 patient receives bone marrow transplant. 2009 status post BMT, BM biopsy reveals RAEB-1 (9983). Is this still the same disease process or a new primary (since status post BMT)?

For cases diagnosed prior to 1/1/2010:Two primaries should be abstracted. Using the Definitions of Single and Subsequent Primaries for Hematologic Malignancies table, compare 9670 (SLL) in 2005 and 9987 (MDS secondary to chemo) in 2006. This is two primaries.

MDS can transform to AML. On the Definitions of Single and Subsequent Primaries for Hematologic Malignancies table, 9987 (MDS) and 9861 (AML) are a single primary. The AML would be documented in follow-up. (While 9670/SLL and 9861/AML are two different primaries, the SLL has already been reported.)

RAEB is a form of MDS. On the Definitions of Single and Subsequent Primaries for Hematologic Malignancies table, 9987 (MDS) and 9983 (RAEB) are a single primary. The RAEB would be documented in follow-up. (While 9670/SLL and 9983/RAEB are two different primaries, the SLL has already been reported.)

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.

 2009
20091111 Grade--Breast: How is this field coded for an "invasive ductal carcinoma, well differentiated, low nuclear grade"? Assign code 1 [Grade 1, well differentiated]. Use the table in the 2007 SEER Manual on page C-607. Both "low grade" and "well differentiated" are coded 1 in the grade field. 2009
20091006

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.

2009
20091055 Date therapy initiated/Systemic/Surgery Sequence--Breast: How are these fields coded when a patient has chemotherapy after a sentinel lymph node biopsy and has a lumpectomy after completing chemotherapy? See Discussion. On 4-10-08 a patient underwent sentinel lymph node biopsies. This was followed by chemotherapy which started on 4-15-08. The patient subsequently underwent a lumpectomy on 11-10-2008.

For this case, code Date Therapy Initiated to the date of the sentinel lymph node biopsy [04102008]. Assign code 3 [Systemic therapy after surgery] in Systemic/Surgery Sequence.

2009
20091054

First course treatment--Liver: Is planned therapy second course therapy if it is administered after documented progression of disease? See Discussion.

A patient with hepatocellular carcinoma of the liver is waiting for a planned liver transplant. During the waiting period, a CT showed an increase in the liver nodule. The physician performed a bridging chemoembolization. Later on, the patient received a liver transplant. Is the liver transplant still first course treatment? Is the chemoembolization part of first course therapy? Per the SEER manual, first course therapy ends when the treatment plan is completed.

In this case, neither the chemoembolization nor the liver transplant is part of the first course of therapy. The documented treatment plan was changed after disease progression. Chemoembolization was not part of the original treatment plan. First course therapy ends at this point.

 2009
20091041

CS Lymph Nodes--Ovary: Are positive lymph nodes removed from "colon tissue" during a modified posterior pelvic debulking regional or distant? If regional, what is the appropriate CS LN code?

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.Pericolonic lymph nodes are "regional" lymph nodes for an ovarian primary. If you do not have enough information to assign codes 12-30, assign code 50 [Regional lymph nodes, NOS].

 2009