Report | Question ID | Question | Discussion | Answer | Year |
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20091090 | First course treatment--Leukemia: How should an allogeneic stem cell transplant for acute myeloid leukemia be coded in the Hematologic Transplant and Endocrine Procedures field? See Discussion. | There is debate as to whether this procedure should be coded as a 12 in order to capture the allogeneic part of the procedure. | Assign code 20 [Stem cell harvest (stem cell transplant) and infusion as first course therapy] for stem cell procedures, even allogeneic procedures. | 2009 |
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20091043 | Multiple primaries--Lymphoma: Should a second primary lymphoma be accessioned if the reporting hospital disagrees with the final diagnosis stated on a review of slides? See Discussion. |
Example: Patient had an original diagnosis of small lymphocytic lymphoma (9670/3) of lung in 1986 and later presents with small B-cell non-Hodgkin lymphoma (9670/3) of small bowel in 2008 at Hospital A. Slides sent for review at Hospital B where patient was also seen. Slides there read as low grade B-cell lymphoma most consistent with extranodal marginal B-cell lymphoma of mucosal associated tissue (MALT Lymphoma). Hospital A's pathology report stated that immunostains would exclude mantle cell lymphoma and MALT lymphoma and the original pathology report has not been amended to match the outside path diagnosis. Is thisĀ a second primary of MALT lymphoma (9699)? |
For cases diagnosed prior to 1/1/2010:The 2008 diagnosis is not a new primary according to the Definitions of Single and Subsequent Primaries for Hematologic Malignancies (the tri-fold heme table) using the pathology report diagnosis from the facility where the procedure was performed (Hospital A). Since Hospital A disagreed with the slide review and did not amend their diagnosis based on the slide review, do not use the slide review diagnosis in this case. 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 |
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20091053 | Multiple Primaries--Breast: How many primaries should be reported when a lobular carcinoma with positive margins is followed 8 years later by a lobular carcinoma near the previous lumpectomy site? See Discussion. |
Left breast invasive lobular ca diagnosed 3/00 and treated with a lumpectomy, but with multiple positive margins; she received no post operative radiation or other medical treatment (unknown why). 10/08 core biopsy of "an area of distortion" near the scar site is positive for invasive lobular ca. The radiologist states "compatible with recurrence at her previous lumpectomy site" on an x-ray report. One thought is that this should not be a new primary because the patient was never disease free (multiple positive margins) and the patient received incomplete treatment. Or should this be a new primary because the tumors are diagnosed more that 5 years apart? |
Abstract the 10/08 diagnosis as a new primary, per Breast rule M5. In spite of the positive margins and apparently incomplete treatment in 3/00, there is no mention of the presence of disease between 3/00 and 10/08 according to the information provided. |
2009 |
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20091094 | 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. | 2009 | |
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20091039 | CS Tumor Size--Lung:. Does code 997 (diffuse, entire lobe) for lung and main stem bronchus take precedence over a stated tumor size? See Discussion. | Per SPCSM 2007 'Coding Instructions for CS Staging Data Items-CS Tumor Size' item 5c states that code 998 (diffuse, entire lung) for lung and main stem bronchus takes precedence over any mention of size. Does this apply to code 997 as well? | 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 the stated tumor size rather than 997. Code 997 does not take precedence over tumor size at this time. According to CoC, the instructions in the CS Manual, Part I-27, rule 5c are to alert the user to special circumstances. Code 997 is not included because it is not diffuse for all of the sites listed. The site-specific rules and codes in the schema always take precedence. Further instructions and clarifications will be added to the lung schema, CS Manual Part II-317 in the next version of CS. |
2009 |
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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 | |
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20091010 | MP/H Rules/Histology--Breast: What histology is coded when a final diagnosis on a lumpectomy specimen states "adenocarcinoma" but the regional lymph nodes show "poorly differentiated adenocarcinoma with signet ring differentiation"? See Discussion. | 3/23 left breast mass bx: infiltrating lobular carcinoma. 6/22 left breast lumpectomy: infiltrating adenocarcinoma; sentinel lymph nodes with metastatic poorly differentiated adenocarcinoma with signet ring differentiation. Axillary resection with poorly differentiated metastasis in 8/9 nodes. The path micro states: tissue consists of sections of breast tissue having an infiltrating ca which in some areas infiltrates as small duct-like structures, and in other areas as small gland-like structures. In addition, there are foci in which the cells infiltrate in a single file fashion. In a few areas, cells having a signet ring appearance similar to those seen in the lymph nodes are encountered. In other areas, the signet ring appearance is not prominent. Areas of ductal or lobular ca in situ are not identified (the lymph node resection specimen shows 'signet ring appearance in some areas but no ductlike or tubular structures observed')
The comment on the lumpectomy path states: 'This is an unusual tumor in that it has histologic characteristics in varying areas, which would be consistent with infiltrating ductal carcinoma, infiltrating lobular carcinoma, tubular carcinoma or signet ring cell carcinoma. The metastatic material (8/9 total axillary lymph nodes) is most consistent with the poorly differentiated signet ring type portion of the tumor undergoing metastasis.' |
For cases diagnosed 2007 or later: Code the histology 8140 [Adenocarcinoma, NOS] using Breast rule H14. Code the histology from the final diagnosis on the pathology report of the most representative specimen (the lumpectomy in this case). Do not code histology from the microscopic description. Code the histology from the primary site whenever available, not the metastatic site.
Comments on pathology reports can be used to code histology. However, in this case the final diagnosis is more definitive than the comments. The comment provides several choices and none of these appear in the final diagnosis; an indication that the pathologist was not able to clearly identify a more specific type in this case. |
2009 |
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20091045 | 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. |
2009 |
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20091057 | CS Site Specific Factor--Lymphoma: Can the term "intermediate risk" be used to code IPI score? See Discussion. | Patient has Hodgkin disease. The physician states that the patient has bulky stage IIA intermediate risk disease. Is the term "risk" another way of stating IPI score? If so, how would intermediate risk be coded? | 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 SSF 3 for lymphoma based on the IPI score stated in the record. Do not attempt to interpret statements or terms in order to assign a code to SSF 3. If no further information is available for this case, code SSF 3 999 [Unknown]. |
2009 |
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20091023 | Sugery of Primary Site--Breast: When a patient is simultaneously diagnosed with bilateral breast cancer and bilateral mastectomies are done, do you code the total mastectomies to 40 or 41 or 42? | Abstract cancer of the left breast and cancer of the right breast as separate primaries. Code the surgery for each primary independent of the other primary. For the first primary, assign code 41 [Total (simple) mastectomy, NOS WITHOUT removal of uninvolved contralateral breast]. For the second primary, assign the code for the procedure performed on that site. |
2009 |