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20091124 | CS Eval--Lung: How is the CS Reg Nodes Eval field to be coded when the FNA of a paratracheal lymph node is positive for adenocarcinoma and the patient subsequently undergoes neoadjuvant chemoradiation therapy followed by an excision of multiple lymph node fragments that show adenocarcinoma? See Discussion. | The CSv1 scheme for lung shows that code 1 under CS Reg Nodes Eval is a path staging basis. However, the definition for code 1 also states that no regional lymph nodes were removed for examination. Would we use code 1 because the case represents path staging basis? If we select code 5 because regional lymph nodes were dissected, the staging basis would be clinical. If we select code 6, the staging basis would be y. | 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.
Use code "6" for the CS LN evaluation field. As explained on page 113 in the 2007 SEER Manual, when post-operative disease is more extensive despite neoadjuvant therapy, this can be coded in the evaluation field. In this case, only an FNA was done on lymph nodes pre-operatively, but actual lymph nodes were removed and documented in the post-neoadjuvant excision of the lymph nodes which documented that they are histologically positive -- proving that the neoadjuvant therapy did not work. |
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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 |
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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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20091097 | Multiple Primaries--Lymphoma: How many primaries should be abstracted if DLBCL (9680/3) and Mantle Cell Lymphoma (9673/3) occur at the same time in different lymph nodes? How would Sequence be coded if the case is multiple primaries? |
For cases diagnosed prior to 1/1/2010:It is important to note for this case that the two different types of NHL occurred in different lymph nodes; one type in one lymph node and the other type in another lymph node. Use the fold-out table to determine single vs multiple primaries. According to the table, 9673/3 and 9680/3 would be two primaries no matter which of these was "first." Assign the lower sequence number to the primary with the worse prognosis when two primaries are diagnosed simultaneously. Base the prognosis decision on the primary site, histology, and extent of disease for each of the primaries. If there is no difference in prognosis, the sequence numbers may be assigned in any order. 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. |
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20091104 | MP/H Rules/Histology--Esophagus: How is histology coded for a biopsy of the esophagus with a pathologic diagnosis of "adenocarcinoma, intestinal type" when there is no evidence of a gastric tumor in scans or EDG? See Discussion. | There is a rule for colon to disregard "intestinal type" and code to adenocarcinoma (8140) but no rule for esophagus. How should histology for this esophageal case be coded? | For cases diagnosed 2007 or later: Follow MP/H Other Sites Rule H11 and code 8144/3 [Adenocarcinoma, intestinal type]. Adenocarcinoma, intestinal type, is called that because it resembles the normal pattern of adenocarcinoma seen in the large intestines. It is not an indication of the location of the adenocarcinoma. We find that it is not uncommon in the sinuses, stomach, lungs, cervix, and many other organs. |
2009 |
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20091087 | Reportability--Appendix: Is a metastatic low-grade appendiceal mucinous neoplasm reportable if the pathologist states that it is a borderline tumor of the appendix? See Discussion. | Low-grade appendiceal mucinous neoplasm; Lt ovary, cul-de-sac, omentum, and small bowel: Metastatic low-grade appendiceal mucinous neoplasm. Per pathologist this is a borderline tumor of the appendix. | Borderline tumors (other than brain and CNS) are not reportable to SEER. In the case of borderline tumors, the term "metastatic" does not automatically make them reportable. When the "metastatic deposits" are also borderline, the case is not reportable. For this case in particular, the "metastases" are actually (benign) implants and not malignant or invasive mets. | 2009 |
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20091069 | CS Extension--Bladder: How should this field be coded for a high grade urothelial carcinoma with "focal micropapillary features and invasion of lamina propria, with a note stating there is invasive carcinoma focally involving thin muscle bundles...difficult to distinguish whether muscularis propria or muscularis mucosae"? | 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 15 [Invasive tumor confined to subepithelial connective tissue (tunica propria, lamina propria, submucosa, stroma)]. The information provided confirms invasion of the lamina propria (code 15) but is not definitive enough to assign a code higher than 15. |
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20091116 | MP/H Rules/Multiple primaries - - Colon: Is a colon tumor reported as "recurrent at the anastomotic junction" just over one year after the diagnosis of a T4 colon tumor to be counted as a new primary? See Discussion. | MP/H rules do not apply to metastasis. However, it has been our experience that pathologists and clinicians tend to use the terms metastatic and recurrence interchangeably. The term "recurrence" is not limited to a tumor recurrence in the same site as a previous malignancy. Sometimes it is obvious that the clinician is using the term recurrence to describe a metastatic lesion. When a "recurrence" is located in tissue that is very different from the original primary site, it is easy to recognize that the intended meaning of the term is metastasis.
Example: Patient with squamous cell carcinoma of the tongue with recurrence in the lung.
However, when the metastatic deposit occurs in similar tissue, it is more difficult to determine the number of primaries.
Example when the term "recurrence" is ambiguous: In April 2008 patient was diagnosed with adenocarcinoma of the ascending colon. At the time of hemicolectomy the tumor was noted to be plastered into the paraduodenal and peripancreatic area. Patient received one dose of adjuvant chemo and then discontinued treatment. In May 2009 the patient was found to have adenocarcinoma in the transverse colon. Per the pathology report the diagnosis for segmental resection at that time showed colonic adenocarcinoma. Tumor location: tumor appears recurrent at anastomotic junction. Abdominal wall mass showed metastatic adenocarcinoma.
One has to wonder if the pathologist found a metastatic nodule at the anastomotic site and called it "recurrent." It is unlikely that the pathologist will compare this specimen to the previous tumor, having already diagnosed it as "recurrent."
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For cases diagnosed 2007 or later, Rule M4 applies to the example of adenocarcinoma of ascending colon diagnosed in 2008 followed by adenocarcinoma of transverse colon diagnosed in 2009. When a colon resection has taken place, the original primary site is no longer present. A colon resection usually includes a portion of uninvolved colon on either side of the tumor. A tumor diagnosed at the anastomotic junction cannot be located in the same site as the previous tumor. Use of the term "recurrent" in this case is not synonymous with "metastatic." Apply the MP/H rules. | 2009 |
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20091064 | Radiation Sequence with Surgery--Head & Neck: How is this field coded for a tonsil primary diagnosed on 4/16/07 by a regional lymph node FNA when the patient subsequently initiates radiation on 5/8/07 and has a tonsillectomy with neck dissection on 7/30/07? | The best way to handle this situation is to assign code 2 [Radiation before surgery] in Radiation Sequence with Surgery. Code 2 provides the best description of the sequence of events in this case. Radiation was delivered prior to the resection of the primary site. | 2009 | |
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20100067 | MP/H Rules/Reportability--Ovary: Should an ovarian tumor with the histology of mixed epithelial borderline tumor with multiple foci of intraepithelial carcinoma be accessioned based on the presence of a foci of intraepithelial carcinoma? See Discussion. | The final diagnosis on the pathology report, "Omentum: mixed epithelial borderline tumor with multiple foci of intraepithelial carcinoma. Peritoneal fluid for cytology: neoplastic cells present; low grade serous neoplasm. Lymph nodes, right pelvic: one lymph node harboring implants of serous borderline tumor and endosalpingiosis within the subcapsular sinus. Bilateral fallopian tubes and ovaries: mixed epithelial borderline tumor with multiple foci of intraepithelial carcinoma involving ovarian surface and serosal surface of the tube. Detached fragment of borderline tumor within the tubal lumen. Uterus, cervix, and segment of colon: mixed epithelial borderline tumor with multiple foci of intraepithelial carcinoma involving parametrial and paracervical tissue, cul de sac, uterine and colonic serosa. Nine pericolonic lymph nodes negative for tumor. Stage III.
I&R # 45622 asked if a mucinous borderline tumor with intraepithelial carcinoma and focal microinvasion is reportable. The answer given on that site was that the case is not reportable. According to MPH, FORDS, and Collaborative Stage, intraepithelial carcinoma is in situ, behavior code 2, and is reportable. Has this changed? |
This case is reportable because there is a diagnosis of carcinoma (intraepithelial carcinoma). | 2010 |
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