Report | Question ID | Question | Discussion | Answer | Year |
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20091130 | MP/H Rules/Histology--Breast: What is the correct histology code and MP/H rule used for 1) infiltrating ductal carcinoma, mucinous type and 2) infiltrating ductal carcinoma with features of tubular carcinoma? See Discussion. |
There is confusion as to which rule applies. Should the histologies be coded to 8480/3 [mucinous adenocarcinoma] and 8211/3 [tubular adenocarcinoma] respectively per rule H12? Rule H12 states to code the most specific histologic term; "type" and "with features of" are used in the pathologic diagnosis and are both terms that can be used to code the specific histology. Or would the histology be coded 8523 for both examples per rule H17 because neither histologic codes 8480/3 or 8211/3 are included as examples of duct carcinomas, nor are they included in Table 2? |
For cases diagnosed 2007 or later, code 8523 [infiltrating duct mixed with other types of carcinoma] for
1. Infiltrating ductal carcinoma, mucinous type and 2. Infiltrating ductal carcinoma with features of tubular carcinoma
The infiltrating ductal types in Rule H12 are listed (8022, 8035, 8501-8508) and do not include mucinous or tubular. We cannot use this rule. The first rule that applies to these single tumors is H17, code to 8523. If you look up 8523 in the numerical morphology section of ICD-O-3, you will see similar examples included in the definition of this code. |
2009 |
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20091028 | MP/H Rules/Multiple primaries/Cancer-directed treatment--Lung: Is a 2008 occurrence of non-small cell carcinoma in the left lower lobe following a 1998 occurrence of the same histology in the left lung to be counted as a new primary if the 1998 primary was treated with chemotherapy and/or radiation but not surgery? See Discussion. |
1998 diagnosis on non-small cell carcinoma treated with radiation and chemotherapy. In 2008, there is an abnormality in the LLL with brushings/washings positive for non-small cell carcinoma. According to the MP/H rules, M8 states this would be a new primary. However, in the document titled " Quality Improvement Meeting August 2008," found on the SEER website, it stated that because the patient never had surgery for the initial primary there is no evidence that the patient was ever disease free. Therefore, the occurrence of the latter tumor would not be a new primary (p. 7, "colon"). Does this answer pertain only to surgery or does it apply to any type of treatment? |
For cases diagnosed 2007 or later, the 2007 MP/H rules apply if the 2008 diagnosis is a new tumor. Was there any statement that the patient was free of disease (NED) after the chemo and radiation therapy? (A patient can be disease free without surgery). If there is no statement to the contrary, no mention of metastasis from the 1998 diagnosis, and no mention of disease between 1998 and 2008, follow lung rule M8 and abstract the 2008 diagnosis as a new primary. This lung case differs from the colon case discussed in the document titled "Quality Improvement Meeting August 2008." For the colon case, there was disease in 2003, 2005 and 2007. Based on the information provided, the 2007 diagnosis was not a new tumor because the patient was never free of disease. Therefore, the 2007 diagnosis is not a new primary. The number of reportable primaries was based on disease status over time, and was not based on the type of treatment given for the initial tumor (i.e., surgery or any other treatment modality). |
2009 |
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20091058 | MP/H Rules/Histology--Kidney: How is histology coded when it is described in the pathology report as "Histologic type: Clear cell (conventional) renal cell carcinoma. Percent of sarcomatoid component: 10%"? See Discussion. | MP/H rules for kidney, Table 1 lists both clear cell and sarcomatoid as specific types of renal cell carcinoma. The MP/H terms and definitions for kidney state that clear cell is architecturally diverse. For this case, does the sarcomatoid component represent a subtype of clear cell that has not been assigned an ICD-O code, and thus histology should be coded to 8310? Or does the sarcomatoid component represent a specific type of renal cell carcinoma for which rule H6 would apply? Should histology be coded 8255 for this case? | For cases diagnosed 2007 or later, assign code 8310 [clear cell adenocarcinoma] according to rule H5. Renal cell, clear cell and sarcomatoid are mentioned in the diagnosis. Sarcomatoid is referred to as a component. Component is not one of the terms listed in rule H5 that indicate a more specific type. Ignore sarcomatoid in this case. Use table 1 to identify clear cell as a specific renal cell type. Code the specific type (clear cell) according to rule H5. | 2009 |
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20091042 | Multiple primaries--Hematopoietic, NOS: How many primaries should be coded when a patient has multiple occurrences of plasmacytoma followed by a diagnosis of multiple myeloma? See Discussion. | Example: Patient had a diagnosis on February 2003, plasmacytoma of the sinus; June 2003, plasmacytoma of the alveolar ridge; July 2003, plasmacytoma of the skin; and June 2004, multiple myeloma.
If this represents a transformation of plasmacytomas to multiple myeloma, will the information on multiple myeloma be available for statistical and research purposes? |
For cases diagnosed prior to 1/1/2010:Accession this case as plasmacytoma diagnosed in Feb. 2003. Each of the subsequent diagnoses are not abstracted as new primaries. They are the "same," one primary only, according to the Definition of Single and Subsequent Primaries for Hematologic Malignancies (the tri-fold heme table). The 2003 diagnosis is a classic example of extraosseous plasmacytoma (9734/3). Plasmacytoma and multiple myeloma would be two primaries in the new hematopoietic rules taking effect in 2010. 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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20091123 | Reportability: Is a tumor reportable if the pathology report indicates a non-reportable diagnosis at the time the specimen is removed but subsequent clinical statements state the patient had a reportable tumor? See Discussion. |
The 2007 SEER Manual (page 3) states that cases diagnosed clinically are reportable. Exception 2 states if enough time has passed that it is reasonable to assume the physician has seen the negative pathology report, but the clinician continues to call this a reportable disease, accession the case. SEER reporting guidelines state that severe dysplasia is not reportable, however, many clinicians regard it to be equivalent to carcinoma in situ. Example 1: In 09-2007 the pathology report for excisional biopsy of right floor of mouth states the final diagnosis is severe dysplasia. At the time, the case is not accessioned based on non-reportable pathology. Patient is subsequently admitted in 3-09. According to the clinical history the patient was diagnosed with squamous cell carcinoma in 2007 and treated with laser. Is this reportable? If yes, how is behavior to be coded? How is "Ambiguous Terminology at Diagnosis" to be coded? Example 2: In 2-08, the pathology report for a punch biopsy of a skin lesion states the final diagnosis is atypical melanocytic hyperplasia. In 3-08, patient is admitted for re-excision. The clinical diagnosis states re-excision being done for melanoma in situ. Reference: SINQ 20061123 |
A tumor that is non-reportable based on the pathology report diagnosis should not be accessioned if later clinician statements mistakenly refer to it as a reportable tumor. The exception in the 2007 SEER manual on page 3 is intended to allow the registrar to accession a case when the clinician actually disagrees with the pathology report and clinically diagnoses a reportable tumor. |
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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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. |
2009 | |
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20091089 | Histology--Hematopoietic: How is histology coded for a "chronic lymphocytic leukemia with plasmacytic differentiation"? | For cases diagnosed prior to 1/1/2010:Assign histology code 9823/3 [Chronic lymphocytic leukemia]. Plasmacytic differentiation does not indicate a plasma cell or plasmacytic leukemia. 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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20091032 | Surgery of Primary Site--Ovary: How should this field be coded for an ovarian primary when there is a BSO and only the fundus of uterus is removed (not a full hysterectomy)? | Assign surgery code 52 [Bilateral (salpingo-) oophorectomy; WITH hysterectomy]. Code 52 does not exclude a partial hysterectomy. | 2009 | |
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20091016 | CS Extension--Pancreas: How do you code this field for a head of pancreas primary with involvement of portal and splenic veins? See Discussion. | The splenic artery/vein is only mentioned in the body and tail scheme; no mention is made of this site in the pancreatic head scheme. | 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 54 [major blood vessels]. The portal vein is listed under code 54 for head of pancreas. The splenic vein branches from the portal vein. |
2009 |