Reportability--Myelodysplastic Syndrome: How we handle cases of myelodysplastic syndromes identified in 2001 casefinding documents that are determined to have an "unknown diagnosis" date after review of the patient's hospital medical record?
Myelodysplastic syndrome cases with unknown dates of diagnosis identified in pre-2001 casefinding documents should not be accessioned and are not SEER reportable.
For cases identified in 2001 casefinding documents, when the diagnosis date cannot be confirmed using the medical records typically accessed by the registrar or central registry staff, do not accession these cases; they are not SEER reportable. This default applies only to those cases identified in 2001 casefinding documents.
For cases identified in 2002 or later casefinding documents, the attending physician should be contacted and asked to clarify the diagnosis date for cases identified with unknown dates of diagnosis. Clarifying the diagnosis date is necessary to determine whether the case is reportable and whether it should be accessioned.
Grade, Differentiation--Bladder: Some pathologists use a two component grade system for bladder carcinomas - either low grade or high grade. Should we continue to code these per SEER rules as grades 2 [low grade] and 4 [high grade]? See discussion.
The AFIP website states that this low grade classification corresponds to grade 1/3, while the high grade corresponds to both grade 2/3 and grade 3/3. Using the 3-grade conversion, this would also classify the low grade as grade 2, but would leave the high grade as a toss-up between grade 3 and grade 4.
Continue to code Grade, Differentiation as specified in the SEER Program Code Manual: "Low grade" is coded to 2 and "high grade" is coded to 4.
Histology--CLL/SLL: If a tissue diagnosis of "small lymphocytic lymphoma" is made six months after an initial blood diagnosis of "chronic lymphocytic leukemia" should the histology be updated from 9823/3 to 9670/3?
For cases diagnosed prior to 1/1/2010:Do not change the histology to small lymphocytic lymphoma (9670/3). The chronic lymphocytic leukemia has advanced/progressed and disseminated into other tissues from the blood during the last six months. If the patient presents with disease in the blood and/or bone marrow only, code to CLL. If a lymph node or other solid tissue is involved initially, code to SLL. For the case cited, the tissue involvement occurred six months after the initial diagnosis and the histology code is not changed to reflect the progression of disease.
For cases diagnosed 2010 forward, 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.
EOD-Lymph Nodes--Breast: Are lymph nodes described as being either "keratin positive" or "keratin positive for metastasis" to be coded as involved lymph nodes?
For cases diagnosed between 1998-2003:
Lymph nodes that are only "keratin positive" would not be coded as involved lymph nodes. The pathologist uses this expression to mean that the nodes stained positive for keratin that does not mean they are also involved with cancer.
However, if the pathologist uses these stains to make a definitive diagnosis of metastatic carcinoma (i.e., uses the expression "keratin positive for metastasis"), then code the nodes as involved.
Scope of Regional Lymph Node Surgery/EOD Fields: When a patient has two simultaneously diagnosed primaries, and a regional lymph node dissection intended for one of the primaries removes nodes that are also regional for the other primary, is the information from the lymph node dissection coded for both primaries?
For cases diagnosed 1998-2003:
If the lymph nodes are negative, the status of nodes that are regional for both sites would be used to code the EOD and Site-Specific Surgery fields for both sites.
If any of the lymph nodes are positive use the histology from the lymph nodes to determine how the EOD and Site-Specific Surgery will be coded. For example: If prostate cancer is an incidental finding when a cystoprostatectomy and pelvic lymph node dissection are done to treat a bladder cancer, and all of the positive lymph nodes reflect the histology of the prostate primary (adenocarcinoma), code the nodes as positive for the prostate primary and negative for the bladder primary.
Histology (Pre-2007): What code is used to represent the histology "adenocarcinoma with abundant mucin production"? See discussion.
If the diagnosis is adenocarcinoma with a mucinous focus, we code as 8140/3. However, when there is abundant mucin production, do we use 8480/3?
See SINQ #20010075: "The tumor must contain at least 50% mucinous, mucin producing, or signet ring to be coded to the specific histology. "
For tumors diagnosed prior to 2007:
Code the Histology field to 8481/3 [mucin-producing adenocarcinoma] if the diagnosis states "adenoca with abundant mucin production". Assume that the term "abundant" represents a term that implies > 50% of the tumor is mucin producing.
When a pathologist makes a diagnosis of mucin-producing adenocarcinoma, the pathologist has determined that more than 50% of the tumor is mucin-producing, so it is unnecessary for the abstractor/coder to look for additional supporting documentation.
If the pathologist states adenocarcinoma "with mucin production," look for a statement about the percentage or amount of mucin production, such as "abundant" or other wording indicating extensive mucin production. If such a statement or wording is present, code 8481/3 [mucin-producing adenocarcinoma]. If not present, code 8140/3 [adenocarcinoma, NOS].
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Date of Diagnosis--Lung: Based on Note 7 in the lung EOD, should the Date of Diagnosis field be coded to an earlier CT scan date with a reported diagnosis of "RUL mass with mediastinal lymphadenopathy" or to the later biopsy date with a reported diagnosis of small cell carcinoma? See discussion.
Note 7 states that "mediastinal lymphadenopathy" indicates involved lymph nodes for lung primaries. Should the date of diagnosis be back-dated to the date of the scan?
For cases diagnosed 1998-2003:
No, code the Date of Diagnosis field to the later biopsy date. Note 7 is intended for use in coding the EOD-Extension field, not the Date of Diagnosis field. The earlier scan has a diagnosis of RUL "mass" not a "malignancy" so the fact that there is mediastinal lymphadenopathy mentioned in that scan is not used to help determine date of diagnosis.
Surgery of Primary Site--Skin: For skin primaries diagnosed 1998-2002, what is the difference between code 40 [Wide excision or re-excision of lesion or minor (local) amputation, NOS] and 50 [Radical excision of a lesion, NOS]?
Codes 40 and 50 are not in the scheme for 2003 forward. See history for coding cases diagnosed 1998-2002.
EOD-Extension--Pancreas: How do you code extension when a mass is described on exploratory laparotomy as compressing the duodenum, arising in the head of the pancreas, "extending around" the superior mesenteric vein and artery, and "encasing" the portahepatis?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 40 [extension to peripancreatic tissue, NOS]. Neither of the terms "extending around" nor "encasing" are interpreted as involvement with tumor by SEER.
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