Primary Site--Meninges: Should the primary site for a meningioma of the right frontal lobe be coded to C71.1 or C70.0? See discussion.
In the opinion of some neurologists it is more important to capture the lobe in which the meningioma is located rather than code the primary site to meninges. Should a meningioma always be coded to meninges for primary site?
Code the Primary Site field to C70.0 [cerebral meninges], the suggested site code for most meningiomas. Meningiomas arise from the meninges, not the brain (although they can invade brain). ICD-O-3 does not differentiate the specific location of the brain that the meninges cover. The information of interest to neurologists would have to be captured in an optional or user-defined field.
Date Therapy Initiated: What date should be entered in Date Therapy Initiated when treatment follows a surgical procedure that is not coded under Surgery of Primary Site? See discussion.
If a patient has a surgical procedure that is not coded in the Surgery of Primary Site field and then the patient undergoes additional first course of treatment, such as radiation therapy, how should the Date Therapy Initiated field be coded?
In this example, code the Date Therapy Initiated field to the date of the first surgical procedure. If a SEER edit is triggered, please notify us.
EOD-Extension--Hematopoietic, NOS: If a solitary plasmacytoma originates in the right tonsil and extends to the left tonsil, vallecula and hypopharynx, is extension still coded to 10 [localized disease, solitary plasmacytoma only]?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 10 [localized disease, solitary plasmacytoma only] for all cases of solitary plasmacytoma.
Histology (Pre-2007): What code is used to represent a review of slides histology of "in situ squamous cell carcinoma and multiple detached fragments of atypical papillary squamous epithelium; highly suspicious for invasive carcinoma"? See discussion.
The original pathologist indicated a final diagnosis of moderately differentiated squamous cell carcinoma. The slides were sent for review to another facility. The reviewing pathologist rendered the diagnosis stated in the question section.
For tumors diagnosed prior to 2007:
Code the Histology field to 8070 [squamous cell carcinoma].
The review diagnosis was also squamous cell carcinoma. The expression "atypical papillary squamous epithelium" does not modify the cancer histology.
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.
EOD-Lymph Nodes--Breast: How do you code this field when the gross description on the pathology report states "nodal tissue is matted" but only 1/18 lymph nodes is found to contain micrometastatsis per the microscopic description of the report?
For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 1 [Micrometastasis] because the matted nodal tissue was found to contain only one node with micrometastasis when examined microscopically. Coding priority is given to the microscopic description over the gross description.
Multiple Primaries (Pre-2007)--Kidney: How many primaries are reportable in a patient treated with a bilateral nephrectomy that revealed multiple tumors within each kidney and the histology in both the left and the right kidney was "renal cell carcinoma, indeterminate type: multiple histologically identical tumors" and the clinical discharge diagnosis was "bilateral renal cell carcinoma, probably surgically cured"? See discussion.
The SEER manual states "If only one histologic type is reported and if both sides of a paired site are involved within two months of diagnosis, a determination must be made as to whether the patient has one or two independent primaries." Frequently, the only statement we have is that "bilateral organs are involved." Additional guidelines for determining number of primaries would be helpful.
For tumors diagnosed prior to 2007:
Report this case as two primaries, left and right kidneys. According to our pathologist consultant, "The description sounds like bilateral multiple primaries. Multicentricity in the same kidney occurs in about 4% of all cases, and bilaterality in 0.5 to 3% (Atlas of Tumor Pathology, Tumors of the Kidney, Bladder, and Related Urinary Structures)."
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.
EOD-Extension--Lymphoma: What code is used to represent this field for a lymphoma that involves the spleen and lymph nodes above the diaphragm (e.g., involvement of only the spleen below the diaphragm and cervical lymph nodes above the diaphragm)?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 32 [30 + involvement of the spleen; III S]. The spleen is counted twice (once as the spleen and a second time as a lymph node region below the diaphragm). As a result, the EOD-Extension field is coded to reflect involvement of lymph node regions on both sides of the diaphragm plus involvement of the spleen. See Note 1 on the EOD scheme that states "Any lymphatic structure is to be coded the same as a lymph node region."
Grade, Differentiation: Do we code to the highest grade even when no grade is given at the time of initial diagnosis, but a grade is obtained on tissue removed after non-surgical treatment has occurred? See discussion.
1. In 2000 a pleural fluid aspirate had no grade. Pt treated with chemo. In 2000 a BSO diagnosed high grade papillary serous adenocarcinoma of the ovary.
2. In 1993 a prostate bx had no grade. Pt treated. In 2001 prostate bx revealed a Gleason's 4+3.
Code the grade at the time of initial diagnosis (if the specimen is from the primary site) or to the grade identified as part of a first course of cancer-directed surgery to the primary site. When different grades are specified for tissue pathologically reviewed from the primary site before and after treatment, code the higher grade. This is true even if the higher grade is obtained while the pt is still undergoing first course of cancer-directed therapy.
1. Code the Grade to 4 [high grade], if the grade information from the BSO specimen represents the grade associated with primary site surgical specimen. Even though the grade was obtained after first course of cancer-directed therapy started, it was obtained during first course of cancer-directed therapy.
2. Code the Grade to 9 [Cell type not determined, not stated or not applicable]. Grade was obtained well after the first course of cancer-directed therapy ended.
EOD-Lymph Nodes/EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined--Cervix: What codes are used to represent these fields for a cervix primary when the only information on lymph nodes is a CT of the pelvis showing "pelvic adenopathy" (no surgery was done)?
Code the EOD-Lymph Nodes field to 9 [unknown]. Code the Pathologic Review of Number of Regional Lymph Nodes Positive field to 98 [No nodes examined] and the Lymph Nodes Examined to 00 [No nodes examined] because there was no resection of the primary organs. Adenopathy, NOS, per SEER guidelines, is not coded as lymph node involvement
EOD-Extension--Breast: The SEER coding scheme classifies the in situ portion as less than 25% [code 14] or equal to or greater than 25% [code 15]. How do you code a pathologist's statement of "less than or equal to 25%"? See discussion.
"insitu ca constitutes less than or equal to 25% of the total mass."
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 14 [invasive and in situ components present, size of entire tumor coded in Tumor Size AND in situ described as minimal (less than 25%)]. The pathologist did not use a code as defined by SEER. For cases described as "less than or equal to 25%", choose the lower of the two EOD code choices.
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