| Report | Question ID | Question | Discussion | Answer | Year |
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20021201 | EOD-Extension--Lymphoma: What code is used to represent this field for a lymphoma with retroperitoneal lymph node involvement and splenomegaly? | For cases diagnosed 1998-2003:
Per AJCC, code spleen involvement which is demonstrated by:
1. Unequivocal palpable splenomegaly alone. 2. Equivocal palpable splenomegaly with radiologic confirmation (ultrasound or CT). 3. Enlargement or multiple focal defects that are neither cystic nor vascular (radiologic enlargement alone is inadequate).
If the spleen is proven to be involved, code extension for this case as 20 [Involvement of two or more lymph node regions on the same side of the diaphragm; Stage II].
If the spleen is not proven to be involved, code extension as 10 [Involvement of a single lymph node region; Stage I]. |
2002 | |
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20021204 | EOD-Size of Primary Tumor--Cervix: When both a depth and diameter of the tumor are provided and the description of the diameter is provided in a range, how do you code the size of the primary tumor? See discussion. | Path states "microscopic focus of endocervical glands considered invasive adenoca...maximum depth of that focus measures approximately 2 mm. Maximum diameter of that focus measures 3-4 mm."
What size would be coded for this case: 999, 002, 003, or 004? |
Code the EOD-Size of Primary Tumor field to 004 [4 mm]. Code the diameter dimension in the EOD-Size of Primary Tumor field and the depth dimension iin the EOD-Extension field. Code the largest number associated if a range is provided for the diameter of the invasive tumor.
If the size of the diameter had not been mentioned, the EOD-Size of Primary Tumor field would have been coded to 001 [microscopic focus or foci only], which ignores the size associated with the depth dimension of the tumor. |
2002 |
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20021193 | Grade, Differentiation--Breast: Does SEER agree with our pathologist who contends that "by convention lobular carcinoma is considered to be grade 2"? | No. SEER does not have a default grade code for lobular carcinoma. Code the grade as stated in the pathology report. If no grade is stated, code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable]. | 2002 | |
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20021117 | Multiple Primaries (Pre-2007)--Bladder/Prostatic Urethra: Is the prostatic urethra a new primary for a case with a history of recurrent noninvasive bladder cancer that was subsequently diagnosed with transitional cell carcinoma in situ of the prostatic urethra and had a subsequent clinical diagnosis of "refractory bladder carcinoma"? | For tumors diagnosed prior to 2007:
If the histology of the bladder primary is "transitional cell carcinoma" or "papillary transitional cell carcinoma," do not code the prostatic urethra as a new primary. This is probably a case of intraluminal (mucosal) spread of the original tumor, rather than separate primaries. The clinical diagnosis supports this view.
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. |
2002 | |
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20021159 | Histology (Pre-2007)--Breast: What code is used to represent the histology "mucinous carcinoma with Paget disease"? | For tumors diagnosed prior to 2007:
Code the Histology field to 8480/3 [mucinous carcinoma]. This answer assumes the patient presented with a single tumor. There is no combination code that includes these two entities. According to the rules for Coding Complex Morphologic Diagnoses, it would appear that the case should be coded to 8540 [Paget disease] because it is the higher code. However, this combination of histologies represents an exception to that rule. The prognosis for mucinous carcinoma is worse than the prognosis for Paget disease. As a result, it would be more appropriate to the histology to mucinous carcinoma.
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. |
2002 | |
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20020062 | Histology (Pre-2007): Can the histology code 8582/3, "thymoma, mixed type, malignant" only be used when you have a thymoma with both type A and type B features? See discussion. | Can this same histology be used when you have two type B features in the thymoma specimen? What code is used to represent the histology?
Example 1: Thymoma, spindle cell and epithelial type Example 2: Thymoma, mixed lymphocytic and epithelioid type |
For tumors diagnosed prior to 2007:
For example 1, code histology to 8582 [Thymoma, type AB]. This code is only applicable to "Type AB thymoma [mixed]" in the WHO classification. Use 8582 only for thymomas with type A and type B features. Spindle cell is a type A feature and epithelial is a type B3 feature.
For example 2, code histology to 8585 [Thymoma, type B3]. Lymphocytic is a B1 feature (8583) and epithelial is a B3 feature (8585). There is no type A component. Code the histology based on ICD-O-3 rule K on page 34.
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. |
2002 |
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20021099 | Reportability/Histology (Pre-2007)--Pancreas: Are the following pancreatic tumors with mention of "low grade malignant potential/borderline" reportable to SEER? If so, what histology and behavior codes should be used? See discussion. | 1. AFIP diagnosis: Pancreas, tail, resection: Mucinous cystadenocarcinoma (mucinous cystic neoplasm) of low grade malignant potential. Comment: There are no reliable histomorphologic features which can separate these neoplasms into benign and malignant tumors, and so we consider them all to be low grade malignant tumors.
2. Whipple resection: Intraductal papillary mucinous tumor of the pancreas with extensive low grade and multifocal high grade ductal dysplasia (so-called borderline tumor and carcinoma in-situ). |
For tumors diagnosed prior to 2007:
Both tumors are reportable to SEER.
1. Code the Histology and Behavior Code fields to 8470/3 [Mucinous cystadenocarcinoma, NOS].
2. Code the Histology and Behavior Code fields to 8453/2 [Intraductal papillary-mucinous carcinoma, non-invasive].
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. |
2002 |
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20021133 | First Course Treatment--All Sites: The patient has undergone part of the planned first course of treatment when a metastatic deposit is identified. If the patient continues with the planned first course of treatment, should the modalities of treatment given after the metastatic deposit is discovered be included in the coding of the first course of cancer-directed treatment fields? |
Yes, those modalities should be counted as part of first course of cancer-directed treatment if the patient continues with the planned first course. For example, if patient has the originally planned type of surgery, radiation, or drug protocol, then code the given treatment as first course. Caution: It is not a change in the treatment plan if the drugs are changed but the action of the drugs remains the same. This is still first course. However, if the treatment is changed from a chemotherapy drug to a hormonal drug following the discovery of the mets, do not code the hormonal therapy as first course. |
2002 | |
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20021059 | Surgery of Primary Site--Soft Tissue: What code is used to represent this field when an excisional biopsy of a soft tissue sarcoma is followed two weeks later with a wide excision (re-excision)? | For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 26 [partial resection]. According to the CoC, "Excision" in the surgery codes refers to the lesion and "partial resection" refers to the organ. The biopsy is a local excision (code 25). The wide resection is code 26, presuming that more than just the remaining lesion was removed. | 2002 | |
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20021184 | EOD-Lymph Nodes--Head & Neck: When a physician provides only "Stage IV" (i.e., an abbreviated stage) for a right posterior tongue primary with lateral extension into the oropharynx and hypopharynx, can you assume "palpable" level 2, 3 and 5 lymph nodes are involved? | For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 9 [Unknown], based on the information provided.
The physician's statement of an N category from a TNM may be used to determine lymph node involvement in the absence of other information. However, you cannot assume nodal involvement based on the incomplete staging information of "Stage IV" for a base of tongue primary. For this primary site, extension into the hypopharynx from this primary is equivalent to T4/Stage IV. Therefore you cannot assume the clinician's assessment of the case as Stage IV represents his assessment of lymph node involvement. |
2002 |
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