Report | Question ID | Question | Discussion | Answer | Year |
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20020050 | EOD Clinical Extension--Prostate: Can you assign code 15 if there is no TURP and no physical exam? See discussion. [Code 15 = Tumor identified by needle biopsy, e.g. for elevated PSA, (T1c)] |
Prostate case: Elevated PSA, Prostate u/s: no abnormal findings, Prostate biopsy: adenocarcinoma. Can this be clinically coded as 15? According to Prostate EOD Coding Guide (6/2001), code 15 requires documentation that the physical exam was negative, but in this case, we have no physical info. | For cases diagnosed 1998-2003:
Code the EOD Clinical Extension field to 30-34 when there is no documentation saying that the physical examination was negative. |
2002 |
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20021100 | Primary Site: How do we code the primary site for a malignancy that occurs in parenchyma located in an ectopic site? See discussion. | 1. Patient presented with a subcutaneous nodule in right axilla. Pathologic impression by initial and reviewing pathologists is that the lesion represents a breast adenocarcinoma arising in ectopic mammary parenchyma. Subsequent breast biopsies were negative. 2. Patient presented with right branchial cleft cyst. The pathologist states the cyst is a primary thyroid adenocarcinoma arising in an ectopic focus of thyroid tissue. The subsequent total thyroidectomy is negative. |
Code the primary site to the location of the malignancy.
1. Code the Primary Site field to C76.1 [Axilla NOS]. 2. Code the Primary Site field to C10.4 [Branchial cleft]. |
2002 |
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20021096 | Grade, Differentiation--Bladder: What codes are used to represent this field for the four bladder cases described in the discussion section that have a combination of grades mentioned in the pathology reports? See discussion. | 1) Final path diagnosis: papillary transitional cell carcinoma, high grade. Micro description states: High grade, poorly differentiated carcinoma. 2) Well to moderately differentiated papillary transitional cell carcinoma, grade 1-2/3. 3) Urothelial carcinoma, high grade (poorly differentiated, grade 3 of 3). 4) High grade papillary urothelial carcinoma (papillary transitional cell carcinoma, grade 3 out of 4). |
For cases diagnosed January 2004 and forward: 1) Grade 4. High grade is coded 4. Code the grade stated in the final diagnosis. 2) Grade 3. Grade 1-2/3 is coded 3. Use the three-grade conversion table in the 2004 SEER manual. 3) Grade 4. Grade 3 of 3 is coded 4. Use the three-grade conversion table in the 2004 SEER manual. 4) Grade 3. "Grade 3 out of 4" is coded 3 and is more precise than "high grade." |
2002 |
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20021066 | Histology: How do we code this field when a less representative specimen has a more specific morphology? See discussion. | Example: Biopsy revealed endometrioid adenocarcinoma and the resection demonstrated adenocarcinoma, NOS. Do we code histology per the most representative sample, or to the more specific morphology? | Code the histology using the pathology report from the most representative specimen, even if that histology is less specific. For the case example above, code 8140 [adenocarcinoma, NOS]. The rationale is that a diagnosis from a smaller specimen will be less accurate and less representative of the true histology compared to a larger tumor specimen. |
2002 |
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20021124 | Multiple Primaries (Pre-2007)/Primary Site/EOD-Extension--Lung: Should lung cases be counted as more than one primary when nodules removed from separate lobes of the same lung have either the same histology or they are different immunophenotypes of the same main histologic classification (e.g., adenocarcinoma)? See discussion. |
1. Path report: "Two nodules (RLL, RUL) of primary pulmonary demonstrate adenocarcinoma with different histologic appearances and different immunophenotypes consistent with synchronous lung adenocarcinomas." Per ICC interpretation, two lung primaries are favored. 2. Path report: "Two peripheral nodules (LLL, LUL) demonstrate similar P.D. non-small cell carcinoma with features of large cell undifferentiated carcinoma." |
For tumors diagnosed prior to 2007: According to current SEER rules, both examples represent one primary because both tumors are in one lung and of a single histologic type. Code the Primary Site field to C34.9 [Lung, NOS] for both examples and the EOD-Extension field to 77 [Separate tumor nodules in different lobe]. This will capture the fact that there are multiple tumors within the lung for each of these examples. Differences in immunophenotypes confirm independent de novo cancers and rule out metastasis. Immunophenotype differences do not equate to different histologies. In the first example described, there are different histologic features; however, the main classification is adenocarcinoma. 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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20021003 | Multiple Primaries (Pre-2007): Whenever two hollow organs are diagnosed simultaneously with the same histology, one being invasive and the other in situ, can one assume that mucosal spread has occurred and that this situation represents one primary? In the absence of a physician statement, how do you determine mucosal spread from one organ to another? | For tumors diagnosed prior to 2007:
Yes, this type of situation represents one primary. A tumor that is breaking down can be invasive in the center with in situ cancer at the margins. Occasionally the in situ margin can move into a contiguous organ with the same type of epithelium.
Physicians may describe mucosal spread in various manners. You will see the terms "intramucosal extension," "in situ component extending to," or statements of an invasive component in one organ, with adjacent/associated in situ carcinoma in a contiguous organ with the same type of epithelium. A frequent example of this process is bladder cancer extending into the prostatic urethra via mucosal spread.
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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20021005 | EOD-Extension--Lymphoma: What code is used to represent this field for an extranodal lymphoma that has more than one tumor in the primary site OR has intraluminal extension from the primary site to an adjacent organ? See discussion. | 1. Small lymphocytic lymphoma with 2 tumors in the stomach. 2. Lymphoma involving the cecum and ileum. 3. Lymphoma of the fundus of stomach with extension into the esophagus. |
For cases diagnosed 1998-2003:
Using the EOD scheme for lymphoma, code the Extension field to 11 [Localized involvement of a single extralymphatic organ or site; Stage IE] for all 3 of these cases.
For the stomach lymphoma: There are 2 areas of lymphoma, but it is still confined to one site.
For the other 2 lymphomas: Intraluminal (mucosal) spread of the lymphoma never equals extension. The same phrase that was added to code 21, "Direct extension to adjacent organs or tissues", will be added to code 11 in the Collaborative Stage System. Neither "mucosal spread to a contiguous organ" or "direct extension into a nearby organ" affect staging. Both are still coded to 11 as long as there are no other sites of lymphoma involvement.
EOD code 80 is poorly written. It does not mean diffuse invovement or multiple tumors in a single organ but rather "diffuse disease in two or more organs." |
2002 |
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20021151 | Reportability: A "gastrointestinal stromal tumor" (GIST) is not always stated to be "malignant" in the path report even though the tumor appears to meet criteria for malignancy. Is the tumor SEER reportable? See discussion. |
Evaluation of Malignancy and Prognosis of Gastrointestinal Stromal Tumors: A Review. Miettinen, M. et al, Human Pathology 2002 May; 33(5) 478-83). This article states there is an increasing number of GISTs because the majority of tumors previously diagnosed as gastrointestinal smooth muscle tumors (leiomyomas, leiomyoblastomas and leiomyosarcomas) are now classified as GISTs. It states that gastrointestinal autonomic nerve tumors (GANTs) are also GISTs based on their KIT positivity and presence of KIT-activating mutations. This article also states that a GIST is probably malignant if it meets the following criteria: 1) Intestinal tumors: Maximum diameter >5 cm or more than 5 mitoses per 50 HPFs. 2) Gastric tumors: Maximum diameter >10 cm or more than 5 mitoses per 50 HPFs. Some of the path reports that meet these criteria use the word "malignant", and others do not. Some of the cases that are not called "malignant" in the path diagnosis are signed out clinically as "malignant." |
The case is reportable if a pathologist or clinician confirms a diagnosis of cancer. If there is no such confirmation, the case is not SEER reportable. |
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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20021002 | Histology (Pre-2007)--Breast: What code is used to represent the histology "ductal carcinoma in situ with comedo necrosis"? See discussion. | SEER distributed breast questions to the Advisory Group made up of pathologists from different SEER regions. One question dealt with the terms comedo type, comedo necrosis and comedocarcinoma. Per the Advisory Group, "Do not code comedo necrosis. These three phrases each represent a different level of diagnosis and can't be compared. "Comedocarcinoma" is an established diagnosis of in situ carcinoma and should be coded as such. "Comedo type" refers to a type of intraductal cancer; whether it is considered to be a true diagnosis is probably still equivocal. "Comedo necrosis" refers to a description of cellular pathological events that occasionally occur within an intraductal tumor of comedo type, which should not be coded at all."
Per the SEER preferred answer: Comedo type = comedocarcinoma. Ignore comedo necrosis. |
For tumors diagnosed prior to 2007:
Code the Histology field to 8500/2 [ductal carcinoma in situ].
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 |