| Report | Question ID | Question | Discussion | Answer | Year |
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20031012 | EOD-Lymph Nodes/Extension: How does one code these fields if the clinical level of disease extension prior to neoadjuvant treatment is greater than demonstrated on pathology at time of resection? See discussion. | Breast case described clinically as a "breast mass and nodal metastases" which is treated with neoadjuvant chemotherapy and at surgery the lymph nodes are pathologically negative. | For cases diagnosed 1998-2003:
Use the combination of clinical and pathologic information to code EOD for primary site, extension and lymph nodes. Code the more extensive disease. If lymph nodes are positive clinically and not positive after neoadjuvant treatment, code lymph node involvement. If lymph nodes are negative clinically and positive on path, code lymph node involvement. When neoadjuvant treatment is administered because of a clinical statement of stage or involvement, code EOD based on this clinical information, even if later pathologic information would lead to a lesser EOD. General guideline number 6 (page 1 of SEER EOD-88 3rd ed.) points out that clinical information must be considered when coding EOD. However, do not code EOD based on clinical information disproved by pathologic findings in the absence of intervening treatment. The scenario above: The clinical involvement of the nodes justifies the neoadjuvant chemotherapy. Therefore, code EOD based on the clinical lymph node involvement. |
2003 |
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20031030 | Primary Site--Head & Neck: What is the primary site for a tumor location described as being in the "gingiva between teeth #s 18 and 19? | Code the primary site as C03.1, lower gum. According to the system used by the American Dental Association, tooth #18 and tooth #19 are lower. Teeth #1-16 are upper. Teeth #17-32 are lower. |
2003 | |
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20031035 | Reportability/Histology--Hematopoietic, NOS: Does the presence of sideroblasts on a bone marrow biopsy confirm a diagnosis of refractory anemia with sideroblasts? | Final path diagnosis of bone marrow biopsy:
I. Hypercellular marrow for age with trilinear hyperplasia. II. Decreased iron stores with decreased sideroblasts.
Comment: Although the overall picture is not diagnostic of a specific entity, it is most consistent with an early stage myelodysplastic syndrome which would best be considered refractory anemia at this point.
In this case the percentage of sideroblasts is not stated. Would the path diagnosis of "decreased sideroblasts" along with the path comment of "refractory anemia" indicate that this case should be coded to 9982/3 [Refractory anemia with sideroblasts]? |
For cases diagnosed prior to 1/1/2010:
For the hematologic diseases, do not accession the case unless there is a definite positive diagnosis. A positive diagnosis, such as "Refractory anemia" must be stated in order to code that diagnosis. Other words associated with the positive diagnosis, such as "sideroblasts" are NOT to be used alone to assume a diagnosis.
Decreased sideroblasts does not make a diagnosis of Refractory anemia with sideroblasts. The sideroblasts for 9982/3 [Refractory anemia with sideroblasts] are characteristic in rings, and are INCREASED to make the diagnosis.
Based on the information provided, this case is not reportable. The final path diagnosis is not a reportable disease. The comment further states that the overall picture is not diagnostic of a specific entity. Therefore, it should not be reported at this point.
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. |
2003 |
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20031117 | Multiple Primaries (Pre-2007): Are simultaneous tumors of the rectosigmoid junction and rectum counted as two primaries? See Description. |
On the same day in 1998, a patient was found to have a T3 adenocarcinoma of the rectosigmoid junction and an in situ adenocarcinoma in a villotubular adenoma in the lower rectum. These would be the same histology if they are in the same site. Are C199 and C209 the same site? They are listed in ICD-O-2 (pg. xxxvii) and in ICD-O-3 (pg. 36), but they are not listed in the SEER Program Manual on page 9 as the same site. Is this one primary or two? |
For tumors diagnosed prior to 2007: Abstract two primaries for the example above, according to the main rule on page 7 in the SPCM. Rectosigmoid junction (C19) and rectum (C20) are in different 3-digit ICD-O-3 topography code categories. Rectosigmoid junction and rectum are not included in the exceptions to the main rule and, therefore, do not appear on page 9 of the SPCM. The table on page 9 is not identical to the table in ICD-O-3. Two site combinations are listed in ICD-O-3, but not in the SEER table: C19 (rectosigmoid junction) and C20 (rectum); C40 (bones of limbs) and C41 (other bones). Abstract multiple tumors in the rectosigmoid junction and rectum as separate primaries. Abstract multiple tumors in the bones of the limbs and other bones as separate primaries. 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. |
2003 |
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20031151 | EOD-Size of Primary Tumor: Can size be coded from a needle bx that removes all of the invasive tumor and just leaves a "focus of in situ"? See Description. | For example: needle bx diagnosis is "tiny focus of tissue highly suspicious for tubular ca." The lumpectomy path states "single focus of low grade DCIS, no residual ductal ca." Can size be coded 001? | Code tumor size to 001 [Microscopic focus or foci only] for the invasive component. Code the tumor size 990 for cases diagnosed in 2004 and forward. Disregard the microscopic tumor found at further resection. | 2003 |
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20031165 | Behavior Code/EOD-Extension--Colon: Are extension codes 10 [Mucosa, NOS (incl. Intramucosal, NOS)] and 11 [Lamina propria] in situ, in accordance with AJCC stage for this site? |
For cases diagnosed 1998-2003: EOD codes 10 and 11 are invasive. SEER, to be compatible with Summary Stage 77 and 2000, calls EOD extension codes 10 and 11 invasive because invasion of the lamina propria is invasion through the lamina propria/basement membrane and therefore invasive. According to AJCC, the survivial rates for tumors that invade only the mucosa or lamina propria are similar to Tis tumors, so the AJCC classifies them as Tis. |
2003 | |
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20031125 | Histology/Reportability/Behavior Code--Testis: Is a mature teratoma that is metastatic to lymph nodes reportable? See Description. |
Pathology report states, "Histologic sections reveal lymph node metastases, consisting predominantly of mature teratoma. In addition, there are cells scattered through the fibrous stroma which exhibit mild cytologic atypia but have low N:C ratios. The largest metastasis grossly measures 10cm. In addition extracapsular extension is identified. Diagnosis: Lymph Nodes--Metastatic Testicular Carcinoma Involving Multiple Lymph Nodes." The morphology code for mature teratoma is 9080/0. The pathologist does not classify this as an immature teratoma (9080/3). Is this reportable? |
Yes, this metastatic teratoma is reportable. This is a malignant teratoma by virtue of the lymph node metastases. Code the histology as 9080/3 [Teratoma, malignant, NOS]. Primary site is testis [C62_]. |
2003 |
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20031083 | Grade, Differentiation: How is this field coded when the only description in the pathology report is "non-high grade?" | Code "non-high grade" as 9 [unknown]. | 2003 | |
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20031145 | EOD-Extension--Head & Neck: Is this field coded 10 [Invasive tumor confined to one of the following subsites: interior wall, one lateral wall, posterior wall] or 30 [Localized, NOS] for tonsillar primary when there is no mention of involvement of surrounding structures? See Description. | Site is stated to be "left tonsil" and was coded to site C099. "The lesion is admixed in tonsillar tissue." No surrounding structures are stated to be involved. Is it logical to assume that since code C099 includes the palantine tonsils and the palatine tonsils are on the lateral wall and since no other areas are stated to be involved that extension code 10 [confined to one lateral wall] would be more appropriate than code 30 [localized NOS]? | For cases diagnosed 1998-2003: Code EOD-extension for the case example to 10 [Invasive tumor confined to one of the following subsites: anterior wall, one lateral wall, posterior wall]. The tonsil lies in a pocket on the wall (tonsillar fossa), so you know it is confined to the wall. | 2003 |
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20031186 | Immunotherapy/Radiation Therapy: Is I-131 labeled immunoglobulin coded as immunotherapy or radiation therapy? | Code treatment with I-131 labeled immunoglobulin as radiotherapy. The primary action is radiotherapeutic. Radioimmunotherapy (RIT) uses antibodies to deliver the radiotherapy to the site of the tumor. | 2003 |
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