Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20031079 | Primary Site: Should we code C80.9 [unknown primary] or code C34.9 [Lung] according to the terminology, "most likely site of origin is lung"? See Description. | We have a case of metastatic keratinizing squamous cell ca. The work-up shows small densities in the lung that may represent inflammatory or chronic changes. No other imaging that shows origin. Physical exam states 2 months of left axillary mass. H/O SCCA of the skin involving chest wall. Path reads: Metastatic w/d keratinizing SCCA. This lesion almost undoubtedly represents mets. The most likely site of origin is lung followed by esophageal primary or head & neck. The final discharge states, "Metastatic SCCA to Left Axilla". |
Code the primary site according to the physicians' opinion, especially the treatment decision. If the physician treats the patient for a lung primary, code primary site as lung. If the primary site cannot be determined, code C80.9. According to the pathologist, the most likely primary site for the example above is lung. The final discharge diagnosis does not reflect the pathologist's opinion, and does not contradict it either. If there is no conflicting medical opinion, code primary site to C34.9 [lung]. |
2003 |
|
20031175 | First Course Therapy: Are radio immune labeled antibodies, such as Bexxar [Tositum--I-131] coded as immunotherapy, radiotherapy, or experimental therapy? |
Agents such as Bexxar or Zevalin are radioisotopes and coded as radiation. These agents destroy cancer cells with radiation. | 2003 | |
|
20031092 | Histology (Pre-2007)/Multiple Primaries (Pre-2007)--Breast: How is the histology of invasive small cell carcinoma of lobular histogenesis coded? Could high grade ductal carcinoma in situ, comedo type be a recurrence of ductal carcinoma diagnosed 18 years earlier? Is "invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type" one or two primaries? See Description. |
A patient was diagnosed in 1984 with 1st breast primary, histology was ductal carcinoma, T1N0, LIQ left breast. In 2002 a mass was found on mammogram, MRM with axillary sampling performed. Histology was invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type, nuclear grade 3/3, T2N1, UOQ left breast. Is the ductal carcinoma in situ recurrent disease from the 1st primary? Does it go with the lobular histogenesis, i.e., lobular carcinoma and DCIS histology code 8522/3 or is the ductal in situ a 3rd primary? | For tumors diagnosed prior to 2007:
According to our pathologist consultant: Invasive small cell carcinoma of lobular histogenesis appears to be an unusual histology for a breast primary. Code it as such 8041 [Small cell carcinoma, NOS]. The 2002 lesion is most likely a new primary since the previous lesion was 18 years ago, in a different quadrant, and invasive. A comedo DCIS would probably not be asymtomatic for 18 years; an unlikely "recurrence" of an earlier ducal carcinoma. Code "invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type" as two primaries. Code the small cell as a separate primary (8041/3), and the DCIS separately (8501/2).
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 |
|
20031021 | Primary Site--Head & Neck: What is the anatomical distinction among tonsillar fossa, tonsillar pillar, and tonsil NOS? | Operative findings describe a right tonsil three times the size of the left tonsil. Tonsil is dissected from the tonsillar fossa. There appeared to be no involvement of tumor below the tonsillar capsule. | The tonsil lies in an indentation called the tonsillar fossa. The tonsillar fossa is bordered on either side by the tonsillar pillars. The tonsillar pillars are part of the supporting structure of the throat opening.
Code C09.9 [Tonsil NOS] as the primary site for the case above. |
2003 |
|
20031194 | Terms of involvement--Lung: Is "intense uptake" described on a PET scan an indication of involvement? See Description. |
We are seeing increasing use of PET scans as diagnostic tools for cancer. PET scans use different terminology than the ambiguous terms listed in the EOD manual. Could we please have guidelines for interpreting PET scans? Example: Patient with right lung cancer. PET scan showed intense uptake in the mediastinum and in the hilum. Can we code "intense uptake" as involvement of mediastinal and hilar lymph nodes? |
Do not interpret "intense uptake" as involvement. Look for a statement of involvement or other terminology, such as "highly suspicious," "strongly suspicious for" malignancy, involvement, etc. | 2003 |
|
20031039 | EOD-Clinical Extension--Liver: How do the segments of the liver described by AJCC Manual correspond to the lobes of the liver described by the SEER EOD Manual? See Description. |
CT described hepatocellular ca involvement of the liver with nodules identified in segments 5 and 7. Would EOD-extension be coded to 30 [multiple tumors (one lobe)]? |
Segments 2, 3, and 4 correspond to the left lobe of the liver. Segments 5, 6, 7 and 8 correspond to the right lobe of the liver. Segment 1 is the caudate lobe, which has completely different drainage and vascularization, is separate from the larger right and left lobes. For cases diagnosed 1998-2003: Since segments 5 and 7 are both in the right lobe, assign EOD-extension code 30 for the case above, unless there is mention of vascular invasion. Be sure to record the size of the largest primary tumor. Tumor size and vascular invasion are the most important factors for AJCC 6th edition staging. |
2003 |
|
20031153 | Laterality/Multiple Primaries (Pre-2007)--Ovary: Are ovarian primaries with bilateral involvement always coded to laterality 4 (bilateral)? See Description. | Example: "Right ovary with mass replacing majority of ovarian tissue consistent with serous adenoca. Lt ovary with foci of adenoca." No specific statement of primary. Can we assume that the malignancy originated in the right ovary since it is more extensively involved or should laterality be coded 4 because both ovaries have tumor? | For tumors diagnosed prior to 2007:
If one ovary is listed as the primary site, code laterality to that ovary. The example above is one of those times when you would code to the single ovary. The issue of one or both ovaries being involved is handled in staging.
Abstract the example above as a single primary with code 1 [Right] for laterality.
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 |
|
20031033 | Grade, Differentiation--Hematopoietic: Is this field coded to 6 [B-cell] from a flow cytometry that specifies the percentage of B-cells that exist within the percentage of lymphoid cells in the bone marrow biopsy? See Description. | Bone marrow biopsy, Final path diagnosis: consistent with small lymphocytic lymphoma/chronic lymphocytic leukemia. Comment: flow cytometry analysis was performed on bone marrow aspirate. The gated population of lymphoid cells comprises approximately 19% of total nucleated cells. Of these, 53% are B-cells which express CD19, CD22. These findings are consistent with the above diagnosis. | For cases diagnosed prior to 1/1/2010:Yes, assign code 6, B-cell. The flow cytometry analysis confirms B-cell. 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 |
|
20031114 | EOD-Extension--Colon: How is this field coded for an appendical primary when the appendix has ruptured and intrapentoneal fluid is positive? | For cases diagnosed 1998-2003: Code EOD extension as 85 [Metastasis]. Positive intraperitoneal fluid is equivalent to distant metastasis (implantation) for colon, including appendix, primaries. | 2003 | |
|
20031180 | Histology (Pre-2007)--Breast: What code is used to represent the histology "ductal adenocarcinoma with medullary features?" | For tumors diagnosed prior to 2007:
Medullary is a subtype of duct and "with features of" is a term that indicates a majority of tumor. If this is an invasive adenocarcinoma with no in situ component, code to 8510/3 [Medullary adenocarcinoma]. If only one of the components is invasive, code that component.
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 |