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.
Reportability/Terminology, NOS--Hematopoietic, NOS: Are the diagnoses "myelodysplastic syndrome," "myelodysplastic syndrome, thrombocytopenia" and "myelodysplastic syndrome, anemia" all reportable to SEER for diagnosis 2001 and later?
For cases diagnosed prior to 1/1/2010:"Myelodysplastic syndrome" (NOS) is reportable to SEER--ICD-O-3 code 9989/3. "Myelodysplastic syndrome, thrombocytopenia" is not reportable to SEER because "thrombocytopenia" is not reportable. "Myelodysplastic syndrome, anemia" is not reportable to SEER because "anemia" is not reportable.
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.
Multiple Primaries (Pre-2007)--Breast: Synchronous invasive right breast tumors. Ductal carcinoma, NOS in UIQ and Ductal carcinoma, tubular type in LOQ. Are these two primaries or a single primary coded to 8523/3?
For tumors diagnosed prior to 2007:
Code as two primaries, one 8500/3 [Infiltrating duct carcinoma] and one 8211/3 [Tubular carcinoma].
Apply the multiple primary rules first. These are synchronous right breast tumors with different histologies. Therefore, they are separate primaries according to rule 5.a on page 12 of the SEER Program Code Manual. ICD-O-3 histology code 8523/3 is NOT to be used to combine histologies from separate primaries; it is used for mixed histologies in a single primary.
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.
CS Site Specific Factor--Prostate: Does perineural invasion affect the coding of SSF3, pathologic extension? See Description.
"Adenoca scattered over a 2.5 cm region bilaterally toward the apex. Perineural invasion is identified, including within the right apex." Does this mean that there is extension into the apex?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.For cases diagnosed 2004 and forward:
Presence or absence of perineural invasion does not affect pathologic extension. Most likely perineural invasion is still localized. It means that there is tumor found along the track of the nerves in the prostate. Where the nerves enter the prostate, the capsule is thinner than in other areas; thus pathologists make note of the potential for extracapsular extension.
The CAP Cancer Protocol for Prostate states that perineural invasion "has been associated with a high risk of extraprostatic extension...although the exact prognostic significance remains to be determined."
Based on the available information, code the case example to 023 [Involves both lobes].
Scope of Regional Lymph Node Surgery 2003+/Number of Regional Lymph Nodes Examined--Hematopoietic/Brain/Lymph Nodes/Ill-defined/Unknown: Are codes 9 [Unknown; not stated] and 99 [Unknown; not stated] used respectively for these data items for the mentioned primary sites?
For cases diagnosed Jan 2003 and later:
The Number of Regional Lymph Nodes Examined field is blank for 2003+ cases.
EOD-Extension--Corpus Uteri: How is this field coded for a stage III A endometrial primary with positive pelvic washings, involvement of the omental serosa, and negative lymph nodes?
For cases diagnosed 1998-2003: Code EOD-extension as 85 [Metastasis]. According to our TNM consultant, Omental metastasis is M1, Stage IVB [EOD 85].
EOD-Lymph Nodes--Breast: Are micrometastases in the lymph nodes, found only on immunohistochemical staining, coded as positive lymph nodes?
For cases diagnosed 1998-2003: Do not code as positive lymph nodes that have micrometastases diagnosed ONLY on immunohistochemistry. By traditional diagnostic methods, these are still negative lymph nodes.
Summary Stage and EOD ignore the IHC positive micrometastases for cases diagnosed through 2003. The collaborative staging system that begins with 2004 cases and is based on the sixth edition of TNM addresses this issue.
Primary Site--Pancreas: Should tumors with the histology "islet cell carcinoma" be coded C25.4 [Islet of Langerhans] even though the tumor location is stated to be in head of pancreas?
Assign code C25.4 [Islets of Langerhans...Endocrine pancreas]. Islet cell carcinoma of the pancreas is a tumor of the endocrine pancreas. Although Islet cells are present throughout the pancreas, the best code is C25.4 to distinguish endocrine from exocrine cancers.
Histology (Pre-2007): Do the terms "keratinizing" or "non-keratinizing" have to be present in the final diagnosis to use codes 8071 through 8073? See discussion.
Should "squamous cell carcinoma, small cell variant" be coded to 8073 even though the final diagnoses does not include the phrase "non-keratinizing?"
For tumors diagnosed prior to 2007:
It is acceptable to assign code 8073/3 for squamous cell carcinoma, small cell, NOS. Code squamous cell carcinoma, large cell, NOS to 8072/3. Code to non-keratinizing unless the pathology report specifies keratinizing.
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.
Histology (Pre-2007)--Kidney, renal pelvis: What codes are used to represent the histologies of 1) "renal papillary (chromophil) carcinoma" and 2) "chromophil renal cell carcinoma?"
For tumors diagnosed prior to 2007:
Code "chromophil" to 8260 [papillary renal cell]. According to our pathologist consultant, in the case of chromophil, most authors regard this as more or less synonymous with papillary renal cell [8260]. "More or less" because papillary is an old term descriptive of the microscopic structure, while chromophil is newer and based on the cytology; because most of the latter are papillary the current usage assumes them to be equivalent.
1) The diagnosis "renal papillary (chromophil) carcinoma" tells us that the pathologist who wrote it was seeing both pattern and cytologic features, and is regarding papillary equivalent to chromophil; thus, code to 8260.
2) Code "chromophil renal cell carcinoma" to 8260.
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.
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