Report | Question ID | Question | Discussion | Answer | Year |
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20031146 | EOD-Size of Primary Tumor--Breast: How do we code this field when there is a difference between the size of the tumor mentioned in the gross (i.e., macroscopic description) and the comment sections of a pathology report? See Description. | Path Macro Summary states size as 1.5 cm. The path comment states "largest area of tumor seen is 1.5 cm. However, 8 of the nearly contiguous sections are involved with an estimated 2.4 cm area of involvement." | For cases diagnosed 1998-2003: Code the size of the largest area of tumor from the path macro summary. For the example provided, code the size as 015 [1.5 cm]. In this case, the additional sections of tumor described in the path comment do not seem to represent pieces of one larger tumor. The 2.4 cm estimated area of involvement was determined by adding together noncontiguous tumor sections. According to the CAP protocol for breast, Note J "When 2 or more distinct invasive tumors are present, each is separately measured...they are not combined into a single larger size." | 2003 |
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20031181 | EOD-Extension--Kaposi Sarcoma: Is a "markedly enlarged spleen" involvement for cases of Kaposi Sarcoma? |
For cases diagnosed 1998-2003: No. Splenomegaly is not synonymous with "extension to" or "involvement of" the spleen in Kaposi's sarcoma. Look for a definite statement of Kaposi's lesion(s) involving the spleen. |
2003 | |
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20031023 | Grade, Differentiation: Can differentiation be coded from the pathology report for a biopsy from tissue involved by local recurrence? | Code grade from original primary site. Do not code grade from a local recurrence. | 2003 | |
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20031068 | EOD-Extension--Colon: Is a pathology description of "superficial invasion of the muscularis mucosa in the upper stalk of the polyp" coded in this field to 10 [mucosa (including intramucosal) NOS], 12 [Muscularis mucosa], or 14 [Stalk of polyp]? See Description. |
Do we use the highest applicable value because all three definitions are used in the following example? Ex: Path diagnosis: Sigmoid polyp: tubulovillous adenoma with a focus within upper portion of stalk consistent with superficially invasive (intramucosal) colonic adenocarcinoma (see Comment). Comment: ... in the upper stalk region, there is evidence of superficially invasive carcinoma which appears to be limited to the muscularis mucosa and thus would be intramucosal by classification. |
For cases diagnosed 1998-2003: Code extension as 12 [muscularis mucosae]. For this case, "upper stalk" is a reference to location rather than extension. This adenocarcinoma extends to the muscularis mucosa. |
2003 |
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20031057 | Grade, Differentiation--Bladder: How is this field coded for a five grade system? See Description. | Example: Invasive, high grade transitional cell carcinoma (Grade 4-5/5) | For this example, code grade as 4 based on the term "High grade." If "high grade" was not stated, the grade would be coded as 9, not determined. There is no SEER translation between the ICD-O grades and a five grade system for bladder. None of the pathololgist experts we querried knew of a five grade system for bladder. | 2003 |
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20031160 | EOD-Extension--Kidney: How would this field be coded when the pathology report shows a 20 mm surface neoplasm with smaller yellow metastatic implants on the surface of the kidney?" | For cases diagnosed 1998-2003: Code extension as 10 [Invasive cancer confined to kidney cortex]. Tumor involves the cortical surface of the kidney with separate surface lesions, but does not extend beyond cortex. | 2003 | |
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20031002 | Histology (Pre-2007)--Cervix: Is 8384/3 [adenocarcinoma, endocervical type] a specific histology type that must be stated or does it apply to any adenocarcinoma arising in the endocervical? Should the ICD-O-3 histology code of 8384/3 [Adenocarcinoma, endocervical type] be used for final diagnoses of "adenocarcinoma of the endocervix" or "adenocarcinoma of the cervix"? | For tumors diagnosed prior to 2007:
Histology code 8384 is for adenocarcinoma of endocervical type. This specific type (endocervical) must be part of the diagnosis in order to assign code 8384. This histology code is not to be used for Adenocarcinoma, NOS of the endocervix or cervix. Adenocarcinoma of endocervical type can be diagnosed in other tissues and if so it will be stated as endocervical type. Adenoca of the endocervix would be coded to plain Adenoca.
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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20031101 | Primary Site/Behavior Code/EOD-Extension: How would these fields be coded for "squamous cell carcinoma in situ involving papilloma -- locally aggressive but not technically invasive" found in the sphenoid sinus, soft tissue of the skull base and brain? See Description. | The managing physician has staged this pathologically as T4 N0 M0 squamous cell carcinoma of the ethmoid sinuses. The final pathology report says " Sinus, sphenoid, resection: papillary neoplasm most consistent with inverted papilloma with squamous cell carcinoma in situ, 7 cm in greatest extent, focus of probable superficial invasion (see comment). Soft tissue, skull base, excision: involved by papillary neoplasm with squamous cell carcinoma in situ (see comment). Brain, extradural, intercranial biopsy: involved by papilloma with squamous cell carcinoma in situ. COMMENT: This is a predominantly exophytic neoplasm with infolding of the tumor epithelium and in situ extension into submucosal glands. There are only focal areas suspicious for invasive squamous cell carcinoma, with probable invasion (<2mm) in one section....The histologic features are most consistent with an inverted papilloma with carcinoma in situ." When asked to comfirm if the diagnosis were in situ or superficially invasive, the pathologist responded "Squamous cell carcinoma in situ involving a papilloma. Locally aggressive but not technically invasive." |
Code site to C31.3 [sphenoid sinus]. Code the site based on the final pathology report diagnosis. In the case example, the site attributed to the managing physician appears to be an error.
Code behavior to 3 [malignant, primary site]. The SEER list of terms meaning involvement may be used to help determine behavior. The terms used by the pathologist are "probable" superficial invasion and "suspicious" for invasive squamous cell carcinoma with "probable" invasion. Interpret as invasive.
For cases diagnosed 1998-2003: Code extension to 70 [Brain] because this tumor involves the brain. |
2003 |
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20031144 | Histology (Pre-2007)--Breast: What code is used to represent the histology "Ductal carcinoma in situ; 6 mm focus of invasion is a pure mucinous carcinoma that appears to have arisen in the background of encysted papillary carcinoma." | Code to mucinous (8480) since that is the only clearly invasive component of this diagnosis. According to our pathologist consultant, "Encysted papillary carcinoma is the same thing as intracystic papillry carcinoma, which I think of as an intraductal papillary carcinoma which has greatly expanded the duct to form a cyst-like structure. It generally behaves in an in-situ rather than an invasive fashion. The only clearly invasive component is the mucinous carcinoma, which is what I would code." |
2003 | |
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20031032 | Diagnostic Confirmation--Hematopoietic, NOS: How should diagnostic confirmation of Hematopoietic diseases be coded in the absence of positive bone marrow? See Description. | Case 1. Patient admitted 9-12-02 with diagnosis of essential thrombocythemia. Per the H&P, patient obviously has had this since January 2001. Per the clinical history: patient with elevated platelets. Path diagnosis of bone marrow biopsy done 9-20-02 showed mildly increased megakaryocytes. 10-31-02 clinical sign-out diagnosis was: essential thrombocythemia. Case 2. Patient admitted for evaluation of erythrocytosis. Assessment: Increased hematocrit only. It is most likely that patient has polycythemia vera. I think it is reasonable to initiate phlebotomy treatment. |
Code 1, Positive histology, includes diagnostic hematologic findings and peripheral blood smears when these are the basis for diagnosis. When the clinician makes a specific diagnosis and the blood work is not diagnostic, code diagnostic confirmation as 8 [Clinical diagnosis only]. The clinician is putting together all evidence, including the blood work and using his/her professional experience to diagnose the case. Case 1. The diagnosis is not based on microscopic findings. Assign code 8 [Clinical diagnosis only]. Megakaryocytes are the immature form of thrombocytes, but mildly increased megakaryocytes are not diagnostic of essential thrombocythemia. Case 2. The diagnosis is not based on microscopic findings. Assign code 8 [Clinical diagnosis only]. |
2003 |