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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. |
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20031082 | EOD-Size of Primary Tumor: Pathologist states that the size of the tumor is difficult to measure but is greater than 3cm but less than 5cm. How would we code the tumor size? | For cases diagnosed 1998-2003:
Code the largest dimension mentioned, since that is the standard rule for coding tumor size. Keep in mind that tumor size is not used in analysis for certain sites such as stomach, colon & rectum, ovary, prostate, and urinary bladder. Tumor size is important for analysis for certain sites such as lung, bone, breast, and kidney. |
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20031115 | EOD-Lymph Nodes/EOD-Extension: Does extracapsular lymph node extension into adjacent tissue or organs affect EOD coding? See Description. | For a lung primary a PET scan showed marked uptake in the right hilum consistent with metastatic disease. A radical pneumonectomy was performed and the operative findings showed that the pulmonary artery was involved with a mass. Pathology: Small cell carcinoma in the lung parenchyma. The distal bronchi showed obstructive pneumonitis. There were mets found on 02/05 on the hilar lymph nodes and 00/02 peribronchial nodes. The mets in the hilar nodes extended beyond the lymph node capsule into the pulmonary artery. |
For cases diagnosed 1998-2003: Extracapsular lymph node extension does not affect the extent of disease. Code the extent of regional lymph node involvement in EOD lymph nodes. | 2003 |
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20031009 | Reportability/Behavior Code--Soft Tissue: Is a final diagnosis of a forearm mass diagnosed as "Angiomatoid malignant fibrous histiocytoma [see note]" reportable? The NOTE reads "Angiomatoid malignant fibrous histiocytoma is a low grade borderline lesion with a tendency for local recurrence, but a very low potential for distant metastases." Is behavior /1 or /3? | Angiomatoid malignant fibrous histiocytoma is reportable with a behavior code of /3 according to ICD-O-3. The Final Diagnosis takes precedence over the "note." | 2003 | |
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20031112 | Primary Site/Histology (Pre-2007)--Unknown & ill-defined site: How are these fields coded for a markedly atypical high grade malignant neoplasm diagnosed by a fine needle aspiration of a large iliac mass, right buttock area? See Description. |
The diagnosis was made in Oct. 2002 by a CT guided fine needle aspiration of a large iliac mass, right buttock area. The cytology report says: a. positive for malignant cells, markedly atypical high grade malignant neoplasm. b. It is impossible to tell from this aspiration biopsy whether or not this represents a high grade sarcoma or a high grade carcinoma, but our consensus opinion is that this lesion is a high grade carcinoma. The combination of soft tissue topography and carcinoma morphology is Impossible by SEER edits. How should we code this? |
For tumors diagnosed prior to 2007: Code the site to C76.3 [Pelvis, NOS]. Code the histology to 8010/34 [Carcinoma, NOS, high grade]. Unless there is better information available regarding the site, assign C76.3. The information provided above does not indicate the exact site of the mass. Code the histology based on the consensus opinion stated above. 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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20031158 | Multiple Primaries (Pre-2007)--Trachea/Lung: Would synchronous lesions, of the same histology, diagnosed in the right upper lobe of the lung and trachea be a single primary when the physician feels they are two separate primaries? |
For tumors diagnosed prior to 2007: According to SEER rules, abstract as one primary because although these sites have separate topography codes in ICD-O-3, they were coded to the same three-digit topography code in the first edition of ICD-O (SEER Program Code Manual, 3rd Edition, page 8, Exception B). Simultaneous lesions of the same histology in trachea and lung are one primary. Code the primary site to C399 [Ill-defined sites within respiratory system]. 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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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. |
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20031025 | Histology (Pre-2007): Is a small cell undifferentiated carcinoma coded to 8041/34 [small cell carcinoma undifferentiated] or to 8045/34 [combination small cell AND undifferentiated carcinoma] using terms from the 2 columns in Appendix 1 of Coding Complex Morphologic Diagnoses? See discussion. | Per pathology report, diagnosis is small cell undifferentiated carcinoma in biopsies taken from the laryngeal surface of the epiglottis and left false vocal cord. | For tumors diagnosed prior to 2007:
Code histology as 8041/34 [small cell carcinoma, undifferentiated]. The diagnosis indicates that this is an undifferentiated small cell carcinoma, rather than a mixture of small cell carcinoma with undifferentiated carcinoma.
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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20031089 | Primary Site/Histology (Pre-2007)--Bone: How are these fields coded for a squamous cell carcinoma in bone? See Description. | The consult path report says "I believe that there is definitely high grade malignant tumor in this amputation specimen, and that this tumor represents an invasive squamous cell carcinoma, which is extending into the bone and permeating in between the bone trabeculae. ... The fact that squamous cell carcinoma can arise from the sinuses of chronic osteomyelitis is well recognized." | For tumors diagnosed prior to 2007:
Based on the information provided, code the primary site as C40._ or C41._ [bone] because the tumor originated in the sinuses of chronic osteomyelitis. Code to the site in which the tumor arises. Override the SEER site/histology edits to allow this rare combination of bone and squamous cell carcinoma.
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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20031052 | Diagnostic Confirmation--Hematopoietic, NOS: Is a multiple myeloma diagnosed by an FNA of the lumbar spine (or any other non-bone marrow location) a diagnostic confirmation 1 or 2? See Description. |
Does the rule on page 111 of the SEER Program Coding Manual, 3rd Edition, for code 1 apply to myelomas (in the same way it applies to leukemias)? |
Assign code 1 [Positive histology] for aspiration of bone marrow. This rule is not limited to leukemias. |
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