Multiple Primaries (Pre-2007)/Histology (Pre-2007)/Grade, Differentiation--Thyroid: How many primaries, with what histologies should be coded when a thyroidectomy reveals "anaplastic carcinoma" and "papillary carcinoma" occurring as two separate tumors? See Discussion.
Example: Thyroidectomy revealed anaplastic carcinoma of the thyroid with mets to lymph nodes. The path report stated that the thyroid specimen also contained a small papillary carcinoma. Differentiation for the papillary carcinoma was not stated.
For tumors diagnosed prior to 2007:
Accession and code as two thyroid primaries:
Anaplastic carcinoma [8021/34]
Papillary carcinoma [8260/39]
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.
Reportability: When a biopsy is suspicious for cancer and re-biopsy is negative, is reportability based on the clinician's judgement (cancer vs NED)?
If the re-biopsy was done because the first biopsy was inconclusive, do not report this case. If the re-biopsy was more complete, or performed in an attempt to gain a wider margin, this case is reportable based on the first biopsy.
Multiple Primaries (Pre-2007)--Colon: What is the number of primaries for a case of familial polyposis with at least three separate tumors having invasive adenocarcinoma, one in the rectum? See Discussion.
A patient had a total proctocolectomy and was found to have familial polyposis. At least 3 separate tumors were identified with invasive adenocarcinoma, one of which was in the rectum. Is this 2 primaries: C18.9 with 8220/3 and C20.9 with 8140/3 or is this all one primary cancer?
For tumors diagnosed prior to 2007:
Familial polyposis is always a single primary. Code the primary site for the case example above to C199 [colon and rectum].
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.
Primary Site--Lymphoma: How should this field be coded when a diffuse large B-cell lymphoma is found in the femur and in the soft tissue of the anterior chest wall but all CT scans are negative for lymphadenopathy?
For cases diagnosed prior to 1/1/2010:Code the Primary Site field to C809 [Unknown primary site]. The primary site of diffuse large B cell lymphoma can be either nodal or extranodal. The case described above is likely extranodal because there is no evidence of lymph node involvement. Because the extranodal site of origin is unknown, code the Primary Site to C809.
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.
Reporting Source: Is an ER patient who is diagnosed on peripheral smear with an acute leukemia coded as an outpatient if the patient died while in the process of being admitted for treatment or is the patient coded as a death certificate case?
Code reporting source as 1 [Hospital Inpatient/Outpatient or Clinic] for the case above. This case will be abstracted using information from the outpatient/ER record (and the death certificate).
Primary Site/Grade, Differentiation, Cell indicator--Lymphoma: Will a Grade, Differentiation code of 6 [B-cell] for a lymphoma coded to primary site C80.9 [unknown] fail edits? See Discussion.
Patient had a large mass in chest wall that was excised and found to be large B cell lymphoma. Scans mentioned no involvement of lymph nodes but indicated nodules in the liver thought to be lymphoma as well.
For cases diagnosed prior to 1/1/2010:The combination of a primary site C809 with a Grade, Differentiation code of 6 when used for a lymphoma will not fail SEER edits. Avoid coding primary site to C809 when possible. Code primary site for the example above to C761 [Chest wall, NOS]. The chest wall is the only area of involvement, except for "liver nodules." Liver is an unlikely primary site for lymphoma.
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--Lymphoma: How many primaries should we abstract when Single Versus Subsequent Primaries table indicates one primary but special pathological studies indicate two primaries? See Description.
The patient had a malignant lymphoma, large B cell (9680) diagnosed in 2000. In 2003, he came in and had a spleen biopsy which showed follicular lymphoma (9690). These are the same NHL, according to the table lookup. However, the pathologist states in 2003, "Special stains now show a kappa clonal lymphoma. Since the first diagnosis was a lambda monoclonal lymphoma, this is not felt to be a recurrence of the original lymphoma."
For cases diagnosed prior to 1/1/2010:Abstract the example above as two primaries. Hematologic malignancies (including lymphoma) and solid tumors are handled differently when determining the number of primaries. For hematologic malignancies, take the physician's opinion into account. Use the Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table as an aid when there is insufficient information available.
For solid tumors, follow the multiple primary rules in the SEER Program Code Manual.
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.
CS Extension/EOD Extension--Renal Pelvis: Primary site is renal pelvis with direct extension to the rt adrenal gland. What is the correct extension code?
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.
Assign CS Extension code 67 [Adrenal gland from renal pelvis] for adrenal extension from renal pelvis -- T4 and regional direct extension.
Histology (Pre-2007)--Colon: Is the histology coded as adenocarcinoma arising in a polyp when the final diagnosis on the pathology report is adenocarcinoma but the colonoscopy report associated with the path states that the surgeon performed a polypectomy? See Discussion.
Histology: 3/04 Colonoscopy with polypectomy of a sessile appearing polyp. Path report: Final Dx: Adenocarcinoma; Micro: Adenocarcinoma apparently arising from the mucosa...noted to invade the muscularis mucosa into the submucosa.
For tumors diagnosed prior to 2007
Code this case to adenocarcinoma [8140]. The best source for histology is the final diagnosis on the path report from the procedure that removed the most tumor tissue. When there is a conflict, the path diagnosis has higher priority than the colonoscopy diagnosis for coding histology.
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.
Ambiguous Terminology/Reportability: Is the phrase "indicative of cancer" SEER reportable?
No. The phrase "indicative of cancer" alone is not a definitive cancer diagnosis. The word "indicative" is not on the list of ambiguous terms that is equivalent to a diagnosis of cancer.
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