Histology (Pre-2007)--Ovary: What code is used to represent clear cell cystadenocarcinoma of the ovary?
For tumors diagnosed prior to 2007:
Code histology to 8310/3 [Clear cell adenocarcinoma, NOS]. This is consistent with the WHO Classification of Tumours and reflects the current practice of placing less emphasis on "cyst-" prefix for ovarian malignancies.
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.
First Course Treatment/Immunotherapy--Colon: Can "Sandostatin" be coded for treatment of carcinoid tumors of the colon because it flushes tumor cells from the colon in addition to controlling diarrhea?
Do not code Sandostatin (Ocreotide Acetate) as treatment. This is an ancillary drug used to treat symptoms of diarrhea. SEER Book 8 is undergoing revision and will include this change.
Date of Diagnosis: When a 4/04 clinical impression indicates the appearance of a carcinoma that is contradicted by a negative 4/04 biopsy but is confirmed by a 5/04 resection, should the diagnosis date be coded to April or May? See Discussion.
4/04 colonscopy: irregular fungating mass that has appearance of carcinoma. 4/04 Bx: high grade dysplasia. 5/04: LAR. 5/04 Path: 3.2 X 2.5 cm mass wd adenoca with invasion of muscularis propria.
Should the diagnosis date be 4/04 based on the clinical impression during the colonoscopy OR 5/04 since the path for the bx was negative?
The date of diagnosis for the example above is 05/04 -- the date of the pathology report confirming malignacy. The biopsy in 04/04 negated the 04/04 clinical statement.
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.
Primary Site: What would the primary site be for carcinoma of the renal pelvis, status post transplant? Please see details below. See Discussion.
The patient has a renal pelvis urothelial carcinoma confined to the pelvis but is status post renal pelvic transplant of the same renal pelvis.
Code the primary site to renal pelvis [C659]. Code the site in which the primary tumor originated. The transplant status in this example does not affect the primary site.
Histology--Hematopoietic, NOS: When the histology is described in both WHO and FAB terms, which terminology has priority to code this field? See Discussion.
Example: Bone marrow biopsy was reported as: "Markedly hypercellular marrow aspirate with myelodysplastic alterations morphologically consistent with refractory anemia (FAB) or refractory cytopenia with multilineage dysplasia (WHO)."
For cases diagnosed prior to 1/1/2010:Give preference to the WHO terminology when both are used in the final pathology diagnosis. The WHO classification of tumors is the current standard and is recommended by the College of American Pathologists.
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--Colon: What is the difference between codes 46 [Adherent to other organs or structures, but no microscopic tumor found in adhesion(s)] and 57 [Adherent to other organs or structures, NOS]? See Discussion.
Code 46 reads "Adherent to other organs or sturcture, but no microscopic tumor found in adhesion(s)".
Would these examples be coded to 46?
Example 1: 7/04 Op findings: mass was adherent to duodenum without obvious invasion. Path: margins negative (no mention of duodenum). Case staged to pT3.
Example 2: Op findings: large mass involving cecum adherent to peritoneum & retroperitoneum. Path: invasion of pericolic soft tissue; margins negative (no metion of peritoneum & retroperitoneum). Case staged to pT3.
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.
Code 46: Attached to other organ (on imaging or surgical observation); pathology says no invasion of the other organ. Code 57: Attached to other organ; pathology is positive for invasion of other organ, or pathology does not specify whether there is invasion of the other organ.
Example 1: Code extension to 46 [Adherent to other organs or sturcture, but no microscopic tumor found in adhesion(s)]. The tumor was attached to the duodenum, but not invading
Example 2: Code extension to 46 [Adherent to other organs or structure, but no microscopic tumor found in adhesion(s)]. The tumor was attached to peritoneum & retroperitoneum, but not invading based on negative margins and no peritoneum or retroperitoneum specimen submitted to pathologist.
EOD-Extension--Sarcoma: How is this field coded for a soft tissue sarcoma that involves the overlying skin?
For cases diagnosed 1998-2003: It depends on the location of the soft tissue sarcoma. If the tumor is very superficial, code EOD-Extension to 60 [Adjacent organs/structures]. However, if the soft tissue sarcoma is between muscles or "deep" according to the AJCC definition, then it would have to grow through the superficial fascia to get to the skin. In this case code EOD-Extension to 80 [Further contiguous extension].