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Report Produced: 11/29/2024 11:34 AM

Report Question ID Question Discussion Answer Year
20041095 Primary site: How is this field coded for a malignancy described as a "intracranial squamous cell carcinoma (8070) arising in a previous epidermoid cyst"? See Discussion.

4-5-02 MRI Brain: Enhancing mass is probably a recurrence of the original tumor resected in 1983 (benign). 4-8-02 Gross resection. Lesion was coming up against her brain stem: Removed it grossly.

Path: 4-8-02 Brain tumor, left temporal: SCC arising from a previous epidermoid cyst of the brain. XRT began 4-25-02.

Path states: "Squamous lesions suspicious for malignant transformation of old epidermal cyst (1983). It has been reported in literature that epidermoid cysts in the brain can undergo a malignant transformation which is what happened in this case."

It appears the patient has an intracranial epidermoid cyst that is now

giving rise to SCC. Squamous cell carcinoma (8070) of the brain (C71_) fails the edit Primary Site, Morphology-Imposs ICDO3 (SEER IF38).

 Code the primary site to C760 [Ill-defined site; Head, face or neck, NOS]. There is an intracranial malignancy arising from a previously resected epidermoid cyst. Squamous cell carcinoma, primary of the brain, is a non-overridable edit error. 2004
20041032 Primary Site--Head & Neck: How is this field coded for a tongue primary described as "located on the lateral" or "left oral" tongue? See Discussion.

Case 1. Patient with squamous cell carcinoma, left oral tongue.

Case 2. Squamous cell carcinoma, left lateral tongue.

Case 3. Patient status post biopsy of lesion on tongue. Exam: healing left lateral tongue incision with sutures in place in underside of tongue.

Code Primary Site for cases 1 and 2 above to C023 [Anterior 2/3 of tongue, NOS]. Code lateral tongue without mention of dorsal or ventral surface to C023 [Anterior 2/3 of tongue, NOS].

Code Primary Site for case 3 to C022 [Ventral surface of tongue]. The underside of the tongue is specified as the site of the biopsy in case 3.

 2004
20051094 Grade, Differentiation/Priorities: Which has priority, the differentiation or the nuclear grade for a liver biopsy histology described as "well differentiated hepatocellular carcinoma, nuclear grade 3/4"? For most sites, differentiation has priority over the nuclear grade when both are specified (excluding breast and kidney). Assign grade code 1 [well differentiated] to the example above. 2005
20051096 Primary Site--Peritoneum: During a second look staging lap following a diagnosis of serous carcinoma of the left ovary, did the physician correctly indicate a new peritoneum, NOS primary for disease described as an endometrioid adenocarcinoma in a "paracaval cyst" that appears to have arisen in endometriosis?

The primary site is C482 [Peritoneum, NOS]. "Paracaval" means alongside or near the vena cava.

Code the site in which the primary tumor originated.

 2005
20051048 Multiple Primaries (Pre-2007)/Recurrence--Cervix: How many primaries should be abstracted if a patient had a diagnosis in 1998 of adenocarcinoma in situ of the cervix treated with a total hysterectomy and a July 2004 vaginal mass biopsy with a diagnosis of invasive adenocarcinoma that is consistent with an endocervical primary?

For tumors diagnosed prior to 2007:

Abstract the July 2004 diagnosis as a new endocervical primary. Abstract an invasive cancer in the same site more than two months after an in situ cancer as a new primary. Residual cervical tissue is present following a hysterectomy.

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.

 2005
20051006 Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Thyroid: How is histology coded for the tumor(s) that exist when the thyroidectomy addendum diagnosis is "Morphologic and IHC evaluations reveal two tumors: papillary thyroid carcinoma and squamous cell carcinoma." See Discussion. The original final diagnosis after a thyroidectomy is "papillary carcinoma of the thyroid with an adjacent invasive squamous cell carcinoma, moderately differentiated." Per the additional addendum comment: "The findings can be interpreted in one of 2 different ways. Either there is a collision tumor of papillary thyroid and squamous cell carcinoma (with the squamous cell ca originating at a site other than the thyroid gland.) Or, less likely, there is a malignant squamous differentiation in the papillary thyroid carcinoma." A university hospital consultation report states the diagnosis as: "Spindle cell squamous cell carcinoma arising in association and from papillary carcinoma, predominantly tall cell variant..." Is this 2 thyroid primaries: 8344/3 [papillary carcinoma, tall cell] and 8074/3 [squamous cell carcinoma, spindle cell]?

For tumors diagnosed prior to 2007:

Our pathologist consultant agrees with the consultant's diagnosis. Therefore, abstract this as one primary of the thyroid. Code the histology as 8344 [Papillary tall cell]. This is the most appropriate histology code available for this complex case.

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.

 2005
20051019 CS Lymph Nodes--Breast: How is this field to be coded if the pathologist staged the case pN1a and the lymph node is stated to be negative on H&E, is .3 cm on IHC stain for pancytokeratin but on review of smears shows no malignant cells?

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 CS Lymph Nodes as negative [00]. The positive stain for pancytokeratin is contradicted by the statement "malignant cells are not identified." See also sinq 20010055.

 2005
20051049 Reportability/Primary Site--Head & Neck: If a wedge resection/shield resection is performed on the lower lip for SCCA and the path report refers to "lip, NOS" with no mention of vermilion border, is this case reportable? Review the operative and pathology reports, and the physical exam for mention of "mucosal surface" (reportable) or "skin" (not reportable). If neither are mentioned, lip, NOS is reportable per the ICD-O-3 code of C009. 2005
20051074 CS Extension/CS Lymph Nodes--Colon: What codes are used when large vessel invasion (V2 grossly evident) is stated to be present on a pathology report? See Discussion.

Example

Cecum, right hemicolectomy: poorly differentiated invasive adenocarcinoma of the cecum. Large vessel invasion (V2-grossly evident) is present. Microscopic description: The grossly described matted lymph node tissue shows an irregular nuclear contour and is classified as V2, grossly evident venous invasion based on staging criteria of the AJCC Cancer Staging Manual, 6th Edition.

Per note 2 in the coding scheme for CS-Extension, a nodule with irregular contour in the pericolic adipose tissue should be coded in CS-Extension to code 45. Is the large vessel invasion described in the path report the same process as a tumor nodule in pericolic fat? Should note 2 be used and CS-Extension coded to 45?

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.The description of large vessel invasion and irregular nuclear contour from the example above describes grossly matted LYMPH NODE tissue. Do not code this in the CS Extension field. Code the CS Lymph Nodes field appropriately based on the rest of the information for this case.

When large vessel invasion and irregular nuclear contour is used to describe a "tumor nodule," rather than a recognizable lymph node, code it in the CS extension field.

 2005
20051061 CS Tumor Size/CS Extension/CS Lymph Nodes--Lung: How are these fields coded when there is no description of a primary lung tumor, lymph node biopsies are negative, but biopsy of a "level 7 mass" is positive for squamous cell carcinoma? See Discussion. Example: Chest CT: Enlarging subcarinal mass, 3.4 cm, is most likely malignant adenopathy or perhaps primary tumor. The clinician subsequently described a patient history of mediastinal lymphadenopathy. He stated that a PET scan revealed multifocal thoracic disease consistent with stage 3B carcinoma. This was followed by mediastinoscopy with lymph node biopsies (all negative) but the biopsies of "level 7 mass and subcarinal level 7 mass" showed squamous cell carcinoma.

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.If this case is determined to be a lung primary, code the CS fields:

CS Tumor Size: 999 [Unknown]

CS Extension: 99 [Primary tumor cannot be assessed]

CS Lymph Nodes: 20 [Subcarinal lymph node involvement] based on positive level 7 biopsy, history of mediastinal lymphadenopathy and subcarinal "adenopathy" per CT.

 2005