Grade, Differentiation--Bladder: If the only indication of grade for a bladder primary is "grade 2, NOS," and we do not know the grading system being used by the pathologist, is the numeric grade 2 coded?
See the General Coding Rules on page 92 of the 2004 SEER Manual for instructions about coding grade.
If the only information available is "Grade 2," assign code 2 [Grade II].
CS Extension/CS Site Specific Factor--Breast: How is extension (localized or unknown) and SSF6 (entire tumor in situ or 888) coded for an in situ breast primary in which bone metastasis is diagnosed 4 months following the mastectomy? See Discussion.
In situ breast primary with bone mets. No mets work up prior to mastectomy done 2/04. Path: 2.5 cm mass: ductal carcinoma in situ, solid type, with comedonecrosis (no invasive carcinoma found in mastectomy specimen). Bone scan done 4/04 showed compression fractures. MRI 6/04 showed diffuse metastatic disease of the bones.
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.
First, determine whether the bone mets in this case are progression of disease. If the patient was asymptomatic at the time of the mastectomy, the bone mets are disease progression, not initial stage.
If the initial stage includes the bone mets and they are not disease progression, extension must be coded to at least 10. Code site-Specific Factor 6 to 040 [Size of entire tumor coded, size of invasive component not stated].
Reportability--Skin: Is a non-small cell carcinoma [8046/3] of the skin SEER reportable?
Non-genital skin primaries with a histology code equal to or less than 8110 are not reportable to SEER; therefore, the combination of C44_ and 8046/3 is not reportable.
CS Lymph Nodes--Breast: Are small isolated tumor emboli occasionally found in lymph node capsular or pericapsular lymphatics sufficient to code as a lymph node metastasis?
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 "small isolated tumor emboli" in the pericapsular lymphatics detected by H&E that are less than 0.2 mm as 05 [Regional lymph node(s) with ITC's detected on routine H & E stains].
CS Extension--Retinoblastoma: When the degree of extension differs between the retinas, how is extension coded for simultaneous bilateral retinoblastoma?
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 the CS extension code that corresponds to the greatest level of extension seen in either eye, excluding information from enucleation.
Record extension based on enucleation in Site Specific Factor 1.
Record bilateral disease under laterality. For retinoblastomas, bilaterality is not a component or consideration for staging.
Surgery of Primary Site--Breast: How is the surgery field coded when an excisional biopsy that is originally stated to be negative is later determined to be positive on ROS and a mastectomy with negative findings is performed 2 years later? See Discussion.
Hospital 'A' performed a breast biopsy and found only atypia. Two years later Hospital 'B' re-read the first biopsy as multifocal ductal carcinoma in situ, cribriform type. A mastectomy at Hospital 'B' followed and all specimens from this were negative.
Do we report the procedure at Hospital 'A' an excisional biopsy, despite the negative findings at the time?
For hospital A, follow the instructions in the 2004 SEER Manual on page 5, #4. For hospital B, the case is not reportable.
The diagnosis date is the date of first excision. Code the breast excision from Hospital A as surgery, first course treatment. The mastectomy was not part of first course treatment.
CS Reg LN Pos/Exam--Breast: How are nodes positive/examined coded for a positive FNA of a lymph node followed by a subsequent lymph node dissection? See Discussion.
A breast cancer patient had an FNA of an axillary lymph node positive for metastases. A modified radical mastectomy with lymph node dissection showed six lymph nodes negative for metastases.
Example 1: Patient received neoadjuvant chemotherapy prior to mastectomy and lymph node dissection.
Example 2: Patient received no neoadjuvant therapy.
This question is answered for EOD in SINQ 20031059. What is the answer for Collaborative Stage?
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.Include all nodes examined by the pathologist in Regional lymph nodes positive and Regional lymph nodes examined, unless there is disease progression. These fields are cumulative -- record the total number of regional nodes positive and examined during first course of treatment. Preoperative treatment does not affect the coding of these fields.
An FNA alone, positive for regional lymph node metastasis is coded as 95 for number positive and 95 for number examined.
For the case examples above, assuming there has been no disease progression, include all nodes positive and all nodes examined from both the FNA and the lymph node dissection in the counts. Code number of regional nodes positive as 01, number examined as 07 for both examples.
Priorities/CS Tumor Size--Breast: What is the priority order used in coding tumor size for this site when there is a larger 2 cm lesion noted on the PET scan and smaller sizes described in the pathology report as two malignant masses one measuring 0.8 cm and the second measuring 1.0 cm per the GROSS?
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 Tumor Size as 1.0 cm. The pathology report is the highest priority source for coding tumor size. When multiple tumors are present, code the size of the largest tumor.
Histology (Pre-2007)--Melanoma: How is histology coded if the final diagnosis is "melanoma" and only in the comment section of the pathology report is there an indication of "Type: Lentigo Maligna. Cell Type: Small Cell"?
For tumors diagnosed prior to 2007:
Code the histology as 8742 [lentigo maligna melanoma]. Code the specific histologic type, even if stated only in the comment section.
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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