Histology (Pre-2007)--Ovary: What codes are used to represent "mixed papillary serous and clear cell carcinoma" and "papillary serous carcinoma with focal clear cell features" of the ovary?
For tumors diagnosed prior to 2007:
Assign code 8323 [Mixed cell adenocarcinoma] to "mixed papillary serous and clear cell carcinoma." This is histology coding rule 3 in the 2004 SEER manual under single tumor (page 86). There is no other code for this mixture.
Example 1: 8323
Example 2: 8461 (clear cell is not coded according to Rule 6, page 87, because it is not the majority of the tumor).
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.
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.
CS Site Specific Factor--Melanoma: What is the correct code for measured thickness in SSF 1 for a melanoma of the choroid without an enucleation? See Discussion.
CS Site Specific Factor 1 for melanoma of the choroid codes "Measured Thickness (Depth), Breslow's Measurement." The note for this field states "Record actual measurement in millimeters from the pathology report." For melanoma of the eye, there is often only an eye exam report stating the thickness. Can PE thickness (clinical statement only) be coded for SSF 1 or is this field coded only from pathology? (i.e., all cases treated without enucleation would have this field coded to 999)
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 SSF 1 999 [Unknown] when there is no enucleation, and therefore, no pathology report for a choroid melanoma.
Date of Diagnosis--Lung: Should the diagnosis date be coded to the date of the scan or the date of the resection when there is a negative biopsy that occurs between the two procedures? See Discussion.
11/2003 CT chest: 2 cm LLL mass should be considered carcinoma until proven otherwise.
2/2004 CT Chest: stable LLL mass still consistent with primary or metastatic lung neoplasm
11/2004 CT chest: LLL mass suspicious for slow growing carcinoma
3/2005 FNA L lung: atypical cells
4/2005 L lobectomy: well-diff adenocarcinoma
Code the date of diagnosis as 11/2003. A clinical diagnosis was made on 11/2003 and this is the earliest date of diagnosis for this case.
Histology--Leukemia: How is "T-Cell prolymphocytic leukemia, cerebriform (Sezary cell-like) variant" coded when the pathology report COMMENT states: The cerebriform (Sezary cell-like) variant accounts for about 5% of cases of T-cell prolymphocytic leukemia?
For cases diagnosed prior to 1/1/2010:
9834/3 [Prolymphocytic leukemia, T-cell type]. According to the WHO Classification of Haematopeietic and Lymphoid Tissue Tumours, cerebriform or Sezary cell-like is a variant form of T-cell prolymphocytic leukemia.
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 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.
CS Eval--All Sites: If any of the CS fields (TS/Extension, LN, or Mets) are based on the TNM and there is no text documenting the basis for the evaluation, are the evaluation fields coded to 0 instead of 1?
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 code 0 [No surgical resection done...based on physical exam...or other non-invasive clinical evidence] to the corresponding eval fields when CS Extension, Lymph Nodes or Mets at Diagnosis are coded based only on the TNM and no further information is available.
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.
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.