CS Lymph Nodes/Reg LN Pos/Exam: Is a final pathologic diagnosis of "Level 8 lymph node: Fibroadipose tissue containing a minute lymphoid aggregate, negative for malignancy" a lymph node for the purpose of coding these fields?
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.
Yes. "Fibroadipose tissue containing minute lymphoid aggregate" qualifies as a lymph node. Include in count as one lymph node examined in the example above assuming this is regional to the primary site.
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.
Reportability--Brain and CNS: Does a case of astrogliosis meet the criteria for gliomatosis cerebri? See Discussion.
Case clinically stated to be a glioma of the brain. Pathology from resection states astrogliosis.
Anderson's Pathology defines astrogliosis as astrocytic proliferations. Gliomatosis cerebri is defined as diffuse neoplastic transformation of poorly differentiated astrocytes over a wide area; predominantly invovles hemispheric white matter.
The pathologic diagnosis for this case, astrogliosis, is not reportable to SEER. Take the definitive diagnosis for this case from the pathology report from the resection. The pathology report takes precendence over the clinical diagnosis.
Date Therapy Initiated/Reason no treatment--Lymphoma: Is the date of the lymph node biopsy used as the date of treatment if the lymph node biopsy is the first treatment or the only treatment performed? Is the reason for no surgery coded to 0 [Surgery of the primary site was performed]?
For cases diagnosed prior to January 1, 2008, enter the date of the lymph node biopsy (excisional biopsy or biopsy NOS) as the Date Therapy Initiated for a lymphoma when the biopsy is the first or only therapy performed.
Code Reason for No Surgery of Primary Site as 0 [Surgery of the primary site was performed] and the biopsy of a lymph node is coded to 25 in Surgery to Primary Site.
Do not code a fine needle aspiration or core needle biopsy in Surgery of Primary Site.
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.
Reportability--Brain and CNS: Which types of neurofibromatosis are reportable to SEER? See Discussion.
Clin exam: probable neurofibromatosis, type I. On the trunk alone are >14 cafe au lait spots all at least 10mm. Both axillary regions have freckling. No palpable fibromas, spine is straight, no organomegaly. MRI of head: no abnormality.
Neurofibromatosis type I (von Recklinghausen's disease, the Elephant Man disease) is primarily tumors of the subcutaneous tissues. By itself, NF1 is not reportable. NF2 is much more likely to develop acoustic neuromas. This syndrome is reportable only when acoustic neuroma(s) is present, because the acoustic neuroma is what is reportable. This case is not reportable because none of the symptoms affect the central nervous system.
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.
2004 SEER Manual Errata/Grade--Breast: Are the codes on page 94 of the SEER manual's Breast Grading Conversion Table requiring conversion of nuclear grades 1/3 and 1/2 to code 1, 2/3 to code 2, and 2/2 and 3/3 to code 3 correct or are the codes on page C-473 in the Three-Grade System (Nuclear Grade) for breast correct that requires conversion of the same examples to codes 2, 3, and 4 respectively?
On page C-473: Delete the section titled "Three-Grade System (Nuclear Grade)" and delete the table. Use the tables on pages 94 and C-472 to code grade for breast cancer. This correction will be made in the next errata.
Reportability--Lung: Is sclerosing hemangioma of the lung with multiple regional lymph nodes metastases reportable?
No, it is not reportable. According to the WHO Classification of Lung Tumours, sclerosing hemangioma "behaves in a clinically benign fashion...Reported cases with hilar or mediastinal lymph node involvement do not have a worse prognosis."
CS Lymph Nodes/CS Site Specific Factor--Breast: When there are no lymph nodes removed and none palpable for an inflammatory breast cancer and the physician stages the case Nx, is the CS Lymph Node field code to 00 [None, no regional lymph nodes involved] or 99 [Unknown, not stated] and would SSF 4 and 5 be coded to 000 [Regional lymph nodes negative...] or 888 [Not applicable]?
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 00 [clinically negative]. See note 3 for CS Lymph Nodes.
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