Histology (Pre-2007)/Diagnostic Confirmation: Which histology code is preferred if the CBD brushing is positive for malignant cells, cytologically most consistent with ductal adenocarcinoma [8500/3], and the common hepatic artery lymph node biopsy has metastatic adenocarcinoma, consistent with cholangiocarcinoma [8160/3]?
For tumors diagnosed prior to 2007:
Assign histology code 8160 [Cholangiocarcinoma]. Code from the pathology specimen when available. In this case, the only pathology is from the lymph node specimen.
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.
Surgery of Primary Site--Melanoma: If the surgical margins are greater than 1 cm for length and width but less than 1 cm for depth, do we code surgery in the 30-33 range?
Yes, assign a surgery code from the 30-33 range when any margin is less than 1 cm. Since tumor thickness is an important prognostic factor for cutaneous melanoma, the deep margin is of particular importance.
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 Site Specific Factor 3--Prostate: When a prostatectomy specimen shows tumor focally penetrating through the capsule into periprostatic striated muscle tissue, is the involvement coded to 041 [periprostatic tissue] or 052 [skeletal muscle, NOS]?
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 052 [Levator muscle, Skeletal muscle, NOS, Ureter]. The description for this case states periprostatic "striated" muscle tissue. According to our pathologist consultant, "striated muscle in this context is skeletal muscle and the term is being used to differentiate the muscle from smooth (non-striated) muscle." Smooth muscle involvement would be most likely be coded 050 [Extension to bladder neck...] because smooth muscle in a prostatectomy or TURP specimen is usually from the urinary bladder neck.
CS Eval--Ovary: How is CS Mets Eval coded when the patient has positive pleural effusion confirmed by cytology?
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 Mets Eval for the example above 3 [path exam of metastatic tissue] assuming there has been no pre-treatment. Positive cytology is required for confirmation of pleural effusion for an ovarian primary.
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.
Reportability/Recurrence (Pre-2007)--Bladder: If a patient has had recurrent invasive bladder cancers since 1971, should the latest recurrence in 2003 be SEER reportable because the case has yet to be reported to SEER?
For tumors diagnosed prior to 2007:
Because this 2003 recurrent bladder cancer was initially diagnosed prior to 1973, it is not reportable to SEER.
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 Extension--Cervix: How are "positive pelvic washings" coded for a cervical primary?
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.
According to the CS Steering Committee, positive pelvic washings for primary cervical cancer are not part of the staging criteria in the collaborative staging system (nor in TNM and FIGO). Document positive pelvic washings in a text field. The CS steering committee will add a statement to CS extension to clarify this for cervix uteri.
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.
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.