Report | Question ID | Question | Discussion | Answer | Year |
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20061142 | Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Skin: How many cases are to be abstracted and how is the histology field(s) coded for cases in which a fibrosarcoma arises in or transforms from a dermatofibrosarcoma protuberans? See Discussion. | 1. If the fibrosarcoma occurs after DFP, and is called metastatic, is it a recurrence or is it a new primary? Example: Pt diagnosed in 7/05 with a high grade fibrosarcoma arising in a dermatofibrosarcoma protuberans. The path indicated "The presence of high grade fibrosarcoma, the extent of the tumor necrosis and the mitotic rate are all adverse prognostic findings that indicate a significant risk for mets." The patient had a recurrence in 8/06 called a low grade fibrosarcoma mets from prev." The DFP code is 8832/3 and a fibrosarcoma code is 8810/3. Our pathologist feels that the fibrosarcoma is a more aggressive tumor so should the case be coded to the 8810/3.
2. If DFSP has areas of fibrosarcoma, should it be coded to the latter because it is more aggressive? Example: Skin and subcutaneous tissue reads: Low grade sarcoma - tumor extends to margin. Comment: "Although the predominant pattern of this tumor is consistent with dermatofibrosarcoma protuberans, focal presence of hypercellularity and increased mitotic figures suggest transformation to Grade I fibrosarcoma. This progression, although focal, carries an increased risk of mets over classic DFSP. Code to 8810/31? |
For tumors diagnosed prior to 2007:
Code histology to 8832/3 [Dermatofibrosarcoma protuberans] for both cases. DFSP with transformation to fibrosarcoma and DFSP with areas of fibrosarcoma are coded to 8832/3.
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. |
2006 |
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20061025 | Histology--Hematopoietic, NOS: How is an "advanced MDS (RAEB-T)/emerging AML" coded when discovered on a bone marrow biopsy? | For cases diagnosed prior to 1/1/2010:Code histology to 9984/3 [RAEB-T]. This particular MDS is refractory anemia with excess blasts in transformation. It has not yet progressed to acute myeloid 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. |
2006 | |
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20061024 | Histology (Pre-2007)--Kidney: How is a "mucinous tubular and spindle cell carcinoma" coded? See Discussion. | Literature search results: "The new WHO-classification of renal tumors includes new subtypes, one of which is the mucinous, tubular, and spindle cell carcinoma. Many of these tumors had been previously diagnosed as sarcomatoid carcinoma. There are areas of cord-like growth and spindle cell configuration, sometimes with a clear cell appearance." | For tumors diagnosed prior to 2007:
Code histology to 8255 [Adenocarcinoma with mixed subtypes]. ICD-O-3 does not have a code specific to this combination histology. 8255 is the best code available.
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. |
2006 |
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20061032 | Behavior--Head & Neck: Should the SEER IF_Morph_3 edit be modified because it does not allow a behavior code 2 with histology 8941 [carcinoma in a pleomorphic adenoma] for a parotid primary? | Code the behavior as 2 and over-ride the edit. The edit is there to flag unusual combinations. Once you have verified that the behavior is coded correctly, over-ride the edit. The surgeon stage of T2 is based on size of tumor, the TIS is based on behavior. Code according to pathologically confirmed TIS. |
2006 | |
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20061117 | Histology (Pre-2007)--Melanoma: Is the code 8740/3 [malignant melanoma in a junctional nevus] to be used when the pathologic diagnosis is "malignant melanoma arising in a compound nevus"? | For tumors diagnosed prior to 2007:
Assign code 8720/3 [malignant melanoma, NOS] for malignant melanoma arising in a compound nevus. A compound nevus is not the same as a junctional nevus. ICD-O-3 does not have a specific code for melanoma in a compound nevus. Assign the code for the type of melanoma specified; for example, NOS, superficial spreading, etc.
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. |
2006 | |
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20061034 | Primary Site--Unknown & ill-defined site: Is the primary site code C809 [Unknown primary site] preferred over the use of a site code for an organ system (e.g., biliary tract, NOS) or a specific primary site (e.g., colon, NOS) when these are "favored" but other potential sites "cannot be excluded"? See Discussion. | Case 1 - CT: Mult pulm nodules, bilat pleural effusions; paraaortic, paracaval, celiac lymphadenopathy. Lytic lesions L4&L5. Bx L3: Met pd adenoca. Based on the histopathologic features and the results of the immunostains, cholangiocarcinoma is regarded as the most likely primary. However, other possible primaries include pancreas, stomach, and (remotely) lung. Should primary be coded as C26.9, digestive organ, NOS?
Case 2 - CT: Mult liver masses. Liver Bx: Mod diff adenoca. The most likely primary sites include cholangiocarcinoma, stomach and pancreas. FDx per attending: Met adenocarcinoma to the liver, probably biliary origin. What primary site code do we use?
Case 3 - Admitting Dx: Unknown primary with mets to lungs, liver and cerebellar area. Liver Bx: Met adenoca. The combination of morphological and immunohistochemical staining favor a colon primary. However other possibilities include cholangiocarcinoma and pancreatic ca. Should we code site as C18.9 or C26.9? |
Code the primary site according to the physician's opinion. An ill-defined site code or an NOS code for the organ system is preferred over C809 [Unknown primary site] whenever possible. Code C809 only when there is not enough information to use an ill-defined or NOS code. Case 1 and Case 2 - Assign code C249 [Biliary tract, NOS]. Based on the available information, the physicians believe these are most likely biliary primaries. Case 3 - Assign code C189 [Colon]. According to the available information, the physician believes this is most likely a colon primary. |
2006 |
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20061031 | CS Extension--Head & Neck: If a 2 cm left tonsil primary extends to the lateral aspect of the soft palate, should extension be coded to 40 [Soft palate, inferior surface including uvula or soft palate NOS] or 42 [Soft palate, superior (nasopharyngeal) surface] for a tonsil 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. Extension code 40 is for extension from the tonsil to the back (lower) part of the soft palate, or soft palate, NOS. Code 42 is for extension to the front (higher, nasopharyngeal surface) part of the soft palate. Inferior soft palate is the back (lower) part of the soft palate (C051). Superior soft palate is the front, (nasopharyngeal surface) of the soft palate (C113). Assign CS extension code 40 to the case above. |
2006 | |
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20061092 | CS Tumor Size--Breast: Should this field be coded to 999 [Unknown] or 008 [0.8 cm tumor] when the tumor size is not provided on a stereomammotomy biopsy for an in situ malignancy and a subsequent excision demonstrates 0.8 cm tumor of residual in situ disease? | 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 008 [0.8cm]. A mammotomy specimen is very small, so for this case, the residual tumor size is quite accurate. Size is not a critical data element for in situ breast cancer. |
2006 | |
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20061140 | CS Extension/CS Mets at Dx--Corpus uteri: Is a microscopic metastasis in a cul-de-sac implant more appropriately reflected in the CS Extension field code 80 [Further contiguous extension; cul-de-sac] or in the CS Mets at Dx field code 40 [Distant 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.Assign code 80 [Further contiguous extension; Cul de sac] for CS extension in this case. Endometrium and ovary are exceptions to the rules that only contiguous extension is coded in Extension code 80. Only true distant metastases are coded in Mets at Dx. |
2006 | |
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20061136 | Primary Site: What site code best reflects the final diagnosis of a metastatic "pancreatobiliary" adenocarcinoma to the liver? See Discussion. |
CT showed multiple masses in the liver and lymphadenopathy in areas of gastrohepatic ligament, celiac axis, superior mesenteric and left periaortic regions. No mention of a mass in pancreas or common duct. When the term "pancreatobiliary" primary is stated in the final diagnosis, what site code should be used? |
Contact the physician for clarification of the term "pancreatobiliary." If no further information can be obtained for this case, assign code C249 [Biliary tract, NOS] based on the CT findings for the specific case in this question. When the primary is described as "pancreatobiliary" with NO FURTHER INFORMATION, assign C269. |
2006 |