Report | Question ID | Question | Discussion | Answer | Year |
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20061003 | Reportability--Brain and CNS: Is Langerhans cell histiocytosis [9751/1] of the meninges [C709] reportable? | For cases diagnosed prior to 1/1/2010:Yes. The criteria for reportable benign/borderline CNS tumors is based on location (site) and behavior (benign/borderline). There is no caveat for histologic type. Therefore, this would be reportable as these tumors have been reported arising from the meninges or choroid plexus. 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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20061039 | CS Tumor Size/CS Site Specific Factor--Breast: Should the tumor size be coded to 1.5 cm or 2.5 cm and SSF6 coded to 020 or 030 respectively for a tumor with invasive and in situ components described as being a 2.5 cm tumor with a "greater than" 1.5 cm invasive portion? See Discussion. | Should tumor size be coded to 1.5 cm and SSF6 coded to 020 [Invasive and in situ components present, size of invasive component stated and coded in CS Tumor Size] or should the tumor size be 2.5 cm with SSF6 coded to 030 [Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated and in situ described as minimal (less than 25%)]? | 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 992 [stated as greater than 1 cm] and SSF6 code 020. The September 2006 revision to the CS Tumor Size table now lists the 992-995 range codes as "greater than ___ cm." It is better to code the invasive size than the entire size of the tumor. In the TNM mapping, this would more accurately portray the tumor as T1c rather than T2. |
2006 |
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20061050 | Neoadjuvant Treatment/Date Therapy Initiated--Breast: If Tamoxifen has been used since 2000 for the treatment of hyperplasia, should it be coded as neoadjuvant treatment for a 2004 diagnosis of breast cancer? | Do not code tamoxifen given for hyperplasia as treatment for breast cancer. In this case, tamoxifen started four years before the breast cancer diagnosis -- not treatment for breast cancer. | 2006 | |
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20061060 | CS Site Specific Factor--Prostate: How are SSF 5 (Gleasons Primary and Secondary Pattern Value) and SSF 6 (Gleasons Score) coded when there is a higher Gleason's pattern in less than 5% of the tumor? See Discussion. | Radical prostatectomy pathology states prostate adenocarcinoma "combined Gleasons score 3+3=6, with a small portion of Gleasons pattern 4 component comprising less than 5% of tumor volume." The WHO Classification of Tumors of the Urinary System and Male Genital Organs refers to "tertiary" Gleasons patterns in addition to the primary and secondary patterns. On prostatectomy, when this tertiary pattern is 4 or 5, WHO recommends that it should be reported in addition to the Gleasons score even when it is less than 5% of the tumor. |
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. Record Gleason's pattern and score from the largest specimen, even if this is a lower number. Ignore the tertiary pattern for now. This may change when the AJCC 7th Edition is published, as there is much discussion regarding the tertiary patterns and when they should be utilized. If there is a change in AJCC, at that time there will be a change to CS. |
2006 |
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20061018 | Multiple Primaries (Pre-2007)--Brain and CNS: Is neurofibromatosis a separate and distinct primary in the presence of a longstanding glioma? Does the following show one or two primaries? See Discussion. | MRI of Brain: 1. Findings compatible with left optic nerve glioma. 2. Stable enhancing focus in left temporal white matter. Lack of interval change since Dec 2000 suggests a white matter finding typical of neurofibromatosis and makes more aggressive processes such as astrocytoma less likely. Small aneurysm can not be excluded. | For tumors diagnosed prior to 2007:
Neurofibromatosis and glioma would be separate brain/CNS primaries. However, there is only one primary in the case example above: Glioma, left opic nerve. "...suggests a white matter finding typical of neurofibromatosis" is not reportable. "Suggests" is not a reportable term. Therefore, in this example neurofibromatosis is not reportable unless there is a more definitive statement in the record.
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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20061081 | Collaborative Staging--Lung: Given that the AJCC lung TNM is not applicable for a high grade sarcoma of this site, how do we code Collaborative Stage for this site/histo combination when the pathologist indicates a TNM stage of T2bN0M0=stage III, using AJCC Soft Tissue Sarcoma schema? | 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. Use the lung schema to code CS for sarcoma of the lung. Complete the CS information as best you can from the medical record WITHOUT using the TNM Soft Tissue Sarcoma staging form. Visceral sarcomas are specifically excluded from soft tissue sarcoma TNM staging and sarcomas are excluded from the TNM staging for lung. Sarcoma is listed on the Histology Exclusion Table for lung. When a case is coded in Collaborative Staging and the histology is on the exclusion list, SEER Summary Stage 1977 and 2000 can be assigned. For these cases, TNM will not be calculated and displayed results will be "T NA N NA M NA and Stage Group NA". |
2006 | |
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20061139 | CS Lymph Nodes--Lung: Do modifying terms such as "borderline" affect whether lymph nodes are coded as involved when they are used in conjunction with the descriptors listed in Note 2 (i.e., mass, adenopathy or enlargement) for lung primaries? See Discussion. | Lung primary: CT states "borderline" enlarged hilar lymph nodes. Note 2 in the Lung schema under CS Lymph Nodes does not address qualifiers. | 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. Do not code the hilar lymph nodes as involved in this case. "Borderline" enlarged hilar lymph nodes do not meet the clinical criteria for enlargement. |
2006 |
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20061070 | Chemotherapy: If a physician does not document the reason chemotherapy was given concurrently with radiation therapy, should it be assumed to have been used as a radiosensitizer or radioprotectant and then, per SEER chemotherapy coding instruction 2, ignore coding the chemo agent as treatment? | Do not assume that a chemo agent given with radiation therapy is a radiosensitizer. Seek additional information. Compare the dose given to the dose normally given for treatment. When chemotherapeutic agents are used as radiosensitizers or radioprotectants, they are given at a much lower dose. |
2006 | |
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20061047 | CS Extension/CS Mets at Dx--Peritoneum: How are these fields coded for extraovarian peritoneal carcinomas presenting with multiple peritoneal implants? See Discussion. | Patient presented with large omental cake and multiple peritoneal implants including implants on the rectosigmoid serosa and right ovary. Path revealed papillary serous adenocarcinoma consistent with peritoneal primary. Per AJCC Manual, extraovarian peritoneal carcinoma is usually staged with the ovarian staging classification. We understand that the CS Manual will eventually be revised to include staging for extraovarian peritoneal primaries. In the meantime, how do we use the existing CS scheme for peritoneum to code these cases? |
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 Extension 99 [unknown] and CS Mets at DX 99 [unknown]. The issue has been sent to the CS steering committee for resolution. This answer will be updated when the steering committee provides a resolution. |
2006 |
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20061108 | Histology/Polyp--Colon: Which histology code is used when a colon biopsy states adenocarcinoma arising in a polyp, but the resection path states only adenocarcinoma, and does not mention arising in a polyp. See Discussion. | This scenario occurs frequently and our QC staff is divided on which code to use. 03-24-06 Rectal Polyp: Adenocarcinoma, moderately differentiated. 6-29-06 Rectum: Adenoca, MD, invades into the submucosa. No malignancy (0/15) LNs. |
Use the polyp information from the biopsy and code adenocarcinoma arising in a polyp (8210, 8261 or 8263 as appropriate). | 2006 |