Surgery of Primary Site--Bladder: Should a TURB be coded to 27 [Excisional biopsy; SEER Note: Code TURB as 27] when there is obvious extravesicular extension demonstrated because the 2004 SEER Manual states "Do not code an excisional biopsy when there is macroscopic residual disease"?
Assign code 27 [excisional biopsy]. The site-specific instructions have priority over the general instructions. According to the instructions for coding surgery of the bladder, use code 27 for TURB.
Reportability/Grade, Differentiation: Does the term "grade 0" refer to differentiation or does its use as a modifying phrase in the final diagnosis of "grade 0 immature teratoma" impact reportability?
Regarding the term "grade 0" for an immature teratoma, determine whether the pathologist is using that term to describe the primary tumor or its implants. The term can be used to describe both situations.
An immature teratoma (IT) may have grade 0 (benign) implants. Grade 0 implants may affect the prognosis and treatment, but the primary tumor (IT) would still be malignant and therefore reportable. If grade 0 pertains to the primary tumor (as opposed to implants) it is benign, and therefore not reportable.
CS Extension--Lymphoma: In the absence of physician staging, is an "enlarged" spleen seen on CT coded as involvement of the spleen for lymphoma 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.
Do not code spleen involvement when the only evidence is an enlarged spleen.
When imaging is the only diagnostic tool (no biopsy or splenectomy), spleen involvement is based on the presence of nodules and not on enlargement. Splenic enlargement alone (by physical exam or imaging) is insufficient to support involvement of spleen.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: For cases diagnosed in 2005, if a specimen contains an invasive 4.5 cm lobular carcinoma of the right breast and also has a tiny focus of intraepidermal tumors cells [Paget disease of nipple], how many cases should be abstracted and how should the histology field(s) be coded?
For tumors diagnosed prior to 2007:
There are two primaries in this example:
1. Invasive lobular carcinoma [8520/3]
2. In situ Paget disease of nipple [8540/2].
There is no combination code for lobular carcinoma and Paget disease.
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.
Diagnostic Confirmation: How is this field coded for a case with a cytology that is suspicious for ductal carcinoma and the clinical diagnosis is carcinoma? See Discussion.
SINQ 20031152 states that histology for this type of case is to be coded per the clinical diagnosis of "carcinoma." Does it follow then that Diagnostic Confirmation is to be coded 8 (clinical diagnosis only)? Would we code Diagnostic Confirmation differently if the clinician stated that the diagnosis of malignancy was confirmed by the suspicious cytology?
Code diagnostic confirmation as 8 [clincial diagnosis] when there is a suspicious cytology and a physician's clinical diagnosis. Do not accession cases with only suspicious cytology.
Code diagnostic confirmation as 8 when the clinician's diagnosis of malignancy is confirmed by the suspicious cytology. It is still a clinical diagnosis made by the physician using the information available for the case.
Histology (Pre-2007)--Lung: How is a poorly differentiated non-small cell carcinoma with "squamoid differentiation" coded?
For tumors diagnosed prior to 2007:
Squamoid and squamous are synonymous. Squamoid is non-standard terminology. It means "squamous like" and is a synonym of squamous.
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 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.
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.
Reportability--Colon: Is a pathologically confirmed "tubulovillous adenoma with high grade dysplasia" reportable if clinical diagnosis at the time of the subsequent re-biopsy states "follow-up for colon polyps with ca in situ"? See Discussion.
SINQ 20000245 states that high grade dysplasia is not synonymous with behavior code 2 (in situ). However, the 2004 SEER manual states that "cases clinically diagnosed are reportable. If the physician treats a patient for cancer in spite of the negative biopsy, accession the case."
A pathologic diagnosis has priority over a clinical diagnosis. According to the pathologist, this case is not reportable. A re-biopsy is not treatment.
Histology (Pre-2007): How is "adenocarcinoma, diffuse type, with signet ring features" coded?
For tumors diagnosed prior to 2007:
Code 8490 [Signet ring cell carcinoma]. Histology coding Rule 7 is the only rule that applies to this diagnosis. Assign the numerically higher ICD-O-3 code.
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.
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