Reportability--Melanoma: Is the following reportable? See Discussion.
PATH: Skin, Lt back exc bx: compound nevus with severe cytoarchitectural atypia and regression. Comment: due to overlap of morphology between MM and nevi with severe atypia, and since there's evidence of regression, consideration for re-excision may be considered if clinically indicated.
The final diagnosis, compound nevus with severe atypia, is not reportable. This diagnosis is not listed in ICD-O-3.
CS Site Specific Factor 6--Breast: If the tumor size for the breast is unknown, and it is unknown whether the tumor is mixed in situ and invasive or "pure", how is SSF6 to be coded? See Discussion.
The definition for SSF6 for breast changed from "Unknown if invasive and in situ components present, unknown if tumor size represents mixed tumor or a pure tumor" to an added clarification of "Clinical tumor size coded." Since the clinical tumor size is NOT coded, this does not fit.
The definition for 060 is "Invasive and in situ components present, unknown size of tumor (CS Tumor Size coded 999). Since it is unknown if the tumor is mixed, this definition does not fit either.
It seems that the revised (April 2005) definition for 888 has left a situation that cannot be coded.
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.SSF 6 should be coded 888 in this case. SEER will make the CS task force aware of this situation.
Multiple Primaries--Lymphoma: Is a diagnosis of mycosis fungoides followed a year later with a biopsy proven diagnosis of anaplastic large T-cell lymphoma stated to represent a transformation of the previous mycosis fungoides reportable as one or two primaries?
For cases diagnosed prior to 1/1/2010:
This is one primary. Code the histology according to the original diagnosis, mycosis fungoides. The physician states that this one disease process started as mycosis fungoides and progressed into lymphoma. A physician's statement has priority over other sources in determining the number of hematopoietic primaries.
In October 2006, a committee will begin working on multple primaries among hematopoietic diseases. The committee will provide further guidance on dealing with disease transformation and other issues.
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.
Reportability/Behavior--Skin: Is an "atypical fibroxanthoma (superficial malignant fibrous histiocytoma)" with an ICDO-3 histology code of 8830 reportable with a behavior code of 3 or is it nonreportable with a behavior code of 1?
Yes, "atypical fibroxanthoma (superficial malignant fibrous histiocytoma)" is reportable. The information in parentheses provides more detail and confirms a reportable malignancy.
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)--Skin: In a patient with Muir Torre syndrome, should each of 12 sebaceous carcinomas diagnosed from 1994-2005 be a new primary or should this process be one primary diagnosed in 1994?
For tumors diagnosed prior to 2007:
Follow the rules in the 2004 manual for determining multiple primaries. When the sebaceous carcinomas are in different sites (topography code difference in the first two numeric digits after the C), they are separate primaries. When the sebaceous carcinomas are more than two months apart, they are separate primaries.
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.
MP/H Rules/Multiple Primaries--Bladder/Renal Pelvis: Is a non-invasive papillary transitional cell carcinoma of the bladder diagnosed one year after the occurrence of an invasive papillary transitional cell carcinoma of the renal pelvis reported as one or two primaries?
For cases diagnosed 2007 or later:
This is a single primary with renal pelvis as primary site.
Use the 2007 MP/H rules to determine if the 2007 diagnosis is a new primary. Use the Urinary rules, multiple tumors module. Start with rule M3. Follow the rules down to Rule M8 and stop. This is an example of implantation effect.
Reportability/Chemotherapy--Hematopoietic, NOS: Is pyridoxine-responsive sideroblastic anemia (SA) reportable and is pyridoxine coded as chemotherapy for SA and refractory anemia with ringed sideroblasts (RARS)? See Discussion.
Patient has refractory anemia with ringed sideroblasts on bone marrow path. The physician mentions it might be due to pyridoxine deficiency. Per the SEER*Rx, pyridoxine (aka Vitamin B6) is not coded as treatment. What causes RARS and SA? Is pyridoxine treatment for either disease process? Or is the pyridoxine just treating one aspect of the anemia? The patient has no other treatment but this.
For cases diagnosed prior to 1/1/2010:Sideroblastic anemia (SA) is not reportable. SA is not the same as refractory anemia with ringed sideroblasts (RARS). Therefore, do not code pyridoxine administered for SA as therapy. If the patient had RARS that "might be due to pyridoxine deficiency," the replacement pyridoxine would not be coded as chemotherapy because it does not control or kill malignant cells. If the pyridoxine was successful in alleviating the refractory anemia, the RARS would be reversible and would not meet the criteria for a reportable blood disease; i.e. irreversible, clonal.
For cases diagnosed 1/1/10 and later, 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.
MP/H Rules--Bladder: Does rule M6 mean that any combination of tumors with the histologies 8050, 8120-8124, or 8130-8131 are the same primary regardless of the amount of time between tumor occurrences? See Discussion.
Many interpret Rule M7 to mean when separate occurrences of TCC of the bladder are diagnosed more than 3 years apart, it is reportable as a second primary. However, doesn't Rule M6 mean that if the histology is any combination of 8050, 8120-8124 or 8130-8131 for tumors diagnosed more than 3 years apart, they are reported as a single primary?
For cases diagnosed 2007 or later:
Papillary, transitional cell and/or papillary transitional cell carcinomas of the bladder are a single primary using Rule M6. Rule M6 includes diagnoses within 3 years of each other AND diagnoses more than three years apart for the histologies listed. If rule M6 applies to your case, stop. Do not continue on to Rule M7.
Histology--Corpus uteri: Because coding a pathology final diagnosis of "serous carcinoma" for an endometrial primary to 8441/3 triggers the site/histology error in the SEER Edits, should histology be coded to 8010/3 [Carcinoma, NOS] instead?
Assign histology code 8441 [serous carcinoma] and override the edit. Endometrium with serous carcinoma is NOT one of the "impossible" site / histology combinations.
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