Report | Question ID | Question | Discussion | Answer | Year |
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20071073 | MP/H Rules/Histology--Breast: How is histology coded for a single tumor with ductal and tubular features in only the invasive component and not in the in situ component? See Discussion. | A breast tumor diagnosed in Feb. 2007 is a single tumor with in situ and invasive components. The invasive component is diagnosed as ductal with tubular features. The only rule that applies is H9 which says 'code the invasive histology.' Is it ductal (8500) or tubular (8211)? If you continue through the H rules, then H12 does not apply, because tubular is not a type of ductal. So then you end up at H17, which would make this 8523. Which code is correct? |
For cases diagnosed 2007 or later, code the histology 8523 [duct mixed with other types of carcinoma]. After determining that the invasive histology is to be coded using rule H9, there is another decision to make in this case -- which invasive histology should be coded? Make a second pass through the histology rules, begining with rule H10. Stop at H17 and code 8523. This advanced concept of a "second pass" through the rules is discussed in an online web training session called "Beyond the basics." Go to the SEER website to view this session http://www.seer.cancer.gov/tools/mphrules/training_advanced.html |
2007 |
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20071028 | MP/H Rules--Lung: Why the term "nodule" is not included as an equivalent term along with tumor, mass, lesion and neoplasm in the 2007 lung multiple primary rules? | Answer revised July 2008 For cases diagnosed 2007 or later: For the purpose of applying the Lung MP/H rules, the word "Nodule" can be used interchageably with "Tumor," "Mass," "Lesion" and "Neoplasm." HOWEVER, this does NOT apply to casefinding or staging. This revision will be added to the next version of the MP/H rules. Sinq question 20071028 will be revised. |
2007 | |
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20071049 | MP/H Rules/Histology--Colon: If a tubulovillous (TV) adenoma is in situ and other polyp(s) have an invasive component, does the in situ TV adenoma still have priority and should rule H18 be applied? | For cases diagnosed 2007 or later, always give precedence to coding the invasive. Rule H18 applies UNLESS the adenocarcinoma in the TV is in situ and the others are invasive. In this case, code the histology of the invasive adenocarcinoma. This clarification will be added when the MP/H manual is revised. |
2007 | |
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20071079 | MP/H Rules/Recurrence--Breast: Do we use a pathologists comment of "recurrent ductal carcinoma" found in the pathology report for a new specimen to determine whether the new specimen actually represents a new primary or recurrent disease? See Discussion. | The patient had a left breast cancer LIQ, ductal with DCIS. Nodes (-) diagnosed in 1998 Treatment: Lumpectomy-clear margins Refused radiation Hormone therapy: Tamoxifen
Present: June 2007 Left breast-invasive ductal ca, UOQ Pathology report comments: Recurrent ductal ca. Left axillary nodes (+) |
For cases diagnosed 2007 or later, apply the 2007 MP/H breast rules. Go to the multiple tumors module and begin with rule M4. Stop at rule M5: tumors diagnosed more than 5 years apart are multiple primaries. The only time you can accept a pathologist's statement of recurrence is when the statement is made based on a review of the slides from the previous diagnosis compared to the slides from the current diagnosis. |
2007 |
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20071008 | Histology (Pre-2007)--Breast: How is "invasive lobular carcinoma with signet ring cell features (95%) and ductal features (5%)" coded for a single tumor diagnosed prior to 2007? | For cases diagnosed 1/1/04-12/31/06, code histology to 8524 [Lobular mixed with other types of carcinoma]. Assuming there is no mention of in situ, Histology Coding Rule 3 applies: Use a mixed histology code if one exists
For cases diagnosed 2007-2014, 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. |
2007 | |
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20071038 | MP/H Rules/Histology--Brain and CNS: Is it generally correct that the code for PNET [9473/3] should be used to code tumors arising in the brain and spinal cord, and the code for pPNET [9364/3] should be used to code tumors arising in the bone and soft tissue? See Discussion. | The terms and definitions for "Brain" in the 2007 MP/H rules distinguish between pPNET and PNET. Is it correct even when the diagnostic terminology alone would lead to other coding, such as "PNET" used to diagnose a soft tissue mass in the chest and "neuroectodermal tumor" used to diagnose a brain mass? Should additional rules be added to both "Brain" and "Other Sites" to enforce this distinction? |
For cases diagnosed 2007 or later: Yes. Assign code 9473/3 for tumors arising in the brain and spinal cord and assign code 9364/3 for tumors arising in the bone and soft tissue. Clarification and reinforcement of this distinction will be added to the "Other sites" terms and definitions with the first revision to the MP/H rules. |
2007 |
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20071011 | Multiple Primaries (Pre-2007)--Breast: How many primaries are to be abstracted when each of multiple breast "re-excisions" performed more than two months apart in 2006 demonstrate intraductal carcinoma and there is no mention of "recurrence"? See Discussion. | Right Breast 06/27/2002 exc bx, DCIS. Margins involved. 09/24/2002 re-exc, several foci of intraductal ca. Margins involved. 10/15/2002 re-exc, microfocus of DCIS Radiation treatment started 11/18/2002. Is this 1, possibly 2, or maybe 3 breast primaries because of the 2 month rule and no statement of "recurrence"? Based on SINQ #20000478, this would be at least 2, but possible 3 primaries. Based on SINQ #20021143, this would be 1 primary if the case were diagnosed from 1998-2003. The excisions appear to represent wider excisions of the same tumor. |
For cases diagnosed prior to 2013:
For tumors diagnosed prior to 2007, this is one primary, assuming these are wider excisions of the same tumor.
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. |
2007 |
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20071060 | Reportability/Ambiguous Terminology--Esophagus: Is a case with a biopsy diagnosis of "... focal areas suspicious for adenocarcinoma in situ change" reportable if the diagnosis on the partial esophagectomy specimen only includes the phrase "... with foci of high grade dysplasia; no invasive carcinoma identified"? |
The case is not reportable. The biopsy with a suspicious result (suspicious for adenocarcinoma) was disproven by the esophagectomy. |
2007 | |
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20071131 | Cell indicator--Lymphoma: If the primary site for a lymphoma is stated to be the lymph nodes but there is no biopsy of a lymph node, can the immunophenotype designation for a lymphoma be coded based on a bone marrow or liver biopsy indicating "diffuse large B-cell lymphoma"? | For cases diagnosed prior to 1/1/2010: The cell indicator or immunophenotype designation for lymphomas may be coded from pathology reports on tissue from bone marrow or liver when there is no tissue from the primary site. Code information on cell type from any available source. See the Appendix C of the 2007 SEER manual, Coding Guidelines for Lymphomas, pages C-1055 to C-1056 for more information about coding this field for lymphomas. 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. |
2007 | |
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20071058 | CS Tumor Size: Is a measured "area" equivalent to a tumor, mass or lesion size? See Discussion. |
Collaborative Stage manual, page 26 Rule 4a: "always code size of the primary tumor, not size of the polyp, ulcer, cyst or distant metastasis." Rule 4e: Additional rule for breast primaries: Example: Duct carcinoma in situ covering a 1.9 cm area with focal areas of invasive ductal carcinoma. Record the tumor size as 1.9 cm. |
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.In general, a measured area is not equivalent to a tumor size. Do not apply the rule related to the breast example to other primary sites. This example in the CS manual pertains to coding tumor size for breast primaries when the size of the invasive component is not stated. In the example, the area involved with duct carcinoma in situ is the only measurement available. The size of the invasive component was not given. |
2007 |