MP/H Rules/Multiplicity Counter--Lung: If metastatic tumors are not counted in this field, should the multiplicity counter be coded to 01 for a case with a primary left lower lobe of lung tumor with a satellite tumor in the left upper lobe?
For cases diagnosed 2007-2013:
No, code multiplicity counter to 02 [two tumors present]. According to the multiple primary rules, these two lung tumors are reported as a single primary. Record the number of tumors reported as a single primary in Multiplicity Counter.
Multiplicity Counter no longer required by SEER as of 1/1/2013.
MP/H Rules/Histology--Colon: When the microscopic description indicates a colon tumor is "tubulovillous," but the final diagnosis only states "adenocarcinoma," is the histology coded to 8263/3 [adenocarcinoma in a tubulovillous adenoma]?
For cases diagnosed 2007 or later:
Yes. This is an example of a site-specific exception to the general rule to code only from the final diagnosis. The Colon Histology Rules specifically state that "other parts of the pathology report" may be used to identify a tumor arising from a polyp, adenomatous polyp, villous adenoma, or tubulovillous adenoma.
MP/H Rules/Histology--Prostate: While cases of "acinar adenocarcinoma" of the prostate are required to be abstracted with the histology code 8140/3 [adenocarcinoma, NOS] for cases diagnosed 1/1/07 or later, can 8550/3 [acinar adenocarcinoma] be used for cases diagnosed prior to 1/1/07? See Discussion.
The SEER Multiple Primary and Histology manual, effective with 2007 forward diagnosis dates, indicates that this histology should be coded to 8140/3 [adenocarcinoma, NOS]. Does this contradict ICD-O-3? Can acinar adenocarcinoma be coded for other primary sites?
For cases diagnosed 2007 or later, code acinar adenocarcinoma of the prostate as 8140/3.
Prior to diagnosis year 2007, code 8550/3 [acinar adenocarcinoma] may be used for prostate cases and for acinar adenocarcinoma of other sites, such as pancreas.
CS Lymph Nodes--Kidney, renal pelvis: Under what circumstances would code 80 [Lymph nodes, NOS] be used to document the presence of positive lymph nodes? See Discussion.
The CS Schema for Kidney (Renal Parenchyma) states to use code 70 for Regional Lymph Nodes, NOS. The schema for for Renal Pelvis states to use code 50 for Regional Lymph Nodes, NOS. Both schemas have a Code 80, for Lymph Nodes, NOS that maps to N1 in both schemas.
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 80 can be used for positive lymph nodes when you are unable to determine if they are regional or distant. CS Lymph Nodes code 80 is provided for this situation in accordance with the downstaging rule.
Code 80 should be used very infrequently and only when there is no indication whether the involved lymph nodes are regional or distant.
MP/H Rules/Histology--Colon: Regarding histology rule H21, is there a hierarchy or do you code the higher histology if there is an adenocarcinoma arising in a polyp and an adenocarcinoma in a villous adenoma?
For cases diagnosed 2007 or later:
If you arrive at H21 and have an additional decision to make regarding the use of 8210, 8261 or 8263, you must make another pass through the histology rules. The second pass will determine which of the two or three histology codes to assign. The answer will vary depending of the specifics of the case.
Example:
Transverse colon: Adenocarcinoma in an adenomatous polyp involving muscularis propria and adenocarcinoma in a villous adenoma involving subserosa of transverse colon. Start with rule H15 because there are multiple tumors. Stop at H21 -- code either 8210 or 8261. To decide between 8210 and 8261, make a second pass through the histology rules, starting again with H15. Stop at H20. Code the histology of the most invasive tumor, 8210 [Adenocarcinoma in adenomatous polyp].
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.
CS Tumor Size/CS Extension--Prostate: Because prostatectomy results are excluded from the CS Extension field for prostate, is code 95 [No evidence of primary tumor] accurate to reflect bilateral lobe involvement of prostate cancer when it is incidentally found following a radical cystectomy for a bladder primary? Why must tumor size be 000 when the CS Extension code is 95?
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 prostate CS Extension to 99 [Extension unknown] and code CS Tumor Size according to the information available from the surgery.
CS Extension code 95 [No evidence of primary tumor] should be used only in that rare situation when the only evidence of disease is distant mets or lymph node involvement, no primary tumor found. That is why CS tumor Size must be 000 when CS Extension code 95 is used.
CS Site Specific Factor/Melanoma: How is CS SSF1 (depth of invasion) coded for a melanoma that demonstrates dermal invasion to a depth of "less than .2 mm" be coded to 999 [unknown]? See Discussion.
The path report says "superficial spreading malignant melanoma; 2 areas of papillary dermal invasion to depth of less than .2mm."
The revised CS pages include codes for "less than" a certain tumor size, but these are not included in the depth of invasion SSF. Using 999 results in an unstageable melanoma, when we know it is "less than .2mm".
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 SSF1 (depth of invasion) to 019 [.19mm]. For any case with an SSF1 code in the range of 001-100 mm, the T category will be determined using CS extension and SSF2 [ulceration]. All cases with an SSF1 code in the range of 001-100 mm will map to a T1 (either T1NOS, T1a or T1b).
Primary Site: Is an "angiosarcoma" stated as arising in the skin of the breast and treated with a mastectomy, coded to the primary site of skin or breast?
Code the primary site as skin of breast when skin of breast is documented as the site of origin.
According to the WHO classification of soft tissue tumors, the majority of angiosarcomas "develop as cutaneous tumors...less than one quarter present as a deep soft tissue mass."
Histology--Melanoma: How is a "malignant melanoma arising in a melanocytic nevus" coded?
The histology code is 8720/3 [malignant melanoma, NOS].
There is no specific code for melanoma arising in melanocytic nevus. According to our pathologist consultant, this is likely because nevi are so common, melanoma arising in association with them is common and appears to have no bearing on prognosis or treatment. Most pathologists do not include the nevus in the diagnosis of melanoma, even when they see it.
Code melanomas arising in melanocytic nevi to the appropriate melanoma code, probably 8720, 8721, or 8743 in most cases.
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