Report | Question ID | Question | Discussion | Answer | Year |
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20071117 | MP/H Rules/Histology--Brain: How many primaries are reported and what is the histology for a single brain tumor described as a low grade astrocytoma at the time of the initial partial resection and a low grade glioneuronal neoplasm at the time of the subsequent total resection? See Discussion. | On 4/20/07 a partial resection of a brain tumor is interpreted as low grade astrocytoma. Patient has a gross total resection on 8/13/07 with this diagnosis: low grade glioneuronal neoplasm (see comment). Comment: This case has been reviewed at ---. Dr. agrees with our interpretation (low grade glioneuronal neoplasm, possibly a dysembryoplastic neuroepithelial tumor). | For cases diagnosed 2007 or later, this is a single primary. A single tumor is always a single primary. Assign histology code 9400/3 [Astrocytoma, low grade]. This diagnosis was not revised or amended based on the later surgery. It is possible that the malignant component was entirely removed during the first surgery. |
2007 |
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20071124 | Multiplicity Counter-Breast: The general instructions say to ignore separate microscopic foci when determining when to use the single tumor or multiple tumor modules. Do these instructions apply if sizes are given for the foci? See Discussion. | For instance, would a 1.2 cm breast tumor with 3 scattered microscopic foci ranging from 2-4 mm be treated as multiple tumors (4), or as a single tumor? | If the microscopic foci are measured and listed as part of the diagnosis, they should be counted as multiple tumors. | 2007 |
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20071110 | Reportability--Hematopoietic, NOS: The Abstracting and Coding Guide for the Hematopoietic Diseases, page 47, states to determine whether the physician is using the term myelodysplasia to describe bone marrow marrow malfunction or a neoplasic syndrome in order to determine reportability. What do we do when there is no information one way or the other? | For cases diagnosed prior to 1/1/2010:Without further information, the term "myelodysplasia" alone is not reportable. If a more definitive diagnosis is made later, the case may become reportable. 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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20071018 | Reportability: Is a "goblet cell carcinoid" of the appendix reportable? | Yes, goblet cell carcinoid of the appendix is reportable. The ICD-O-3 code for goblet cell carcinoid is 8243/3. | 2007 | |
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20071103 | MP/H rules/Histology--Breast: How many primaries and what histologies are coded for a left breast when a bi-lumpectomy path reveals one tumor with a microscopic focus of mucinous adenocarcinoma and extensive DCIS and a second .9 cm mucinous adenocarcinoma with extensive DCIS, and the subsequent mastectomy reveals foci of residual DCIS and Paget's disease of the nipple? | For cases diagnosed 2007 or later:
There are two primaries. Primary 1: The two tumors described on the pathology report from the lumpectomy are a single primary using rule M13. Primary 2: Disregard the foci of residual DCIS. Paget disease of the nipple is a separate primary using rule M12.
Primary 1: invasive mucinous adenocarcinoma and extensive ductal carcinoma in situ: Code the histology as 8480/3 [mucinous adenocarcinoma] using rule H27. Primary 2: Paget disease of nipple: Code the histology as 8540/3 [Paget disease] using rule H14. |
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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20071070 | CS Tumor Size--Melanoma: How is this field coded when a smaller invasive and a larger in situ melanoma are reported as a single primary? See Discussion. | Patient has a 1.2 cm lesion right upper arm with a diagnosis of melanoma in situ. A second lesion on right wrist, 0.5 cm mole, has a diagnosis malignant melanoma, Breslow's 0.78, Clark's level III.
According to the 2007 MP/H rules, this is a single primary. Because the larger lesion is completely in situ, do you ignore it altogether and go with the smaller, invasive lesion? SEER Program Manual 2007, page 127, rule 4.l, states that when two lesions are reported as a single primary, code the size of the larger lesion, which in this case would be the in situ. |
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 as 005 (0.5 cm). Code CS Tumor Size based on the invasive lesion. Use the data items "Multiplicity Counter" and "Type of Multiple Tumors Reported as One Primary" to document that there are two tumors present, in situ and invasive. |
2007 |
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20071076 | MP/H Rules/Histology--Thyroid: Regarding rule H15, is the mixed code 8340 [Papillary carcinoma, follicular variant] used when there are subtypes of these histologies described, such as a tumor diagnosed with follicular and papillary microcarcinoma or should 8341 [Papillary microcarcinoma] be used? | For cases diagnosed 2007 or later: For coding purposes, this is a papillary and follicular combination that would be coded to the combination code 8340/3 [Papillary carcinoma, follicular variant].
For thyroid cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult, usually less than 1 cm. in diameter. |
2007 | |
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20071022 | Reportability--Hematopoietic, NOS: If the bone marrow biopsy diagnosis is not reportable and cytogenetics studies indicate no clonal abnormality, is a case reportable if only the flow cytometry results show a "small monoclonal B-lymphocyte population consistent with a lymphoid component of a lymphoplasmacytic lymphoma or Waldenstrom macroglobulinemia"? See Discussion. | Bone marrow bx final diagnosis: Markedly hypercellular marrow consisting primarily of erythroid hyperplasia and, also, diffusely distributed small lymphocytes. Addendum comment: Flow cytometry demonstrated a small monoclonal B-lymphocyte population consistent with a lymphoid component of a lymphoplasmacytic lymphoma or Waldenstrom's Macroglobulinemia. Addendum comment: Cytogenetic analysis states no clonal abnormality was apparent. Normal female karyotype. Question 1: Is this case reportable, and if so, what histology? Question 2: Is there a hierarchy when flow cytometry and cytogenetics are done, but do not agree? |
For cases diagnosed prior to 1/1/2010:This case is not reportable at this point. A lymphoid component is not equivalent to a diagnosis of a reportable disease. In order to be a malignant, reportable disease, the condition must be monoclonal and irreversible. Cytogenetics were negative for malignancy (i.e. no monoclonal abnormality identified which is the criteria used to establish this diagnosis). Use all information available when determining reportability. 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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20071074 | MP/H Rules/Multiple Primaries--Lung: How many primaries should be reported when an "adenocarcinoma" is discovered in one of several new nodules at the scar in a lung and it is less than a year after a wedge resection for a diagnosis of "bronchioalveolar adenocarcinoma" in the same lung? See Discussion. | In March 2006 patient diagnosed with bronchioalveolar adenocarcinoma [8250/3] and had wedge resection. In November 2006 a CT chest shows nodules at the scar suspicious for recurrence. In January, 2007, there was a biopsy of one of the nodules showing adenocarcinoma [8140/3]. Is this part of the original disease process diagnosed in March 2006 or should it be abstracted as a new primary based on 2007 MP/H rules (histology is different at the first 3 digits)? |
For cases diagnosed 2007 or later:
Try to obtain more information/clarification on the 2007 diagnosis -- for example, is it metastasis? Based only on the information provided for this case, the 2007 diagnosis is a separate primary. Use the 2007 MP/H rules to assess the 2007 diagnosis. Begin with rule M3 in the multiple tumors section. Stop at rule M11, multiple primaries. |
2007 |