Report | Question ID | Question | Discussion | Answer | Year |
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20071046 | Ambiguous Terminology: Why was 60 days chosen for ambiguous terminology? | The Histology Task Force approved a 60 day time frame for ambiguous terminology. The majority of cases are first identified by ambiguous terminology; for example, a patient has a mammogram that shows a lesion suspicious for cancer. That first indication of cancer prompts a work-up to either confirm or rule-out the cancer diagnosis. The data item "Ambiguous terminology" is not intended to capture information on this routine method of detecting and diagnosing cancer. The 60 day time frame should keep these cases out of the ambiguous terminology data item. The data item is intended to identify those cases where the cancer diagnosis is NOT confirmed during the work-up, but the case is still entered into the database. For example a patient who has a TRUS because of elevated PSA. The pathology from the TRUS says "Suspicious for adenocarcinoma of the prostate." The physician only documents that the patient is to return in 6 months for another PSA and TRUS. The registrar would enter this case into the data base because the word "suspicious" is on the ambiguous terminology list. |
2007 | |
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20071114 | Ambiguous Terminology/Date of Diagnosis: How would you code the diagnosis date when the body of an imaging report uses reportable ambiguous terminology while the final impression in that same report uses non-reportable ambiguous terminology? Would you code the diagnosis date to the date of the scan or to the subsequent biopsy date that confirmed a malignancy? See Discussion. | Within the body of a mammogram report, the radiologist stated, "diffuse inflammatory tissue throughout the rt breast w/ large rt axillary lymph nodes, consistent with an inflammatory carcinoma of rt breast." His final impression, however, said "extremely suspicious rt breast w/ extremely dense breast parenchyma and adenopathy in axilla, suggesting an inflammatory carcinoma." The patient then went on to have a biopsy, which was indeed positive for cancer. | Accept the reportable ambiguous terminology from the body of the mammogram. Record the date of the mammogram as the date of diagnosis. The guidelines on page 4 of the 2007 SEER manual addressing discrepancies within the medical record can be applied to discrepancies within one report. The instructions are: If one section of the medical record(s) uses a reportable term such as apparently and another section of the medical record(s) uses a term that is not on the reportable list, accept the reportable term and accession the case. |
2007 |
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20071127 | Multiplicity Counter--Breast: How should the multiplicity counter be coded for a 3.8 cm infiltrating duct carcinoma with two "satellite nodules" measuring 5 mm and 7mm that are not described as either metastases or multiple foci? | Include these nodules in the multiplicity counter because they are measured and are part of the final diagnosis on the pathology report. | 2007 | |
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20071052 | CS Extension/CS Lymph Nodes--Lung: How are these fields coded if a lobectomy path specimen indicates that two intrapulmonary lymph nodes are involved by direct extension from the primary tumor? | 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 regional lymph node involvement in CS lymph nodes even when the lymph nodes are involved by direct extension. Do not code direct extension to lymph nodes in CS extension. |
2007 | |
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20071092 | Reportability/Primary Site--Brain and CNS: Is a chondroma, NOS or a chondroblastoma, NOS that occurs in an intracranial site or along the spinal cord reportable? See Discussion. | In ICD-O-3, chondroma and chondroblastoma are site-associated morphologies for bone. If a chondroma or a chondroblastoma occurs along the spinal cord, is this one of those situations where we can be quite comfortable with a default site to bone and not to spinal cord?
Reference: ICD-O-3; Primary Central Nervous System Tumors, NPCR Training Materials 2004; SINQ 20021152 |
Chondroma, NOS or chondroblastoma, NOS occuring in intracranial sites or along the spinal cord are not reportable.
Chondroma, NOS and chonroblastoma, NOS are benign tumors of the bone itself, not the intracranial contents. |
2007 |
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20071099 | MP/H rules/Histology--Lung: How is histology coded for a path diagnosis of "pleomorphic carcinoma with adenocarcinoma, squamous, clear cell and spindle components"? Please see discussion. |
Path diagnosis of lung tumor is pleomorphic carcinoma, with adenocarcinoma, squamous, clear cell, and spindle cell components. Path comment states: "While the majority of tumor displays usual adenocarcinoma-type features, elsewhere the tumor shows varying differentiation, including squamous, clear cell and spindle cell differentiation. Therefore the tumor is best categorized as pleomorphic carcinoma." This tumor is best described by a non-specific histology. However, the MP/H rules guide the abstractor to identify a more specific histology. If we work through the lung rules, would we end up using rule H7 and code the histology with the numerically highest ICD-O-3 code? |
For cases diagnosed 2007 or later, assign histology code 8022 [pleomorphic carcinoma] based on the pathologist's assessment and rule H3. He/she reviewed all of the histologic components and rendered a final diagnosis of pleomorphic carcinoma. "Components" is not a term indicative of a more specific histology. See note under rule H5. |
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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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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20071086 | Histology--Pancreas: How is a "gastrin and somatostatin producing endocrine neoplasm" coded that has lymph node metastasis? | The best code available for this situation is 8153/3 [Gastrinoma, malignant]. Many pancreatic endocrine tumors produce more than one peptide, such as gastrin and somatostatin in this case. ICD-O-3 does not provide a code for pancreatic endocrine tumors which produce more than one peptide. According to the WHO Classification of Tumours of Endocrine Organs, there is a distinct hormonal syndrome associated with gastrin producing tumors, and not with many of the somatostatin producing tumors. Therefore, our pathologist consultant advises us to code to gastrinoma in this case. |
2007 |