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Report Produced: 09/01/2024 12:19 PM

Report Question ID Question Discussion Answer Year
20031073 EOD-Pathology Extension--Prostate: Is extracapsular extension implied by the phrase, "involvement of periurethral or urethral margins"? See Description. The prostatectomy final pathology diagnosis states that the tumor involves the periurethral margin. The microscopic describes involvement of the urethral margin. For cases diagnosed 1998-2003: Code the EOD-Extension field in the 20-34 range, which implies no extension beyond the prostate. Disregard involvement of periurethral margin or urethral margin, NOS, unless the pathologist or surgeon specifically mentions "extraprostatic urethra" involvement. 2003
20031072

EOD-Pathologic Extension--Prostate: Is extracapsular extension implied by the phrase "tumor invades the fibrous tissue of the capsule"? See Description.

The physician staged to a pathology stage of T3. It appears the physician regards the following pathology statement to be equivalent to capsular invasion on the right side: "Tumor invades the fibrous tissue of the capsule on the right side where it approaches to within 1 mm. of the surgical margin." Should pathologic extension be coded to 42[unilateral extracapsular extension]?

Use the best information available to stage the case. In this case, the best information is the pathologist's description of the tumor extension rather than the AJCC stage.

For cases diagnosed 1995-2003: Extracapsular extension is not implied by the phrase in the question. Code the capsular involvement described to 32 [invasion into but not beyond the prostatic capsule] on the basis of the pathology report.

 2003
20031071 EOD-Extension--Brain and CNS: How does one code this field for a brain primary with drop metastases and/or seeding? See Description.

In the past SEER has advised coding these cases to extension 60. However, SS2000 states to code these cases to distant.

1. Primary in the cerebrum, hypothalamic region, with drop mets to spinal cord.

2. Primary in the cerebellum with spinal cord drop mets.

3. Primary in the fourth ventricle, with drop mets along the spinal cord.

For cases diagnosed 1998-2003: Assign extension code 85 [Metastasis] for drop metastases and/or seeding of the spinal cord from a brain primary.

Assign code 85 to each of the three cases above.

 2003
20031069 Hematologic Transplant and Endocrine Procedures--Brain and CNS: Is stem cell transplant coded as treatment for medulloblastoma? See Description. The PDQ lists high-dose chemotherapy with autologous bone marrow rescue as treatment for children under three. A case of medulloblastoma that was treated with gross total resection of the tumor, followed by chemotherapy and autologous PBSC (peripheral blood stem cell) transplant. A stem cell transplant does not fit the definition of "treatment" because it does not affect, control, change, remove or destroy proliferating cancer tissue. However, there is a place to code this procedure. Code stem cell transplant under Hematologic Transplant and Endocrine Procedures. Assign code 20 [Stem cell harvest]. 2003
20031068

EOD-Extension--Colon: Is a pathology description of "superficial invasion of the muscularis mucosa in the upper stalk of the polyp" coded in this field to 10 [mucosa (including intramucosal) NOS], 12 [Muscularis mucosa], or 14 [Stalk of polyp]? See Description.

Do we use the highest applicable value because all three definitions are used in the following example? Ex: Path diagnosis: Sigmoid polyp: tubulovillous adenoma with a focus within upper portion of stalk consistent with superficially invasive (intramucosal) colonic adenocarcinoma (see Comment). Comment: ... in the upper stalk region, there is evidence of superficially invasive carcinoma which appears to be limited to the muscularis mucosa and thus would be intramucosal by classification.

For cases diagnosed 1998-2003: Code extension as 12 [muscularis mucosae]. For this case, "upper stalk" is a reference to location rather than extension. This adenocarcinoma extends to the muscularis mucosa.

 2003
20031067 Primary Site/Histology (Pre-2007)/Sarcoma: How do you code these fields for a vulvar tumor diagnosed by FISH analysis as "extra-osseous Ewing sarcoma?" See Description. A literature search relates soft tissue malignancy described as "extra-osseous Ewing sarcoma/PNET." Neither are compatible with site.

For tumors diagnosed prior to 2007:

Code histology as 9260/3 [Ewing sarcoma]. ICD-O-3 does not have a code for extra-osseous Ewing sarcoma (EOE). Ignore the topography code listed in ICD-O and use the code for the primary site (vulva).

Site codes associated with morphology codes in the ICD-O are the most common sites and are not intended to limit coding only to those sites.

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.

 2003
20031066 Histology (Pre-2007): Is 8524 [lobular mixed with other carcinoma] or 8490 [signet ring cell carcinoma] used to represent a diagnosis of "infiltrating lobular with signet ring features?"

For tumors diagnosed prior to January 1, 2004:

According to our pathologist consultant, for this specific case, code to 8490 [Signet ring cell carcinoma].

Our pathologist states: "Signet ring cell carcinoma is most often a variant of lobular carcinoma (as it appears to be in this case - it is less frequently a variant of ductal), and I think it's appropriate to code it as such. Coding to lobular would also be ok, though that would lose the special feature of the signet ring cells. I would rather not code to 8524, since it is not really a mix of lobular and something else."

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.

 2003
20031063 Date of Diagnosis: When the clinical information on a scan indicates a history of cancer, how do you code the month and/or year of diagnosis given these terms: "early in year," "late in year," "2-3 months ago," "7 months ago," "new diagnosis." See Description.

Case 1. Diagnosed with CLL in late 1996. Assumptions: Code the term "late" in the year to December. Date of diagnosis would be coded to December 1996.

Case 2. Diagnosed with CLL in early 1997. Assumptions: Code the term "early" in the year to January. Date of diagnosis would be coded to January 1997.

Case 3. Admitted July 2000. Per H & P, patient was diagnosed with prostate cancer 2-3 years ago. Assumptions: Select the higher number in the range (in this case 3 years) and subtract 3 years from date of admit to calculate year of diagnosis. Code diagnosis month to the month patient was admitted. Diagnosis date would be coded July 1997.

Case 4. Admitted in October 2001. H&P states that colon cancer was diagnosed 7 months ago. Assumptions: Subtract 7 months from date of admit. Code date of diagnosis to March 2001.

Case 5. Admitted in December 2001. Per H&P, patient has CLL, presumably a new diagnosis. Assumptions: Assume the H&P statement of "new" to be equivalent to "recent" and code date of diagnosis to date patient was admitted. In this case, date of diagnosis would be coded to December 2001.

Case 6. Admitted for radical prostatectomy for prostate cancer in March 2001. H&P states that his PSA was 5 in November 2000 and in January 2001, PSA was 5.3. Biopsies showed adenocarcinoma. Assumptions: Assume the biopsy was done the same month as the January 2001 increased PSA. Date of diagnosis would be coded to January 2001.

Case 7. Outpatient bone scan done December 2001. Clinical history on the scan stated patient has history of prostate cancer. The physician was queried about date of diagnosis. Per the physician response, patient was diagnosed in 2001. Assumptions: Assume the bone scan was part of the initial work-up for prostate cancer and estimate the date of diagnosis to December 2001.

SEER agrees that these are reasonable assumptions based on the information provided.

Estimate the month and year of diagnosis using the available information. If the information is not sufficient to make an estimation on the month, code the month of diagnosis as "99." Avoid coding "unknown" for the year of diagnosis.

 2003
20031062 Primary Site--Melanoma: How would this field be coded for a pleural effusion consistent with metastatic melanoma and "no skin lesions?" Code primary site as C44.9 [Skin, NOS]. ICD-O-3 does not list a suggested site code for 8720/3 because melanoma can arise in other parts of the body. However, C44.9 [Skin, NOS] is the default when the primary cannot be found. 2003
20031060

Histology--Hematopoietic, NOS: Because histology 9895/3 [Acute myeloid leukemia with multilineage dysplasia] was recognized as a distinct entity by WHO with too few cases of the subtypes [with or without prior MDS] to warrant separate histology codes for each, should the wording for the non-bold definitions in ICD-O-3 be changed to the following in both the alpha and numeric sections? See Description.

AML with multilineage dysplasia and prior MDS

AML with multilineage dysplasia and without prior MDS

How do we code histology for the following case of AML?

Patient was admitted for profound anemia and thrombocytopenia with

no immediate explanation. Path final diagnosis on bone marrow biopsy: acute myelogenous leukemia (AML). Per micro description: findings are

characteristic of AML that appears to be arising within the context of a myelodysplastic syndrome. The discharge diagnosis (2 days after bone marrow biopsy) read: myelodysplastic syndrome with profound anemia and

thrombocytopenia.

Do we code the histology per the final path diagnosis (code 9861/3)?

Using the current version of ICD-O-3, we could arrive at a histology code of 9895/3 based on the micro findings of AML with prior myelodysplastic syndrome. However, per the above-mentioned SEER e-mail, we would not because there was no mention of multilineage dysplasia.

For cases diagnosed prior to 1/1/2010:To assign code 9895, it is important that the diagnosis includes "multilineage dysplasia." Use code 9895 when the diagnosis is with or without prior (not concurrent) myelodysplastic syndrome AND multilineage dysplasia. Acute myeloid leukemia without prior myelodysplastic syndrome and without multilineage dysplasia is coded 9861 [Acute myeloid leukemia, NOS].

Although the wording of 9895 cannot be changed, coders can make a note that the synonyms are intended to include:

-Acute myeloid leukemia WITH multilineage dysplasia with prior myelodysplastic syndrome

and

-Acute myeloid leukemia WITH multilineage dysplasia without prior myelodysplastic syndrome.

The histology code for the case example is 9861/3 [Acute myeloid leukemia, NOS].

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.

 2003