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.
CS Extension--Breast: Is the term "erosion" the same as "ulceration"?
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.
"Erosion" is not synonymous with "ulceration" when coding CS extension for breast.
Primary Site/CS Extension--Lymphoma: How are these fields coded for a lymphoma found in the spleen and retroperitoneal lymph nodes? See Discussion.
A patient presents with a 6-month history of night sweats, low grade fever and significant weight loss. Physical exam reveals no palpable lymph nodes, tender abdomen and splenomegaly. Patient undergoes an exploratory laparotomy with splenectomy and dissection of two retroperitoneal lymph nodes. Spleen and both lymph nodes were positive for small cleaved-cell lymphoma, high grade.
Code the primary site to spleen.
Code CS extension as 22 [involvement of spleen plus lymph nodes below the diaphragm]. This gives it a stage IIS.
Spleen is an extranodal (not extralymphatic) site.
The retroperitoneal lymph nodes are located below the diaphragm.
Multiplicity Counter: Are in situ tumors diagnosed more than 60 days after invasive tumors of the same site and histology included in the Multiplicity Counter?
If an in situ tumor following an invasive tumor is a single primary according to the multiple primary rules for that particular site, include the in situ and the invasive tumors in the multiplicity counter.
CS Extension--Prostate: Can the phrase "hard, fixed prostate" be interpreted as clinical extracapsular extension and coded to 50 [extension or fixation to other structures]? See Discussion.
Patient had a "hard, fixed prostate" with needle core bx positive for Gleason grade 4+5=9 adenocarcinoma extensively involving gland. PSA was 87.5. Lymphadenectomy showed 3 positive pelvic/obturator lymph nodes. No prostatectomy was done and no physician TNM staging documented.
Do we need a specific clinical description of other organs to which the prostate is fixed in order to code CS Clinical Extension 50, or does the statement "hard, fixed prostate" qualify? If not, how would we code extension for this seemingly advanced cancer?
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.Assign extension code 50 [extension or fixation to adjacent structures] based on the term "fixed." Fixation to a particular structure(s) does not have to be specified in order to use code 50.
Do not use the statement "hard" to determine CS extension.
MP/H Rules/Recurrence: Is a subsequent diagnosis of an in situ tumor (bladder cancers excluded) a "recurrence" if it follows a prior invasive diagnosis of the original primary cancer made 5 years before?
For cases diagnosed 2007 or later, use the 2007 MP/H rules to determine whether or not a subsequent diagnosis (either invasive or in situ) is a new primary or a recurrence. Do not use the statement "recurrence" from the medical record to make this decision.
When evaluating a subsequent diagnosis and the MP/H rules indicate "single primary," the tumor being evaluated is a "recurrence" of the original primary cancer.
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 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.
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--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.
An official website of the United States government
Home