Date of Diagnosis/Histology (Pre-2007)/Behavior--Melanoma: How are these fields coded when the first shave biopsy finds "what appears to be the top of a melanoma" and a subsequent shave biopsy finds "features consistent with lentigo maligna?"
For tumors diagnosed prior to 2007:
Evaluate each case using all available information, including all pathology reports. Use the date of the first biopsy because it did identify the melanoma. The second biopsy confirmed the histologic type.
According to WHO's Histological Typing of Skin Tumors, lentigo maligna melanoma is similar to lentigo maligna, but has dermal invasion by atypical melanocytes.
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.
Multiple Primaries (Pre-2007)--Trachea/Lung: Would synchronous lesions, of the same histology, diagnosed in the right upper lobe of the lung and trachea be a single primary when the physician feels they are two separate primaries?
For tumors diagnosed prior to 2007:
According to SEER rules, abstract as one primary because although these sites have separate topography codes in ICD-O-3, they were coded to the same three-digit topography code in the first edition of ICD-O (SEER Program Code Manual, 3rd Edition, page 8, Exception B). Simultaneous lesions of the same histology in trachea and lung are one primary. Code the primary site to C399 [Ill-defined sites within respiratory system].
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.
EOD-Size of Primary Tumor--Testis: Should this field be coded to the gross pathological size when the pathology states "tumor dimension essentially the same as testicle, but is not appropriate in this case because the infiltrate does not form a mass lesion"? See Description.
Gross describes a testicle that measures a 4cm. Path micro states "several large atypical cells...These never form a true mass. Path comment states, "tumor dimension essentially the same as testicle, but is not appropriate in this case because the infiltrate does not form a mass lesion."
For cases diagnosed 1998-2003: Code the tumor size as 999 [Not stated] for the case example above. Keep in mind that tumor size is not used in analysis for certain sites such as testis, stomach, colon & rectum, ovary, prostate, and urinary bladder. Tumor size is important for analysis for certain sites such as lung, bone, breast, and kidney.
EOD-Size of Primary Tumor: Can size be coded from a needle bx that removes all of the invasive tumor and just leaves a "focus of in situ"? See Description.
For example: needle bx diagnosis is "tiny focus of tissue highly suspicious for tubular ca." The lumpectomy path states "single focus of low grade DCIS, no residual ductal ca." Can size be coded 001?
Code tumor size to 001 [Microscopic focus or foci only] for the invasive component. Code the tumor size 990 for cases diagnosed in 2004 and forward. Disregard the microscopic tumor found at further resection.
Radiation: How would this field be coded for treatment with quadramet [radioactive samarium]? See Description.
Paitent is receiving quadramet for treatment of lung metastases.
Code Quadramet in the RX Summ-Radiation field as 3 [Radioisotopes]. Quadramet is a radioisotope used to palliate bone pain. The instructions in the SEER manual state: "Record all radiation that is given, even if it is palliative."
EOD-Patholgic Review of Number of Regional Lymph Nodes Examined: How is this field coded when there is no lymph node count in the final pathology diagnosis and the gross description states "four possible lymph nodes are dissected"? See Description.
Patient with kidney cancer underwent nephrectomy and lymph node removal. Final path diagnosis was Lymph nodes, pericaval biopsy, lymph nodes with no evidence of carcinoma. Per Gross description: Received in formalin as pericaval lymph node is 2.5 cm piece of fibrofatty tissue, from which four possible lymph nodes are dissected.
For cases diagnosed 1998-2003: Code the number of regional lymph nodes examined as 04. This is as accurate as possible for this situation.
EOD-Extension--Lymphoma: How is the following guideline of "any mention of lymph nodes is considered indicative of involvement" applied for EOD-Extension of lymphoma cases when there is a discrepancy between physicians as to the stage at diagnosis? See discussion.
A biopsy of mesenteric nodes confirmed lymphoma. A bone marrow biopsy was negative. A CT of the chest indicates "small mediastinal and bilateral hilar nodes, but without convincing adenopathy." The case was Stage 2 per the oncologist and Stage 3 per the surgeon's TNM form.
For tumors diagnosed 1998-2003:
Based on the information provided for this example, the lymphoma involves one site, mesenteric nodes. Code EOD extension as 10 [Involvement of a single lymph node region].
The statement "For lymphomas, any mention of lymph nodes is indicative of involvement" refers to the terms in the paragraph above it on page 8 of the EOD manual: Palpable, enlarged, visible swelling, shotty, lymphadenopathy. While these terms are ignored for other malignancies, they should not be ignored for lymphomas. None of these terms apply to the example provided here. According to the CT, the mediastinal and hilar nodes are "small" "without convincing adenopathy." In other words, the mediastinal and hilar nodes are negative.
Histology (Pre-2007)--Kidney, renal pelvis: What codes are used to represent the histologies of 1) "renal papillary (chromophil) carcinoma" and 2) "chromophil renal cell carcinoma?"
For tumors diagnosed prior to 2007:
Code "chromophil" to 8260 [papillary renal cell]. According to our pathologist consultant, in the case of chromophil, most authors regard this as more or less synonymous with papillary renal cell [8260]. "More or less" because papillary is an old term descriptive of the microscopic structure, while chromophil is newer and based on the cytology; because most of the latter are papillary the current usage assumes them to be equivalent.
1) The diagnosis "renal papillary (chromophil) carcinoma" tells us that the pathologist who wrote it was seeing both pattern and cytologic features, and is regarding papillary equivalent to chromophil; thus, code to 8260.
2) Code "chromophil renal cell carcinoma" to 8260.
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.
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