CS Extension--Lung: Can extension be coded to 10 (Tumor confined to one lung) when either an autopsy or a CT scan describes the tumor as a mass of a specified size located in one lobe of the lung without any description of extension and no available TNM provided? See Discussion.
Example 1: Lung primary within the right lower lobe described clinically as greater than 3 cm on scan but was found to be 3 cm at autopsy.
Example 2: CT scan February shows 2 cm mass in RUL.
In both cases, the only tumor description was the size of tumor without any information regarding extension.
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.
Yes, assign code 10 [Tumor confined to one lung] for a mass in one lobe when none of the descriptions in codes 11 to 80 are documented.
CS Lymph Node Examined--Lung: How is this field coded when a mediastinoscopy and lobectomy are performed and the pathology report indicates multiple lymph node fragments were removed as biopsy specimens and the lobectomy specimen revealed 3 interlobar lymph nodes?
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 the CS Lymph Node Examined field to 98 [number unknown] because the biopsy information is not clear and as a result you do not know how many lymph nodes were examined.
CS Reg LN Pos/Exam: Are lymph nodes coded as positive or negative when the pathology report for a lymph node dissection performed after radiation and chemo reveals that the nodes are negative but they demonstrated previous involvement by cancer? See Discussion.
Scenario: The patient was treated with radiation and chemotherapy prior to resection for esophageal cancer. The pathology report stated, "1/3 nodes c/w treated previous ca."
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.Record lymph nodes that are pathologically confirmed as positive in Regional Nodes Positive. Evidence of previous involvement by cancer is not recorded in this data item.
In the above scenario, the lymph nodes are negative according to pathology.
Clinically positive lymph nodes are coded in CS Lymph Nodes.
Reportability--Skin: Is a pilomatrix carcinoma of the skin reportable if it is described as being a malignant diagnosis based on poor circumscription, infiltrative growth pattern, and focal abundant mitoses?
No. Pilomatrix carcinoma is not reportable to SEER. Please see page 1 of the 2004 SEER manual. Skin primaries with histology codes from 8090 to 8110 are not reportable. Pilomatrix carcinoma is coded 8110/3.
CS Tumor Size--Breast: Should this field be coded to 999 [Unknown] or 008 [0.8 cm tumor] when the tumor size is not provided on a stereomammotomy biopsy for an in situ malignancy and a subsequent excision demonstrates 0.8 cm tumor of residual in situ disease?
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 008 [0.8cm]. A mammotomy specimen is very small, so for this case, the residual tumor size is quite accurate. Size is not a critical data element for in situ breast cancer.
Histology (Pre-2007)--Corpus uteri: How is a polyp with "endometrial carcinosarcoma (Malignant Mixed Mullerian tumor), endometrial adenocarcinoma, and some areas of high grade spindle sarcoma" coded? See Discussion.
The path report for the TAH stated the endometrium contained an endometrial polyp measuring 6x3x3cm. Within the polyp there was endometrial carcinosarcoma (Malignant Mixed Mullerian tumor), endometrial adenocarcinoma, and some areas of high grade spindle sarcoma. There is no myometrial invasion by the tumor. (The Endometrial bx before surgery was positive for Malignant Mixed Mullerian tumor.)
For tumors diagnosed prior to 2007:
Assign code 8980 [Carcinosarcoma, NOS]. According to the WHO Classification of tumors, Malignant mullerian mixed tumor is a synonym for carcinosarcoma and carcinosarcoma is now the preferred terminology rather than malignant mixed Mullerian tumor.
Carcinosarcoma has both malignant epithelial and mesenchymal components. The epithelial component is usually glandular (adenocarcinoma in this case). The mesenchymal component is usually sarcoma (as in this case).
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.
Histology/Polyp--Colon: Which histology code is used when a colon biopsy states adenocarcinoma arising in a polyp, but the resection path states only adenocarcinoma, and does not mention arising in a polyp. See Discussion.
This scenario occurs frequently and our QC staff is divided on which code to use.
03-24-06 Rectal Polyp: Adenocarcinoma, moderately differentiated. 6-29-06 Rectum: Adenoca, MD, invades into the submucosa. No malignancy (0/15) LNs.
Use the polyp information from the biopsy and code adenocarcinoma arising in a polyp (8210, 8261 or 8263 as appropriate).
CS Extension--Pancreas, Head: When a tumor is described as having "vascular encasement of the celiac artery", is extension coded to 68 [tumor is inseparable from the celiac axis]?
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 vascular encasement of the celiac artery to CS extension code 68 [tumor is inseparable from the celiac axis].
This celiac axis is a small (1cm) area of branching arteries. The celiac artery branches into hepatic, gastric, and splenic at the axis. Dissecting tumor out from around the celiac axis is very tricky and usually encasement by tumor is a sign of inoperability.
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