Grade/Sarcoma--Breast: Is the correct grade for high grade angiosarcoma of the breast a code 3 or 4? The breast usually uses a three grade system but sarcoma is not a typical histologic type of the breast.
Assign grade code 4 using the sarcoma table. Nottingham or Bloom-Richardson (BR) Score/Grade does not apply to angiosarcomas. This is a good question and points out needed clarification of the grade rules.
CS Lymph Nodes/CS Mets at Dx--Melanoma: How are these fields coded if a sentinel lymph node biopsy reveals no malignancy but there is an aggregate of melanoma cells in the lumen of a large vein immediately adjacent to the lymph nodes?
This question was answered by the CoC:
Do not count this as regional metastatic disease since there is no evidence it is an established tumor. Stage this as a N0.
Date of Diagnosis: How do you code this field when the pathologic confirmation is delayed for 2 months because the clinician decides to "watch and see what happens" to a CT identified mass thought to be either a "metastasis from a previously diagnosed malignancy or a new primary"?
Code the Date of Diagnosis field to the date of the scan. This is the earliest date that a recognized medical practitioner said the patient had cancer. The diagnosis on the CT scan was a malignancy. The only question was whether the mass on the scan was metastatic or a primary.
CS Lymph Nodes--Melanoma: If the primary site is coded to C449 because no primary skin lesion is identified for a melanoma case, are any positive lymph nodes assumed to be regional?
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 Nodes field to 80 [Lymph Nodes, NOS].
Although it is in the CS LN field, use the code for Lymph Nodes, NOT OTHERWISE SPECIFIED when you don't know whether the nodes are regional or distant. There are separate codes to use when you definitely know that the nodes are regional.
MP/H Rules/Histology--Colon: When the microscopic description indicates a colon tumor is "tubulovillous," but the final diagnosis only states "adenocarcinoma," is the histology coded to 8263/3 [adenocarcinoma in a tubulovillous adenoma]?
For cases diagnosed 2007 or later:
Yes. This is an example of a site-specific exception to the general rule to code only from the final diagnosis. The Colon Histology Rules specifically state that "other parts of the pathology report" may be used to identify a tumor arising from a polyp, adenomatous polyp, villous adenoma, or tubulovillous adenoma.
MP/H Rules--Lung: In reference to lung, SINQ 20071028 states "'nodule' is not an equivalent term for tumor, mass, lesion, or neoplasm." However, slide 5 for the MPH lung section of "Beyond the Basics" states "we use the words 'mass, nodule and lesion' interchangeably." Which is it?
For cases diagnosed 2007 or later:
For the purpose of applying the Lung MP/H rules, the word "Nodule" can be used interchageably with "Tumor," "Mass," "Lesion" and "Neoplasm." HOWEVER, this does NOT apply to casefinding or staging.
This revision will be added to the next version of the MP/H rules. Sinq question 20071028 will be revised.
Histology (Pre-2007)--Corpus Uteri: What code is used to represent the histology "endometrioid carcinoma with squamous differentiation" for an endometrium primary?
For cases diagnosed 2004-2006:
Endometrioid adenocarcinoma with squamous differentiation is coded 8570 [Adenocarcinoma with squamous metaplasia].
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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