Primary Site--Kaposi Sarcoma: Would the following Kaposi primaries be examples of cases not coded to skin for primary site? See discussion.
1. KS developed initially as a lesion in the oral cavity and followed by the appearance of skin lesions.
2. KS found in a resected parotid gland with metastasis to the parotid gland lymph node. No skin lesions identified.
3. KS discovered in a biopsied 3 cm axillary lymph node. Clinically, the patient had hepatosplenomegaly, ascites, and extensive mesenteric lymph nodes. (No mention of skin.)
Code the Primary Site field as follows:
1. C44.9 [Skin, NOS] as the default value when lesions develop simultaneously in skin and non-skin areas.
2. C07.9 [Parotid gland]
3. C44.9 [Skin, NOS] as the default value when there is no mention of lesions in the skin or other primary site.
Edward Klatt states in Practical AIDS Pathology, "...Visceral Kaposi (involving one or more internal organ sites) is also present in three-fourths of cases, but may not be diagnosed prior to autopsy. Visceral involvement frequently includes the lung, lymph nodes and gastro-intestinal tract."
EOD-Extension--Lung: If LUL mass "crosses the pleural surface" into the LLL, do we assume this represents extension to the pleura? See discussion.
9/22/93 Left upper lobe lobectomy: 3 x 3 cm mass in the periphery of the LUL near the LLL. Multiple enlarged nodes around the aortic arch and within the pulmonary fissure.
9/22/93 Pathology: Moderately differentiated Adenoca. The neoplasm does cross the pleural surface into the segment of the lower lobe. Lower margin of resection is free of neoplasm. Six lymph nodes negative for metastatic carcinoma. Tumor staged as T2N0M0 Stage Ib by physician.
Is tumor extension coded 10 [confined to one lung] or 40 [extension to pleura]?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 40 [extension to pleura]. The tumor has penetrated (extended to) the pleura.
Grade, Differentiation--Brain and CNS: Can grade IV be implied for brain primaries with the histology of glioblastoma multiforme, even if there is no statement of grade in the path report? See discussion.
Dr. Platz has instructed the Iowa registry to code glioblastoma multiforme to grade IV, even when there is no corroborating statement of grade in the path report. This is also supported in some references.
Code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable] in the absence of a stated grade on the pathology report. If a grade is stated, code the stated grade. SEER does not recommend adopting the rule in the Discussion.
EOD-Clinical Extension--Prostate: For prostate cancer, can an elevated PSA be used to code metastasis? See discussion.
5/31/98 PE: 30 gm prostate with nodularity, suspicious for CA.
Final diagnosis: Stage D Ca of prostate with mets, NOS
PTA IVP: Normal collecting system
5/11/98 CXR: NED
PSA 86.3 Suggestive of prostate Ca per MD
5/13/98 TURP and bilat. orchiectomy: Plan was to perform orchiectomy as treatment of choice if biopsy was positive. Appears MD feels that the patient has mets, NOS based on the elevated PSA.
5/13/98 TURP Adenocarcinoma, PD
For cases diagnosed 1998-2003, do not code the EOD-Clinical Extension field based on elevated PSA alone. If a recognized practitioner states that there is metastasis, then metastasis should be coded.
In this case, code the EOD-Clinical Extension field to 85 [Metastasis] because it is Stage D. But if you had D1 or D2 staging based on the involvement of lymph nodes, then that involvement would be coded under EOD lymph nodes and not under the clinical extension field.
Terminology: Do focus, focal, foci and chips mean the same thing?
Focus, focal, and foci are variations of the same word. Focus (noun) describes an area or point of disease, either grossly or microscopically. Focal (adjective) relates to the area/focus of disease; an example is a prostate with focal adenocarcinoma. This means that the majority of the prostate is benign and the adenocarcinoma is confined to one small area/point. Foci (plural) describe more than one area/focus of disease. A prostate with foci of adenocarcinoma means the disease is multifocal (several areas/points of disease).
Chips are microscopic amounts of either tissue or tumor. A pathologist might examine several chips of prostate tissue, one of which contains a focus of adenocarcinoma.
EOD Fields--All Sites: Is EOD information limited to what is available exactly two months from the day of diagnosis?
For cases diagnosed 1998-2003:
EOD should include all information available within four months of diagnosis in the absence of disease progression or through completion of surgery(ies) in first course of treatment, whichever is longer.
Mets known to have developed after EOD was established should be excluded.
EOD-Extension--Lymphoma: What code is used to represent a non-Hodgkin lymphoma presenting with involvement of an extralymphatic organ and lymph nodes on the opposite side of the diaphragm?
For cases diagnosed 1998-2003: Code the EOD-Extension field to 31 [30 + localized involvement of an extralymphatic organ or site; Stage III E].
EOD-Pathologic Extension--Prostate: If there is residual tumor in the distal urethra on prostatectomy, does that mean there is distal urethral margin involvement? See discussion.
2/98 Prostate bx: Right apex, right mid and right base positive for adenocarcinoma.
6/1/98 Radical retropubic prostatectomy w/ bilateral pelvic lymph node dissection. Pathology: Residual adenocarcinoma in distal urethra, right lateral sections and posterior lobe. Right apical margin, other margins, seminal vesicles, and 7 pelvic LN negative for malignancy.
For cases diagnosed 1998-2003:
For the example above, code the EOD-Pathologic Extension field to 34 [extending to apex] because most of the right side is involved.
The pathology report says all margins are free. The comment on residual tumor in the urethra, meant the first surgery did not completely remove tumor tissue from the urethra, it does not mean that tissue is at the margin.
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: How are these fields coded if radiation to the primary site and/or regional lymph nodes is performed prior to surgery?
For cases diagnosed 1998-2003:
Code the EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined fields per the information in the pathology report(s). Radiation to the primary site would not affect the status of the lymph node involvement. Radiation to the regional lymph node region may or may not affect the pathologic status of the lymph nodes. However, for these fields code the best information available about the status of the lymph nodes which is reflected in the pathology report(s).
EOD-Extension--Corpus Uteri: What code is used to represent this field for a corpus primary (sounding 8 cm or less in length) treated with radiation prior to a hysterectomy that pathologically showed superficial myometrial invasion? Is it possible that the invasion could have been more extensive prior to the radiation treatment?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 12 [Myometrium, inner half] which represents the extension you know. In this particular case, there was no clinical evidence of extension outside the corpus. As long as the surgery was not performed because of disease progression, use information from the surgery to code EOD extension.
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