CS Extension--Lung: If only a "single" cytology is performed on pericardial fluid and it is negative, can Note 6 B, which states that pleural effusion [code 72] is coded as malignant unless there are "multiple" negative cytologies, be used to infer that the pericardial fluid should also be coded as involvement?
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.
No, do not apply the instructions for pleural effusion to pericardial effusion. Do not code a pericardial effusion proven negative by cytology in CS Extension.
Chemotherapy: If a physician does not document the reason chemotherapy was given concurrently with radiation therapy, should it be assumed to have been used as a radiosensitizer or radioprotectant and then, per SEER chemotherapy coding instruction 2, ignore coding the chemo agent as treatment?
Do not assume that a chemo agent given with radiation therapy is a radiosensitizer. Seek additional information.
Compare the dose given to the dose normally given for treatment. When chemotherapeutic agents are used as radiosensitizers or radioprotectants, they are given at a much lower dose.
CS Extension/CS Mets at Dx--Corpus uteri: Is a microscopic metastasis in a cul-de-sac implant more appropriately reflected in the CS Extension field code 80 [Further contiguous extension; cul-de-sac] or in the CS Mets at Dx field code 40 [Distant metastasis]?
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 code 80 [Further contiguous extension; Cul de sac] for CS extension in this case. Endometrium and ovary are exceptions to the rules that only contiguous extension is coded in Extension code 80. Only true distant metastases are coded in Mets at Dx.
CS Extension--Head & Neck: If a 2 cm left tonsil primary extends to the lateral aspect of the soft palate, should extension be coded to 40 [Soft palate, inferior surface including uvula or soft palate NOS] or 42 [Soft palate, superior (nasopharyngeal) surface] for a tonsil primary?
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.
Extension code 40 is for extension from the tonsil to the back (lower) part of the soft palate, or soft palate, NOS. Code 42 is for extension to the front (higher, nasopharyngeal surface) part of the soft palate.
Inferior soft palate is the back (lower) part of the soft palate (C051). Superior soft palate is the front, (nasopharyngeal surface) of the soft palate (C113).
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Testis: If an orchiectomy specimen contains non-seminomatous mixed germ cell tumor and a separate satellite of seminoma, how many tumors should be abstracted and how should the histology field(s) be coded?
Pathology: R Orchiectomy: 2.1 cm non-seminomatous mixed germ cell tumor (50% teratoma primarily mature, 50% embryonal CA and yolk sac tumor). Located 3cm from the main tumor is a 2mm satellite pure seminoma.
For tumors diagnosed prior to 2007:
This is a single primary because the first three digits of the ICD-O-3 histology codes are the same, according to Rule 3a on page 11 of the 2004 SEER manual. Code the histology 9065 [Germ cell tumor, nonseminomatous]. Code 9065 is preferred over the less-specific code of 9061 [Seminoma, NOS].
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--Breast: Does "cancerization" mean invasive for a breast tumor described as "DCIS with lobular cancerization"?
No, cancerization is not a synonym for invasive. Cells of DCIS can extend not only along the duct but also into the terminal lobules. This extension is referred to as lobular cancerization.
CS Lymph Nodes--Esophagus: Is a resected positive "periesophageal nodule" coded as an involved lymph node for an esophagus primary? See Discussion.
Per SINQ 20000846: Each gross nodule of metastatic carcinoma in the fat surrounding an organ is counted as one positive regional lymph node. SINQ 2000846 applied to EOD. Can this concept be used for Collaborative Stage?
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.
For cases diagnosed on or after January 1, 2004:
Search for additional information on the "nodule." Review the gross and microscopic descriptions to determine whether or not the nodule is a lymph node. If it is not possible to obtain further information, apply the downstaging rule and select the Extension or LN code that results in the lower category.
CS Extension--Lymphoma: If bilateral tonsils are involved with lymphoma, is it one or two regions of involvement and how is extension coded?
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.For cases diagnosed 1-1-08 and later: Assign CS extension code 10 [involvement of a single lymph node region]. Bilateral tonsils are one organ/site.
See Note 1 under CS Extension. Tonsil is coded the same as a lymph node region.
Histology--Leukemia: How is a "plasmacytoid dendritic cell leukemia/lymphoma" coded when it is discovered on a bone marrow biopsy for a patient who presented with multiple enlarged lymph nodes and the discharge diagnosis was Type 2 plasmacytoid dendritic cell leukemia?
For cases diagnosed prior to 1/1/2010:
The best code currently available for this entity is 9727/3 [precursor cell lymphoblastic leukemia].
The WHO classification refers to this as "Blastic NK-cell lymphoma." The 2005 WHO-EORTC classification for cutaneous lymphomas states that blastic NK-cell lymphoma may be derived from a plasmacytoid dendritic cell precursor. They suggest more appropriate terms for this condition may be "CD4+/CD56+ hematodermic neoplasm," and "early plasmacytoid dendritic cell leukemia/lymphoma." According to WHO, this is a rare form of lymphoma.
Willemze, et al. WHO-EORTC classification for cutaneous lymphomas. Blood, 15 May 2005. Volume 105, Number 10.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
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