Surgery of Primary Site--Ovary: How should this field be coded for an ovarian primary when there is a BSO and only the fundus of uterus is removed (not a full hysterectomy)?
Assign surgery code 52 [Bilateral (salpingo-) oophorectomy; WITH hysterectomy]. Code 52 does not exclude a partial hysterectomy.
CS Site Specific Factor--Head & Neck: How is Site Specific Factor 2 coded when the pathologist describes regional lymph nodes as "matted"? See Discussion.
The primary tumor is located in the tonsil. The patient underwent neck dissection. Pathology report stated there were matted regional lymph nodes. Does the term matted describe extracapsular extension? The definition for site specific factor 2 uses the term "fixed" to describe extracapsular extension (but not matted). For breast, fixed/matted appear to be interchangeable. Would they also be interchangeable for head and neck cases?
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."Matted" is not a synonym for "Fixed" in the CS schema for Head and Neck. "Matted" is not indicative of extracapsular extension for the Head and Neck schema.
MP/H Rules/Histology--Esophagus: Should the modifying expression "with areas of" be used to code histology? See Discussion.
Patient was found to have two tumors in the esophagus. The large tumor was diagnosed as adenocarcinoma with areas of neuroendocrine differentiation (small cell carcinoma). The smaller tumor was diagnosed as small cell carcinoma. If we accept the "areas of" to be part of the diagnosis, rule H16 indicates that histology for the large tumor would be coded 8045 (combined small cell and adenocarcinoma). If we ignore the "areas of," then histology for the large tumor would be coded to 8140 (adenocarcinoma). Either way, when counting primaries, rule M17 would be applied and the two tumors would be classified as separate primaries. However, it seems that the two tumors are probably the same disease process since they both show small cell carcinoma.
For cases diagnosed 2007 or later, do not use the modifying expression "with areas of" to determine a more specific histology per rule H13 in the MP/H rules.
Reportability--Anal canal: Are squamous cell carcinomas arising in a condyloma of the rectum reportable or should we assume that the site is skin of anus or perianal area and not reportable?
Squamous cell carcinoma arising in a rectal condyloma is reportable. Do not assume the site is skin of anus or perianal.
MP/H Rules/Multiple Primaries--Head and Neck: How many primaries are to be accessioned for a case in which a second tumor occurs in an area previously involved by direct extension from a prior primary located in an adjacent site? See Discussion.
Patient diagnosed in August 2007 with squamous cell carcinoma in the right tonsil. This tumor extended to the base of tongue. Treatment consisted of radiation and chemotherapy. In May 2008, the patient was found to have squamous cell carcinoma of the base of tongue. How many primaries are to be accessioned for this case? Rule M7 states that tumors in sites with ICD-O topography codes that are different at the second or third character are multiple primaries. The topography code for base of tongue differs from that of tonsil. Would rule M7 apply? On the other hand, the base of tongue was involved by the tonsil primary which was diagnosed less than one year before.
For cases diagnosed 2007 or later:
The May 2008 diagnosis is not a new primary. Base of tongue involvement was originally present in August 2007. The May 2008 diagnosis does not represent new tumor. The 2007 rules apply to new tumors only; therefore, the 2007 rules do not apply to this case.
CS Extension--Lymphoma: Does peripheral blood involvement affect the stage for lymphoma? See Discussion.
2009 Diagnostic Year
Lymph node bx is positive for Mantle Cell lymphoma. Flow cytometry on lymph node tissue shows CD+ pos B cell lymphoproliferative disorder. IHC findings support Mantle Cell lymphoma. Flow cytometry on peripheral blood shows CD+ B cell lymphoproliferative disorder. Because the lymph node is positive for Mantle Cell lymphoma and the flow cytometry findings are the same on the lymph node tissue and peripheral blood, is the peripheral blood involved (Stage IV 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.No. Peripheral blood is not the same as bone marrow involvement which is what would be required for stage IV.
Lymphomas can arise in lymph nodes which are connected by lymphatic vessels. Both lymphatic vessels and blood vessels travel through lymph nodes and malignant cells can travel between the vessels. Cells in peripheral blood do not prove Stage IV.
Reportability--Kidney: Is the donor or the recipient the reportable patient when a cyst removed from a pre-transplanted kidney is determined to be cancerous? See Discussion.
A patient received a kidney from her son. The son's kidney had a cyst which was removed prior to the transplant and later determined to be renal cell ca. Who do we report, the donor or the recipient?
The renal cell carcinoma should be reported for the donor. The cyst that was determined to be carcinoma was removed before the kidney was transplanted.
Surgery of Primary Site/Scope Regional LN Surgery--Breast: How should these fields be coded when a sentinel lymph node dissection removes one-to-three axillary lymph nodes and a total/simple mastectomy is done?
Assign code 41 [Total (simple) mastectomy, NOS WITHOUT removal of uninvolved contralateral breast] for Surgery of Primary Site. Assign code 2 [Sentinel lymph node biopsy] for Scope of Regional Lymph Node surgery. Code 41 applies to a total/simple mastectomy with any number of sentinel lymph nodes removed -- as long as all of the nodes removed are designated as sentinel nodes.
Multiple Primaries--Breast: How many primaries should be reported when a lobular carcinoma with positive margins is followed 8 years later by a lobular carcinoma near the previous lumpectomy site? See Discussion.
Left breast invasive lobular ca diagnosed 3/00 and treated with a lumpectomy, but with multiple positive margins; she received no post operative radiation or other medical treatment (unknown why). 10/08 core biopsy of "an area of distortion" near the scar site is positive for invasive lobular ca. The radiologist states "compatible with recurrence at her previous lumpectomy site" on an x-ray report.
One thought is that this should not be a new primary because the patient was never disease free (multiple positive margins) and the patient received incomplete treatment. Or should this be a new primary because the tumors are diagnosed more that 5 years apart?
Abstract the 10/08 diagnosis as a new primary, per Breast rule M5. In spite of the positive margins and apparently incomplete treatment in 3/00, there is no mention of the presence of disease between 3/00 and 10/08 according to the information provided.
Grade/Cell indicator--Lymphoma: How is Grade/Cell indicator coded for anaplastic large cell lymphoma? See Discussion.
The SPCM states cell indicator codes take precedence over grade/differentiation codes for lymphoma and leukemia cases.
For cases diagnosed prior to 1/1/2010:Because there is no cell indicator information, code 9 [cell type not determined] in the grade/cell indicator field. Do not code grade for lymphoma. For lymphoma and leukemia this field is the cell indicator.
For cases diagnosed 1/1/10 and later, 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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