Histology--Head & Neck: How do you code histology for a myofibroblastic sarcoma of the soft tissue of the head and neck?
Assign code 8825/3 [Myofibroblastoma, malignant]. According to the WHO Classification of Soft Tissue Tumors, "Low grade myofibroblastic sarcoma represents a distinct atypical myofibroblastic tumor often with fibromatosis-like features and predilection for the head and neck." Also called myofibrosarcoma.
Multiplicity Counter--Ill-defined sites: How is this field coded for Ill-Defined sites (C760-C768)?
Code the number of tumors present if known. If the number of tumors present is not known, code 99 [unknown number of tumors, unknown if multiple tumors].
First course treatment--Prostate: If a patient has a prostatectomy and the margins are positive, then several months later radiation is given because the PSA levels never decreased or have risen, is the radiation coded as first course of treatment or subsequent treatment?
Record the radiation as first course of treatment even though it was delayed for several months.
Radiation is highly effective when there is a small or microscopic amount of tissue left at the margin following prostatectomy. In most regions, radiation therapy is the standard of care for positive margins at prostatectomy.
Reportability--Lung: Is carcinoid tumorlet of the lung a reportable disease? See Discussion.
The literature on this is rather ambiguous as to whether these tumorlets (defined as <0.5 cm) are benign, such as atypical hyperplasia, or actual carcinoid tumors.
Carcinoid tumorlets are not reportable. The histology can be similar to typical carcinoids; however, they are <5 mm in diameter and are benign/nonreportable.
First course treatment: Is subsequent treatment with R-ICE first course or second course therapy if the patient underwent ABVD x2 cycles and subsequent imaging showed no response to treatment and evidence of progression [new adenopathy] for a lymphoma case? See Discussion.
Patient was initially diagnosed with Hodgkin Lymphoma, Nodular Sclerosing on 3/3/06.
Patient received ABVD x 2 cycles. Had disease reassessed in May, 2006, no response to treatment, showed evidence of progression (new adenopathy). Patient's pathology from 3/06 was sent for consult: Diagnosis was Hodgkin with some overlapping features of B-cell Non Hodgkin Lymphoma. Treated 5/18/06 with R-ICE FOR NHL.
The R-ICE treatment in this case is not part of the first course. Documentation of treatment failure and/or disease progression signifies the end of the first course of treatment.
Primary Site/CS Extension--Lymphoma: How are these fields coded for an epidural lymphoma that extends into the bone marrow of the adjacent vertebral body?
For cases diagnosed prior to 1/1/2010:After verifying that the lymphoma originated in the epidural space, code to C729 [nervous system, NOS (epidural)]. This is a rare type of extranodal lymphoma.
Assign CS extension code 80 for lymphoma with bone marrow involvement.
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.
Multiple primaries--Lymphoma: Is mediastinal large B-cell lymphoma followed by classical Hodgkin lymphoma reportable as one or two primaries? See Discussion.
Diagnosed 06/06/2006 with mediastinal large B-cell lymphoma, 9679/36. On 05/10/2007, another mediastinal lymph node biopsy done and the diagnosis was recurrent malignant lymphoma, classical Hodgkin's. A Hematopatholgy Consultant states, "it appears likely that the preceding mediastinal diffuse large B-cell lymphoma and the current classical Hodgkin's lymphoma are clonally related and represent different manifestations of the same entity. One might also place this in the spectrum of 'mediastinal gray zone lymphoma' described by Dr. Jaffee and colleagues."
For cases diagnosed prior to 1/1/2010:Report this case as two primaries. Report non-Hodgkin lymphoma followed by Hodgkin lymphoma as separate primaries.
According to the Table of Single and Subsequent Primaries for Hematologic Malignancies, mediastinal large B-cell lymphoma and Hodgkin disease are "D" - Different disease processes.
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.
MP/H Rules--Breast: Is inflammatory breast cancer always one primary per lifetime? Or is a subsequent inflammatory breast cancer a second primary if diagnosed more than five years later?
For cases diagnosed 2007 or later, a diagnosis of inflammatory breast cancer more than five years after a previous diagnosis of inflammatory breast cancer is a separate (new) primary. See rule M5 in the Breast Multiple Primary Rules.
CS Tumor Size--Lung: If a 5/11/07 CT showed a 6.5 cm LLL mass and a 7/24/07 CT showed 8.4 cm LLL mass, do we code the larger tumor size identified within four months of diagnosis or do we code the first size documented at the time of diagnosis?
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 larger tumor size.
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