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Pathology report states: the individual nodules of trichoblastic cells resemble those seen in trichoblastoma, but the lesion is very poorly circumscribed with an infiltrative border that extends into the subcutis. the lesion may behave in a locally aggressive fashion, and should be completely removed. High grade trichoblastic carcinomas can metastasize.

Examples

8/xx/13 TURBT with path specimen (27): Papillary Urothelial Carcinoma, HG    9/xx/13 Bladder fulgeration w/o path specimen (12)

5/xx/14 Segmental Mastectomy(24): Ductal carcinoma with <1mm marg    6/xx/14 Breast Re-excision (23): Residual ductal carcinoma 1.5mm, marg neg

Should it be coded to where the testis was physically at the time of diagnosis (C621), or should it be coded to C620 to reflect the increased risk for developing malignancy in an undescended testis?

This patient underwent a "partial decortication" per the operative report. While the operative report does not specifically note that this was performed with a partial pleurectomy, it appears the patient had a partial pleurectomy because the largest specimen removed was a "pleural peel" specimen, which included the parietal and visceral pleural surfaces with a small amount of underlying lung tissue. The operative report notes the patient had involvement of both the lung and chest wall. A total resection was not possible due to the extent of the tumor. However, this patient does appear to have undergone at least a partial resection of the pleura/tumor burden. The patient did not simply undergo a pleurodesis to free adhesions. Per the NCI's PDQ, pleurectomy and decortication are performed together. Because the operative report and pathology report only called this procedure a "partial decortication" without specifically mentioning a pleurectomy, would this be coded as a tumor excision (surgery code 20)? Or should we assume the procedure is best coded as a partial pleurectomy and decortication and use code 30 (simple/partial resection)?

Procedure stated = Bilateral skin-sparing mastectomies, left axillary sentinel lymph node biopsy. On the pathology report it indicates two additional lymph nodes were removed that were not SLN. The axillary aspect measures 2 x 2 x 1 cm. Two lymph nodes are identified ranging from 0.5 up to 1 cm. The lymph nodes are bisected and entirely submitted. Final Diagnosis Left breast, mastectomy including nipple: no residual carcinoma; FINAL DIAGNOSIS for LN = Lymph nodes, left axillary sentinel #1; excision: Two lymph nodes examined - negative for tumor (0/2); Two lymph nodes - negative for tumor (0/2)

There are multiple SEER Notes in the Breast Surgery Codes of Appendix C instructing us to code tissue expanders as reconstruction but none address the type of reconstruction to be coded.

1. Is a tissue expander always equivalent to Implant reconstruction?

2. Is AlloDerm always equivalent to Tissue reconstruction?

3. Is the combination of AlloDerm and tissue expander always equivalent to Combined (tissue and implant) reconstruction?

Is the instruction under #4.b. on page 114 of the 2014 SEER Program Coding and Staging Manual incorrect? It says to code Rituxan as chemotherapy.  

LARYNGOSCOPY - ENDOLARYNGEAL EXAM WAS GROSSLY UNREMARKABLE EXCEPT THAT SHE APPEARS TO HAVE A T1A SQUAMOUS CELL CARCINOMA OF THE RIGHT TRUE VOCAL FOLD. IT EXTENDS FROM ALMOST THE ANTERIOR COMMISSURE ALL THE WAY BACK TO THE VOCAL PROCESS AND IS EXOPHYTIC IN NATURE. IT DOES NOT EXTEND INTO THE VENTRICLE OR ONTO THE FALSE VOCAL FOLD. NO SUBGLOTTIC EXTENSION IS SEEN. A. RIGHT POSTERIOR FALSE VOCAL CORD FOLD, BIOPSY:  SQUAMOUS CELL CARCINOMA IN SITU. B. RIGHT POSTERIOR TRUE VOCAL CORD FOLD, BIOPSY:  SQUAMOUS CELL CARCINOMA, SUSPICIOUS FOR INVASION. C. RIGHT MID TRUE VOCAL CORD, BIOPSY:  SQUAMOUS CELL CARCINOMA, SUSPICIOUS FOR INVASION. D. RIGHT ANTERIOR TRUE VOCAL FOLD, BIOPSY:  INVASIVE AND IN SITU SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED.