Surgery of Primary Site--Lung: How is surgery coded when a patient undergoes a mediastinoscopy with mediastinal lymph node sampling and then a later upper lobectomy? See discussion.
The mediastinal nodes were submitted as a separate specimen. The patient also had several peribronchial nodes identified within the lobectomy specimen.
Does code 33 (Lobectomy with mediastinal lymph node dissection) require a complete mediastinal lymph node dissection (i.e. the removal of all lymph nodes in mediastinal chain(s) as opposed to a selective sampling/dissection of lymph nodes from multiple mediastinal chains)?
Assign code 33 in this situation. Code 33 can include mediastinal lymph node sampling.
First course treatment/Surgery of Primary Site--Anus: Would infrared coagulation be coded as treatment for AIN III of the anus/anal canal? See discussion.
SINQ 20051064 indicates infrared coagulation is not treatment for cancer. Internet search explains that infrared coagulation delivers heat to destroy the tissue so it can be removed. In our region it is currently used to treat internal and external anal low grade squamous intraepithelial lesions (LSIL) and high grade squamous intraepithelial lesions (HSIL). While it is understandable that this wouldn't be coded as treatment for an invasive anal primary, could it be treatment for an in situ tumor? If it is treatment, should it be coded under Surgery code 15
The answer to SINQ 20050164 still applies. Do not code infrared coagulation as cancer treatment. It is used to coagulate blood vessels and not to destroy cancer tissue.
MP/H Rules/Kidney, renal pelvis--How many primaries are there for this case? Should we stop at rule M8 making this all one primary (C689) even though there were right and left renal pelvis tumors? Rule M3, which contains laterality, does not apply because there is also a bladder tumor. See discussion.
Kidney: originally diagnosed 12/21/2011 with right renal pelvis high grade papillary urothelial cancer. Status post right nephrectomy. Then on 01/10/2013 diagnosed with low grade papillary urothelial cancer of the bladder. 01/21/2013 diagnosed with left renal pelvis urothelial carcinoma iIn situ. Path report stated this may represent a hgh grade papillary urothelial cancer – unable to confirm due to specimen size. On 01/24/2013 left periaortic lymph node biopsy revealed poorly differentiated carcinoma consistent with prior diagnosed right renal pelvis high grade urothelial cancer. Neither the bladder nor the left renal pelvis tumor was compared to the previous right renal pelvis tumor. Also has bone mets.
Abstract this case as a single primary.
First, apply the MP/H rules to compare the 2013 bladder tumor to the 2011 renal pelvis tumor. Rule M8 applies, this is a single primary. Next, apply the MP/H rules to compare the 2013 in situ renal pelvis tumor to the 2011 renal pelvis tumor. Rule M8 applies, this is a single primary. As you correctly pointed out, Rule M3 for bilateral renal pelvis tumors, does not apply because there is also a bladder tumor in this case.
Reportability--Testis: Is a mature teratoma of the testis reportable? See discussion.
Mature teratoma is listed as a benign neoplasm (9080/0) in the ICD-O-3. SINQ 20120085 references a NAACCR Webinar that indicated pure mature teratomas of the testis in adults are reportable. We are not aware of any further documentation of this change in reportability. When did mature teratomas of the testis for adults become reportable? What is the defined age range for "adult"? The original SINQ question above lists the 2012 SEER Manual as a Reference, however, no clarification or mention of this change in reportability was found in that manual.
For testis, mature teratoma in an adult (post-puberty) is reportable because it is malignant (9080/3); however, mature teratoma in a child is benign (9080/0). The 2011 NAACCR webinar introduced this concept and it was documented in the 2012 SINQ question. You may use 2011 or 2012 as the date of this change. The next edition of the SEER manual will include reportability examples.
MP/H Rules/Histology/Multiple primaries--GE junction: How is histology coded for a goblet cell carcinoma in the GE junction? See discussion.
The patient was diagnosed with GE junction signet ring adenocarcinoma (8490/3) in 5/2012, treated with radiation. GE junction biopsy on 9/20/2012 showed residual signet ring carcinoma. Subsequent biopsies on 7/8/2013 showed GE junction biopsy of invasive adenocarcinoma, signet ring cell type along with “Esophagus, distal and GE junction biopsies” (site not further clarified in available documentation) with Goblet cell carcinoma. The histology code for the goblet cell carcinoma is needed to determine the number of primaries.
According to our expert pathologist consultant, goblet cell is a descriptive term and not a specific histology in this context. There is no ICD-O-3 code for it. The "goblet cell carcinoma" in this case is not a new primary.
Goblet cell is used to describe some cells containing mucin. In addition to individual tumor cells containing mucin which compresses the nucleus to give the appearance of signet rings, the mucin is present in columnar cells with the nuclei at one end -- this latter is a pattern often seen when glandular structures are formed by the tumor cells. It is also often intermixed with the signet ring cells in the surrounding stroma.
MP/H Rules/Multiple primaries--Ampulla of vater: Is this a new primary? Patient has intramucosal adenocarcinoma in a tubulovillous adenoma of the ampula of vater in Sept. of 2011. In May of 2012, patient has another ampullary adenoma with intraepithelial carcinoma (pTis) and an area suspicious for invasion. This is coded 8263/3.
Rule M14, Multiple in situ and/or malignant polyps are a single primary, precedes rule M15, An invasive tumor following an in situ tumor more than 60 days after diagnosis is a multiple primary, per the MP rules for 'Other sites',
Rule M14 applies. Abstract this case as a single primary.
Reportability--Brain and CNS: Is Tuberculum sellae meningioma reportable? Is it same as sphenoidale meningioma?
Path: Brain tuberculum tumor resection: Meningioma, WHO grade I.
Revised answer based on ST rules
Yes, a Tuberculum sella meningioma is reportable if diagnosed 2004 or later. Code the primary site C700, cerebral meninges. It is a meningioma originating from the meninges of the Tuberculum sellae, which is part of the sphenoid bone.
Grade--Heme & Lymphoid Neoplasms: Why isn't "T-cell granular lymphocytic leukemia" (9831/3) coded as "5 T-cell" instead of "9" as specified in the Heme database? My path department did not specify any type of grade, but since "T-cell" is part of the name, wouldn't you code it to "5"?
Assign code 5 when the diagnosis on the pathology report specifies "T-cell granular lymphocytic leukemia." The Heme DB grade instruction states "Code grade specified by pathologist. If no grade specified, code 9." In this case, T-cell was specified - code it. The code for T-cell (5) was not automatically assigned in the Heme DB because of the alternate names for this neoplasm. Some of these include NK-cell. Assign code 8 for alternate names with NK.
The alternate names are: Chronic lymphoproliferative disorder of NK cells, Chronic NK-cell lymphocytosis, Chronic NK-large granular lymphocyte (LGL) lymphoproliferative disorder, CLPD-NK, Indolent large granular NK-cell lymphoproliferative disorder, NK-cell lineage granular lymphocyte proliferative disorder, NK-cell LGL lymphocytosis
Surgery of Primary Site--Corpus uteri: What is the correct surgery code to assign for dilation and curettage (D&C) for an in-situ endometrium (C541) primary? The code to use for the cervix uteri (C530-C539) is specified, but not for the corpus uteri (C540-C549).
Assign code 20 for endometrial D&C for in situ cancer of endometrium.
MP/H/Multiple primaries--Urinary: In Aug 2008 Patient was diagnosed with Noninvasive Bladder Cancer. In Oct 2013 Patient was diagnosed with Transitional Cell Carcinoma of Right Ureter involving lamina propria, Noninvasive Transitional Cell Carcinoma Left Ureter and Invasive Transitional Cell Carcinoma of Prostatic Urethra. Is this a new primary and what is the primary site?
Rule M7 applies when comparing the 2008 diagnosis to the 2013 diagnosis: multiple primaries.
Rule M8 applies to the tumors identified in 2013: single primary.
Based on the information provided, code the primary site for 2013 to C689 because there is no indication of the site of origin among the involved sites.