Primary site--Bladder: What is the primary site for bladder tumor biopsy: invasive adenocarcinoma, enteric type favor urachal origin, stage III
Based on the information provided, code the primary site to urachus (C677). Primary adenocarcinoma of the bladder accounts for less than 1% of all bladder malignancies. Of these, 20–39% are urachal in origin.
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.
Behavior--Breast: Is behavior for encapsulated papillary carcinoma (EPC) of the breast coded as noninvasive or invasive?
The pathologist has the final say on behavior. Code behavior based on the pathologist's final diagnosis. See Rule F in ICD-O-3.
According the WHO Classification of Breast Tumors, encapsulated papillary carcinoma of the breast is in situ, /2. Encapsulated papillary carcinoma with invasion is assigned /3. WHO describes "frank invasive carcinoma" for this histology as "neoplastic epithelial elements infiltrate beyond the fibrous capsule of encapsulated papillary carcinomas." WHO cautions that true infiltration should be "differentiated from entrapment of neoplastic epithelial cells in the fibrous capsule and from epithelial displacement into the biopsy site, which is frequently encountered following needle-core procedures of papillary lesions."
Surgery of Primary Site--Brain and CNS: What procedure code would be used for NeuroBlate Laser Interstitial Thermal Therapy? This procedure was used for a Glioblastoma of the brain.
If a pathologic specimen is not taken during this procedure, code in the surgery field using code 10 (Local tumor destruction, NOS). If specimen is sent to pathology, code 90, surgery, NOS. We will request this procedure be included in future treatment field coding documentation.
Our research notes that this procedure, also known as LITT (Laser Interstitial Thermal Therapy), is a surgical treatment. Lasers transmit heat to coagulate or destroy the brain tumors from the inside out.
Grade--Brain and CNS: How should grade be coded for a pineal parenchymal tumor of "intermediate differentiation"? See discussion.
Per a web search, the term "pineal parenchymal tumor of intermediate differentiation" refers to a pineal tumor with the histology/behavior that falls somewhere between the category of pineocytoma (9361/1) and pineoblastoma (9362/3). In other words, it is a malignant tumor that is a WHO grade II/III neoplasm because it's histologic features and behavior are not quite equivalent to a pineoblastoma (WHO grade IV). Thus, it appears the expression "intermediate differentiation" is actually referring to a type of WHO classification system rather than the grade field.
Should the type of documentation provided in pathology report be used to imply the grade field is being referenced and thus be coded to 2 for "intermediate differentiation" or should grade be coded to 9 based on the information found during the web search?
Code the grade as 2 based on instruction #8 in the revised grade instructions for 2014.
Do not use WHO grade to code the grade field for CNS tumors.
First course treatment: When a patient has a Haplo bone marrow transplant, is this coded as an allogenic bone marrow transplant since part of his marrow was used in addition to a donor?
Use code 12 in the Hematologic Transplant & Endocrine Procedures data field. Per the NCI, this procedure is an allogeneic transplant.
Rather than wiping out a patient’s immune system before transplanting donor bone marrow, doctors administer just enough chemotherapy to suppress the immune system, which keeps patients from rejecting the donated marrow without harming their organs. The procedure requires just a half-match, meaning that a patient’s parents or children could be suitable donors. AKA: Half-match transplants.
Reportability--Breast: Is an inflammatory myofibroblastic tumor of the breast with metastasis to the lung reportable?
Inflammatory myofibroblastic tumor of the breast with metastasis to the lung is reportable. Metastasis to the lung from the breast tumor indicates that the breast tumor is malignant. All malignant neoplasms are reportable.
Reportability/Primary Site--Lip: Is a right lower lip (NOS) squamous cell carcinoma reportable when the microscopic description states the tumor arises from the epidermis and extends through the dermis? See discussion.
We are having difficulty determining whether the primary site is lip, NOS (C009) or skin of lip (C440). Usually we look for a statement of “skin” or “mucosa” in the microscopic description if the specimen label is only lip, NOS as instructed by the previous SINQ 20051049. Is a statement of "epidermis" or "dermis" in the microscopic description enough to indicate carcinoma is arising in the skin of the lip (C440) and thus not reportable?
This case is interpreted as skin of lip and not reportable. According to our expert pathologist consultant, the pathologist in this case "is specifically saying "epidermis" and "dermis" and I would have to think it is skin, and thus not reportable."
MP/H Rules/Multiple primaries--Bladder: Is this a single primary or multiple primaries? Transurethral resection of the bladder identifies two bladder tumors. Pathology states one is high grade papillary carcinoma (8130/3) and the other is lymphoepithelioma-like urothelial carcinoma (8082/3). Lymphoepithelioma-like is listed as a urothelial type in Table 1 but rule M6 does not include it in the list of histologies and we are not told to refer to Table 1. M8 refers to Table 1 but does not include multiple bladder tumors (C67_). Specify which rule would apply and why.
Rule M9 applies to this case. Abstract two primaries. M6 does not apply to this case because code 8082 is not one of the applicable histology codes for M6. This situation will be reviewed as we prepare the next version of the rules.
Surgery of Primary Site/Surgical Procedure of Other Sites--Endometrium: How are these fields coded for an endometrial primary when the patient undergoes a radical tumor cytoreduction including modified radical hysterectomy, BSO, omentectomy, resection of intra-abdominal and intrapelvic implants, and partial cystectomy? See discussion.
When other regional sites (besides the omentum) are removed with the primary site, how is Surgical Procedure of Other Site coded? There is no cytoreduction surgery code for endometrial primaries, and this patient does not appear to qualify for any of the specific pelvic exenteration codes.
Per SINQ 20091118, an omentectomy is not coded in the Surgical Procedure of Other Site field when it is performed with a hysterectomy.
In general, record surgery of sites/organs not covered in the surgery of primary site codes under surgery of other site. For this case, code the partial cystectomy under surgery of other site. As you point out, the omentectomy is not recorded under surgery of other site when performed with a hysterectomy for an endometrial primary.
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