MP/H Rules/Histology--Brain and CNS: How is histology coded for a left occipital parietal area tumor stated to be a "low grade neuroectodermal neoplasm most consistent with neuronal tumor but lacking classic features of ganglioma" if the pathologist states the tumor is not malignant?
Code 9505/0 [Ganglioglioma, benign] is the best option according to our pathology expert. He states, "There recently has been a spate of tumors called low grade glio-neuronal tumors that are not PNETs and have no propensity to become malignant."
Immunotherapy/Chemotherapy: Are monoclonal antibodies, such as Avastin and Erbitux, coded as immunotherapy or chemotherapy? See Discussion.
In review of the "FDA-approved oncology agents not listed in SEER Book 8" provided in 5/02, it appears "monoclonal antibodies" are coded as immunotherapy.
Code Avastin and Erbitux as chemotherapy because both of these drugs are growth inhibitors. Code growth inhibitors (cytostatic agents) as chemotherapy. Do not assume that monoclonal antibodies are coded as immunotherapy.
Primary site: What is the correct primary site code for angiosarcoma of the spleen with mets to bone marrow C42.2 vs C49x? See Discussion.
Robbins Pathology states the following about liver angiosarcomas: Hepatic angiosarcomas are rare but of interest because they are associated with distinct carcinogens, including arsenic (exposure to arsenical pesticides), Thorocast (a radioactive contrast medium previously widely used in radiology), and polyvinyl chloride (PVC) (widely used in plastics). The increased frequency of angiosarcomas among works in the PVC industry is one of the truly well-documented instances of chemical carcinogenesis in humans. With all these agents, there is a very long latent period of many years between exposure and the development of tumors.
Could the same apply to the spleen?
Code C422 [Spleen] as the primary site for angiosarcoma of spleen with metastasis to bone marrow.
Primary Site--Breast: What subsite is to be coded for a case of invasive Paget disease of the nipple with an infiltrating ductal carcinoma of the lower inner quadrant?
Code C50.9 [Breast, NOS]. Code the last digit of the primary site to '9' for single primaries when multiple tumors arise in different subsites of the same anatomic site and the point of origin cannot be determined. Nipple [C50.0] and LIQ [C50.3] fit this rule. This is a single primary per MP/H Breast Rule M9.
CS Extension--Prostate: How do you code clinical extension for prostate primaries diagnosed at autopsy? See discussion.
A patient was not diagnosed prior to autopsy. The autopsy diagnosis states that this is adenocarcinoma of the prostate without capsular invasion.
Should clinical extension be coded to clinically inapparent, NOS (10) and pathologic extension be coded to no prostatectomy done within first course of treatment (97)?
Code CS Extension (clinical) to 99 [Unknown]. Code SSF 3 according to the amount of tumor found using the information from the autopsy.
Multiplicity Counter--Lung: How is this field coded when there is no evidence of the primary tumor? See Discussion.
Patient presented with large mediastinal mass. CT showed no intraparenchymal lung tumor. Biopsy of mediastinal mass revealed adenocarcinoma consistent with lung primary.
First course treatment/Other therapy--Skin: How is PUVA [psoralen (P) and long-wave ultraviolet radiation (UVA)] coded when used for skin primaries such as melanoma and mycosis fungoides?
Code PUVA as "Other treatment" with Code 1 - Other. We do not have a code specifically for ultraviolet radiation.
Primary Site--Head & Neck (Middle ear): How do you code site for a skull based tumor consistent with a low grade papillary adenocarcinoma of "endolymphatic sac origin"?
Code Primary Site to C30.1 [Middle ear]. The endolymphatic sac is part of the inner ear labyrinth located with in the petrous portion of the temporal bone.
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