Reportability/Ambiguous Terminology--Prostate: Is a prostate biopsy that states "highly suspicious for, but not diagnostic of adenocarcinoma, suggest another biopsy" reportable?
Do not report. "Not diagnostic of" means that while the pathologist is seeing some features that resemble cancer, there are not enough features to feel comfortable making an unquestionable diagnosis. Watch for another biopsy of the patient in the next 3-6 months. The statement "not diagnostic of" overrules the "highly suspicious" statement.
EOD-Extension--Lymphoma: Would a lymphoma involving mesenteric and retroperitoneal nodes (both site code C77.2) be coded to extension 10 [Involvement of a single lymph node region; Stage I], based on the fact that while more than one "chain" is involved only one "region" is involved?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 20 [Involvement of two or more lymph node regions on the same side of diaphram]. The AJCC lists mesenteric as a core nodal region, but does not list retroperitoneal lymph nodes as a part of this region, so retroperitoneal is a separate region.
The EOD staging scheme for lymphoma uses lymph node REGIONS as the criteria for assigning the extension code. Use the AJCC Cancer Staging Manual as the definitive source for classifying lymph node regions, not the ICD-O-3. If it is a separate LN region per the AJCC, it is coded in the EOD as a separate region.
According to the AJCC curator, the nodal regions are defined in Kaplan's book on Hodgkin disease. Bilateral cervical, or axillary, or hilar, or pelvic, or inguinal nodes count as two regions. Mediastinal and para-aortic lymph nodes count as one region regardless of laterality as they are centrally located. A large mediastinal mass constitutes one region involved regardless of the size.
Laterality--Breast: Should laterality be coded to 9 [Paired site but no information concerning laterality] or to the side with the positive lymph nodes for a case in which no breast mass is found but positive axillary lymph nodes are found on only one side?
Code laterality of the primary site to the side with the positive nodes when there are unilateral positive nodes and the laterality of the primary site is otherwise unknown.
Surgery of Primary Site--Skin: What surgery code is used to reflect the amputation of a finger for subungual melanoma?
47 [Wide excision or reexcision of lesion or minor (local) amputation with margins greater than 2cm] is the correct surgery code for amputation of a finger for melanoma.
Histology (Pre-2007)--Sarcoma: How is "acral myxoinflammatory fibroblastic sarcoma" coded?
For tumors diagnosed prior to 2007:
The ICD-O-3 histology code is 8811/3 [Fibromyxosarcoma] according to the WHO Classification of Tumours of Soft Tissue and Bone. WHO defines myxoinflammatory fibroblastic sarcoma (MIFS) as "a unique low grade sarcoma with myxoid stroma, inflammatory infiltrate and virocyte-like cells that predominantly involves the hands and feet."
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Update to current manual/Lymphovascular invasion: Are lymphvascular invasion and lymphvascular space invasion on a pathology report the same thing or do they describe different things?
We confirmed with our expert pathologist consultant that lymphovascular invasion and lymphovascular space invasion are synonymous.
MP/H Rules/Histology--Colon: What histology would be coded when the right colon demonstrates a combined adenocarcinoma and high grade small cell neuroendocrine carcinoma [forming the dominant component] arising in a villotubular adenoma and the liver biopsy demonstrates metastatic high grade small cell neuroendocrine carcinoma?
For cases diagnosed 2007 or later, start with rule H1 in the Single Tumor module. Stop at rule H4. Assign code 8263 [adenocarcinoma in tubulovillous adenoma].
Stop at the first rule that applies. Code histology based on a specimen from the primary site whenever available.
EOD-Extension--Breast: If the pathology report states "infiltrating duct carcinoma...measuring 7mm in diameter...focal areas of intraductal carcinoma," do we code this field to 14 [Invasive and in situ components present, size of entire tumor coded in Tumor Size and in situ described as minimal] or to 16 [Invasive and in situ components present, size of entire tumor coded in Tumor Size and proportions of in situ and invasive not known]?
For cases diagnosed 1998-2003: If 7mm is the measurement of the infiltrating duct portion of this cancer, assign extension code 13 [Invasive and in situ components present, size of invasive component stated and coded in Tumor Size].
If 7mm is the size of the whole malignancy and the size of the invasive portion cannot be determined, assign extension code 14 [Invasive and in situ components present, size of entire tumor coded in Tumor Size (size of invasive component not stated) and in situ described as minimal (less than 25%)]. "Focal areas of in situ carcinoma" qualifies as minimal.
Histology (Pre-2007)--Ovary: What code is used to represent clear cell cystadenocarcinoma of the ovary?
For tumors diagnosed prior to 2007:
Code histology to 8310/3 [Clear cell adenocarcinoma, NOS]. This is consistent with the WHO Classification of Tumours and reflects the current practice of placing less emphasis on "cyst-" prefix for ovarian malignancies.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
CS Tumor Size/CS Site Specific Factor--Breast: How do you code the CS Tumor size and SSF6 fields for a breast cancer described as "Paget disease with underlying intraductal carcinoma (4cm x 3.2cm)"?
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.CS Tumor Size: Assign code 040 for tumor size and code SSF6 as 050 [Invasive and in situ components present, size of entire tumor coded in CS TS]. The size of the invasive component is not stated AND proportions of in situ and invasive are not known.
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