EOD-Lymph Nodes--Lung: Are positive "neck nodes" coded to 7 [Distant lymph nodes, other than above (including cervical lymph nodes)] in this field because we do not have a specific lymph node chain named or are they coded to 6 [Contra lateral hilar or mediastinal (incl. bilateral); supraclavicular (transverse cervical), ipsilateral or contralateral; scalene, ipsilateral or contralateral] because this code represents the lowest possible code for involved neck nodes?
For cases diagnosed 1998-2003: Code EOD-Lymph Nodes as 7 [Distant lymph nodes, other than above (incl. cervical neck nodes)]. Lymph nodes in the "neck" are distant, rather than regional, for lung.
Update to current manual/SS2018--Breast: Should Code 3 of the Summary Stage 2018 (SS2018) for Breast designate the intramammary and infraclavicular lymph nodes as being ipsilateral? Similarly, should Code 7 designate infraclavicular lymph nodes as contralateral/bilateral? Laterality (ipsilateral, contralateral/bilateral) is included for axillary and internal mammary nodes in the respective codes.
Based on your question, a review of the AJCC manual was done to clarify how these nodes would be coded. A review of Extent of Disease (EOD) Regional Nodes and EOD Mets was also done. That information is correct and in line with AJCC 8th edition. We apologize that SS2018 was not updated accordingly and thank you for bringing this issue to our attention.
Per AJCC, infraclavicular and intramammary nodes are ipsilateral for the N category. Contralateral or bilateral involvement are included in the M category.
The following will be applied to the planned 2020 update of the SS2018 manual.
Code 3
Ipsilateral will be added to Infraclavicular and Intramammary
Infraclavicular (subclavicular) (ipsilateral)
Intramammary (ipsilateral)
Code 7
The following will be added under Distant lymph nodes
Infraclavicular (subclavicular) (contralateral or bilateral)
Histology (Pre-2007): Is an intra-abdominal mass with the histology of "squamous cell carcinoma arising in a dermoid cyst" coded to 8070/3 [Squamous cell carcinoma] or 9084/3 [Dermoid cyst with malignant transformation]?
For tumors diagnosed prior to 2007:
Code histology to 9084/3 [Dermoid cyst with malignant transformation] per the ICD-O-3. Dermoid cysts may contain a malignant component of a type typically encountered in other organs and tissues.
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.
MP/H Rules/Histology--Bladder: How is this field coded for a patient with ureter specimen with "high grade urothelial carcinoma with adenocarcinoma differentiation" and a TURB specimen with "urothelial ca, high grade, a biphasic pattern with cautery-distorted urothelial carcinoma and adenocarcinoma"?
According to the MP/H rules, code histology to 8120/3 [urothelial carcinoma] for cases diagnosed 2007 or later. The term "glandular differentiation" is equivalent to adenocarcinoma differentiation. 8120/3 [urothelial carcinoma] would be the best way to code a "biphasic pattern with cautery-distorted urothelial carcinoma and adenocarcinoma" according to a pathologist consultant.
The steps used to arrive at this decision are as follows:
Go to the Urinary Histo rules found in the Multiple Primary and Histology Coding Rules Manual.
Start at the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY module, rule H9. Code the histology to 8120 [transitional cell/urothelial carcinoma] when there is transitional cell carcinoma with glandular differentiation.
Recurrence (Pre-2007)--Colon: When there is no statement of recurrence on the abstract, is a colon tumor at the anastomosis site a recurrence of the previous colon cancer or a new primary?
For tumors diagnosed prior to 2007:
If the cancer at the anastamosis site is more than two months after the previous colon cancer, abstract as a separate primary.
If the cancer at the anastamosis site is within two months of the original diagnosis and the histologies are the same, do not abstract as a separate primary.
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.
Multiple Primaries (Pre-2007)/Date of diagnosis--Cervix: How is this field coded when initially carcinoma in situ is diagnosed by biopsy and at a later date invasive tumor is found pathologically?
For tumors diagnosed prior to 2007:
Since carcinoma in situ of the cervix is not reportable to SEER (as of 1/1/1996), the diagnosis date is the date of the invasive diagnosis.
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.
Reportability--Skin: Is atypical intradermal smooth muscle neoplasm (AISMN) of the skin reportable? The comment on the path report states: Atypical intradermal smooth muscle neoplasm (AISMN) was previously termed "cutaneous leiomyosarcoma."
Atypical intradermal smooth muscle neoplasm (AISMN), previously termed "cutaneous leiomyosarcoma," is not reportable. It is classified as a borderline, /1, neoplasm.
EOD-Extension--Lymphoma: What code is used to represent this field for a lymphoma that involves the spleen and lymph nodes above the diaphragm (e.g., involvement of only the spleen below the diaphragm and cervical lymph nodes above the diaphragm)?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 32 [30 + involvement of the spleen; III S]. The spleen is counted twice (once as the spleen and a second time as a lymph node region below the diaphragm). As a result, the EOD-Extension field is coded to reflect involvement of lymph node regions on both sides of the diaphragm plus involvement of the spleen. See Note 1 on the EOD scheme that states "Any lymphatic structure is to be coded the same as a lymph node region."