Histology (Pre-2007)--Melanoma: How is histology coded if the final diagnosis is "melanoma" and only in the comment section of the pathology report is there an indication of "Type: Lentigo Maligna. Cell Type: Small Cell"?
For tumors diagnosed prior to 2007:
Code the histology as 8742 [lentigo maligna melanoma]. Code the specific histologic type, even if stated only in the comment section.
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.
Primary Site--Sarcoma: What is the correct topography code for a partial lung lobectomy with pathology diagnosis of "pulmonary sarcoma with smooth muscle differentiation"? See Discussion.
Operative report: palpable 2x2cm mass in the mediastinal surface of the rt middle lobe and the contiguous upper lobe together.
Path comment after partial lung lobectomy: In all likelihood this is a malignant process occurring in smooth muscle changes surrounding vessels within the lung versus an undifferentiated epithelial tumor.
ADDENDUM DX: low grade pulmonary sarcoma with smooth muscle differentiation.
Consultant's report concurs with that of the original pathologist's report of malignant neoplasm compatible with smooth muscle origin.
This case is unique. Assign topography code C493 [Connective, subcutaneous and other soft tissue of thorax]. Based on the information provided, this sarcoma has smooth muscle differentiation and originated in the muscle. Code the primary site to muscle.
CS Site Specific Factor/Terminology--Breast: Does the term "focal areas" of in situ carcinoma qualify as "minimal" in situ component when coding SSF6 field (assessment of the invasive and in situ components present) in the CS breast scheme?
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.
Yes, the term "focal areas" of in situ carcinoma describes a minimal in situ component.
Chemotherapy/Radiation Therapy--Lymphoma: How is treatment coded when Rituxan is given in combination with the monoclonal antibody Zevalin conjugated to 90-Yttrium or the monoclonal antibody Bexxar conjugated to 131-Iodine in the treatment of NHL?
Code Rituxan as chemotherapy. Code 90-Yttrium as radioisotope. Code 131-Iodine as radioisotope when given with Rituxan as treatment for lymphoma.
Zevalin is a monoclonal antibody conjugated to Yttrium 90. Bexxar is a monoclonal antibody conjugated to Iodine 131. In both drugs, the monoclonal antibody is only the delivery agent for the radioisotope. Both drugs should be coded as radioisotopes. The one-two-three punch of Rituxan and zevalin followed by Rituxan and Bexxar should be coded as chemotherapy plus radioisotopes. Zevalin is also used by itself for people who have not responded to Rituxan.
Multiple Primaries (Pre-2007)/Recurrence--Cervix: How many primaries should be abstracted if a patient had a diagnosis in 1998 of adenocarcinoma in situ of the cervix treated with a total hysterectomy and a July 2004 vaginal mass biopsy with a diagnosis of invasive adenocarcinoma that is consistent with an endocervical primary?
For tumors diagnosed prior to 2007:
Abstract the July 2004 diagnosis as a new endocervical primary. Abstract an invasive cancer in the same site more than two months after an in situ cancer as a new primary. Residual cervical tissue is present following a hysterectomy.
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.
Histology (Pre-2007)--Ovary: What codes are used to represent "mixed papillary serous and clear cell carcinoma" and "papillary serous carcinoma with focal clear cell features" of the ovary?
For tumors diagnosed prior to 2007:
Assign code 8323 [Mixed cell adenocarcinoma] to "mixed papillary serous and clear cell carcinoma." This is histology coding rule 3 in the 2004 SEER manual under single tumor (page 86). There is no other code for this mixture.
Example 1: 8323
Example 2: 8461 (clear cell is not coded according to Rule 6, page 87, because it is not the majority of the tumor).
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.
Primary Site--Peritoneum: During a second look staging lap following a diagnosis of serous carcinoma of the left ovary, did the physician correctly indicate a new peritoneum, NOS primary for disease described as an endometrioid adenocarcinoma in a "paracaval cyst" that appears to have arisen in endometriosis?
The primary site is C482 [Peritoneum, NOS]. "Paracaval" means alongside or near the vena cava.
Code the site in which the primary tumor originated.
Priorities/CS Tumor Size--Breast: What is the priority order used in coding tumor size for this site when there is a larger 2 cm lesion noted on the PET scan and smaller sizes described in the pathology report as two malignant masses one measuring 0.8 cm and the second measuring 1.0 cm per the GROSS?
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.Code CS Tumor Size as 1.0 cm. The pathology report is the highest priority source for coding tumor size. When multiple tumors are present, code the size of the largest tumor.
Reportability/Recurrence (Pre-2007)--Bladder: If a patient has had recurrent invasive bladder cancers since 1971, should the latest recurrence in 2003 be SEER reportable because the case has yet to be reported to SEER?
For tumors diagnosed prior to 2007:
Because this 2003 recurrent bladder cancer was initially diagnosed prior to 1973, it is not reportable to SEER.
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 Eval--Colon: When the surgical resection occurs after radiation or chemo, how is the tumor size/extension evaluation field coded when there is no mention of the tumor size or extension in the surgical resection pathology report? See Discussion.
6/30/04 CT Scan abd/pelvis: 7.5x7.2 cm large rectal mass with l cm nodular densities in perirectal region probably adenopathy; irregularity of perirectal soft tissue which could be due to tumor infiltration. 7/26/04 Patient has radiation therapy and 5FU. 10/19/04 LAR: MD Adenoca rectum with regional node mets (3/8).
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.Based on the information provided above, code CS Tumor Size and Extension from CT scan. Code CS TS/Ext eval 5 [Surgical resection performed with pre-surgical treatment...size based on clinical evidence].
Code CS lymph nodes using information from resection. Code CS Reg Nodes eval 6 [Regional LN removed...with pre-surgical treatment...based on pathologic evidence].
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