Histology (Pre-2007)--Corpus uteri: How is a polyp with "endometrial carcinosarcoma (Malignant Mixed Mullerian tumor), endometrial adenocarcinoma, and some areas of high grade spindle sarcoma" coded? See Discussion.
The path report for the TAH stated the endometrium contained an endometrial polyp measuring 6x3x3cm. Within the polyp there was endometrial carcinosarcoma (Malignant Mixed Mullerian tumor), endometrial adenocarcinoma, and some areas of high grade spindle sarcoma. There is no myometrial invasion by the tumor. (The Endometrial bx before surgery was positive for Malignant Mixed Mullerian tumor.)
For tumors diagnosed prior to 2007:
Assign code 8980 [Carcinosarcoma, NOS]. According to the WHO Classification of tumors, Malignant mullerian mixed tumor is a synonym for carcinosarcoma and carcinosarcoma is now the preferred terminology rather than malignant mixed Mullerian tumor.
Carcinosarcoma has both malignant epithelial and mesenchymal components. The epithelial component is usually glandular (adenocarcinoma in this case). The mesenchymal component is usually sarcoma (as in this case).
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 Extension/CS Mets at Dx--Corpus uteri: Is a microscopic metastasis in a cul-de-sac implant more appropriately reflected in the CS Extension field code 80 [Further contiguous extension; cul-de-sac] or in the CS Mets at Dx field code 40 [Distant metastasis]?
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.Assign code 80 [Further contiguous extension; Cul de sac] for CS extension in this case. Endometrium and ovary are exceptions to the rules that only contiguous extension is coded in Extension code 80. Only true distant metastases are coded in Mets at Dx.
CS Extension--Pancreas, Head: When a tumor is described as having "vascular encasement of the celiac artery", is extension coded to 68 [tumor is inseparable from the celiac axis]?
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 vascular encasement of the celiac artery to CS extension code 68 [tumor is inseparable from the celiac axis].
This celiac axis is a small (1cm) area of branching arteries. The celiac artery branches into hepatic, gastric, and splenic at the axis. Dissecting tumor out from around the celiac axis is very tricky and usually encasement by tumor is a sign of inoperability.
CS Extension/CS Mets at Dx--Peritoneum: How are these fields coded for extraovarian peritoneal carcinomas presenting with multiple peritoneal implants? See Discussion.
Patient presented with large omental cake and multiple peritoneal implants including implants on the rectosigmoid serosa and right ovary. Path revealed papillary serous adenocarcinoma consistent with peritoneal primary.
Per AJCC Manual, extraovarian peritoneal carcinoma is usually staged with the ovarian staging classification.
We understand that the CS Manual will eventually be revised to include staging for extraovarian peritoneal primaries. In the meantime, how do we use the existing CS scheme for peritoneum to code these cases?
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 Extension 99 [unknown] and CS Mets at DX 99 [unknown].
The issue has been sent to the CS steering committee for resolution. This answer will be updated when the steering committee provides a resolution.
CS Lymph Node Examined--Lung: How is this field coded when a mediastinoscopy and lobectomy are performed and the pathology report indicates multiple lymph node fragments were removed as biopsy specimens and the lobectomy specimen revealed 3 interlobar lymph nodes?
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 the CS Lymph Node Examined field to 98 [number unknown] because the biopsy information is not clear and as a result you do not know how many lymph nodes were examined.
First Course Treatment--Hematopoietic, NOS: How are Decadron and Zometa coded when used in the treatment of multiple myeloma? See Discussion.
The 2004 SEER Program Manual instructions for coding hormone therapy do not provide any specific instructions for coding adrenocorticotrophic agents. Per Abstracting and Coding Guide for the Hematopoietic Diseases pg. 3, prednisone and decadron are coded as hormonal therapy (when given as part of a chemotherapy regimen). Does this mean that Decadron without chemo agents is not coded as treatment? In paging through the hematopoietic disease manual, one sees this instruction for other sites as well. Yet, for other diseases (e.g., Waldenstroms macroglobulinemia on page 18), prednisone is coded as hormone therapy (not necessarily as part of chemo regimen).
Code the decadron as hormonal treatment. Do not code the zometa--it is an ancillary agent.
In the August 2006 update of SEER*Rx, a note was added to decadron and other hormonal agents that they can be used to control white cell proliferation in lymphoma and multiple myeloma.
In general, decadron is used more commonly for supportive care and as an antiemetic than as hormone therapy.
CS Site Specific Factor--Head & Neck: If a lymph node dissection of the neck reveals that 1/24 lymph nodes is positive and the positive 5.6 cm lymph node extends throughout levels II-IV, how are the SSF 3 (status of levels I-III lymph nodes) and SSF4 (status of levels IV-V lymph nodes) fields coded?
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.According to the CS Steering Committee, code 999 for SSF 3 and SSF 4. In this case, do not make assumptions about which level of lymph nodes were involved.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Brain and CNS: How many primaries should be abstracted and should the histology field(s) be coded to 9530/1 [Meningiomatosis, NOS] or 9530/0 [Meningioma, NOS] to represent a case that presents with MRI confirmed multiple meningiomas (e.g., left dura, right parasagittal region, and left frontal lobe)?
For tumors diagnosed prior to 2007:
Abstract this case as two primaries, right and left cerebral meninges. Code the histology for both primaries to 9530/0 [Meningioma, NOS]. Use code 9530/1 [Meningiomatosis, NOS] only when the diagnosis is stated to be meningiomatosis, or multiple meningiomas.
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.
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