CS Lymph Nodes--Melanoma: If the primary site is coded to C449 because no primary skin lesion is identified for a melanoma case, are any positive lymph nodes assumed to be regional?
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 Nodes field to 80 [Lymph Nodes, NOS].
Although it is in the CS LN field, use the code for Lymph Nodes, NOT OTHERWISE SPECIFIED when you don't know whether the nodes are regional or distant. There are separate codes to use when you definitely know that the nodes are regional.
CS Extension/CS Lymph Nodes--Lung: How are these fields coded if a lobectomy path specimen indicates that two intrapulmonary lymph nodes are involved by direct extension from the primary tumor?
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 regional lymph node involvement in CS lymph nodes even when the lymph nodes are involved by direct extension. Do not code direct extension to lymph nodes in CS extension.
MP/H Rules/Histology--Colon: Regarding histology rule H21, is there a hierarchy or do you code the higher histology if there is an adenocarcinoma arising in a polyp and an adenocarcinoma in a villous adenoma?
For cases diagnosed 2007 or later:
If you arrive at H21 and have an additional decision to make regarding the use of 8210, 8261 or 8263, you must make another pass through the histology rules. The second pass will determine which of the two or three histology codes to assign. The answer will vary depending of the specifics of the case.
Example:
Transverse colon: Adenocarcinoma in an adenomatous polyp involving muscularis propria and adenocarcinoma in a villous adenoma involving subserosa of transverse colon. Start with rule H15 because there are multiple tumors. Stop at H21 -- code either 8210 or 8261. To decide between 8210 and 8261, make a second pass through the histology rules, starting again with H15. Stop at H20. Code the histology of the most invasive tumor, 8210 [Adenocarcinoma in adenomatous polyp].
MP/H Rules/Histology--Colon: When the microscopic description indicates a colon tumor is "tubulovillous," but the final diagnosis only states "adenocarcinoma," is the histology coded to 8263/3 [adenocarcinoma in a tubulovillous adenoma]?
For cases diagnosed 2007 or later:
Yes. This is an example of a site-specific exception to the general rule to code only from the final diagnosis. The Colon Histology Rules specifically state that "other parts of the pathology report" may be used to identify a tumor arising from a polyp, adenomatous polyp, villous adenoma, or tubulovillous adenoma.
Multiplicity Counter/CS Tumor Size: The Multiplicity Counter rule 6c states "Use code 99 when the tumor is described as diffuse". Is code 99 used in all circumstances when tumor size is coded to 998? See Discussion.
The CS manual lists esophagus, stomach, familila/familial polyposis (colon), lung, and breast as the only circumstances when code 998 is valid. If this is correct, then if TS is coded to 998, then Multiplicity Counter must be 99.
If the number of tumors is known, code the number in Multiplicity Counter. If the number of tumors is not known, assign code 99. If "diffuse" is the only information available to describe the tumor, assign code 99.
MP/H Rules--Urinary: How many primaries are abstracted when a patient has a May 2000 invasive papillary transitional cell carcinoma of the bladder, a November 2004 invasive papillary transitional cell carcinoma of the right ureter and a May 2007 urothelial carcinoma in situ of both the left and right ureters?
For cases diagnosed 2007 or later:
Using the pre-2007 multiple primary rules, the PTCC of the bladder in 2000 and the invasive TCC of the right ureter in Nov. 2004 would have been abstracted as separate primaries.
Use the 2007 MP/H rules to evaluate the May 2007 diagnosis. Start with rule M3. Stop at rule M8. The May 2007 diagnosis is the same primary.
Rule M4 does not apply because of the 2000 bladder primary. A clarification will be added to M4 to stress that for the urinary rules, any urinary tumor up to the present point in time is counted when applying this rule.
MP/H Rules/Multiple Primaries--Lung: If the biopsy for a lung primary is actually taken from a pleural mass, can the default rule "when there are several lung masses and only one lesion is biopsied, consider this a single primary" apply? See Discussion.
Scenario: A parenchymal lesion in each lung. One lung also has a pleural lesion. MD biopsies the pleural mass only and it is positive for cancer.
For cases diagnosed 2007 or later:
Do not assume the biopsy of the pleural mass is a biopsy of the lung. Apply the 2007 MP/H Lung rules to the lung tumors only. For this case, the pleural lesion would be a metastasis (outside the lung). The 2007 MP/H rules do not apply to metastatic lesions.
The 2007 MP/H Lung rules do not apply to pleura as a primary site. If the pleural lesion is primary, it should be abstracted as a separate primary.
First Course Treatment--Melanoma: How and where is the excision for an in-transit metastasis coded if the in-transit metastasis is coded in CS Lymph Nodes? See Discussion.
Excision of skin of scalp nodule reveals in transit metastasis of melanoma. Patient also has lung metastasis and begins systemic treatment. No primary tumor identified.
Code the excision in Surgical Procedure of Other Site because no primary tumor was identified.
MP/H Rules/Multiple Primaries/Laterality--Brain and CNS: How many primaries are to be abstracted and how is laterality to be coded for two meningiomas, one occurring at the midline and the other in the right termporal region? See Discussion.
MRI of the brain shows two meningiomas: One is stated to be 'midline' (laterality code 9) and one is stated to be in the 'right' temporal region. The rules state if same site (C700), same histology & laterality is same side or one side unknown, then abstract as single primary. Based on this, the MRI findings would be one primary, but how should laterality be coded?
For cases diagnosed 2007 or later, abstract two primaries. The lateralities of both meningiomas are known. Right (code 1) and midline (code 9) are different lateralities.
Reportability--Hematopoietic, NOS: If the bone marrow biopsy diagnosis is not reportable and cytogenetics studies indicate no clonal abnormality, is a case reportable if only the flow cytometry results show a "small monoclonal B-lymphocyte population consistent with a lymphoid component of a lymphoplasmacytic lymphoma or Waldenstrom macroglobulinemia"? See Discussion.
Bone marrow bx final diagnosis: Markedly hypercellular marrow consisting primarily of erythroid hyperplasia and, also, diffusely distributed small lymphocytes. Addendum comment: Flow cytometry demonstrated a small monoclonal B-lymphocyte population consistent with a lymphoid component of a lymphoplasmacytic lymphoma or Waldenstrom's Macroglobulinemia. Addendum comment: Cytogenetic analysis states no clonal abnormality was apparent. Normal female karyotype.
Question 1: Is this case reportable, and if so, what histology?
Question 2: Is there a hierarchy when flow cytometry and cytogenetics are done, but do not agree?
For cases diagnosed prior to 1/1/2010:This case is not reportable at this point. A lymphoid component is not equivalent to a diagnosis of a reportable disease. In order to be a malignant, reportable disease, the condition must be monoclonal and irreversible. Cytogenetics were negative for malignancy (i.e. no monoclonal abnormality identified which is the criteria used to establish this diagnosis). Use all information available when determining reportability.
For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
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