CS Extension--Lymphoma: Does peripheral blood involvement affect the stage for lymphoma? See Discussion.
2009 Diagnostic Year
Lymph node bx is positive for Mantle Cell lymphoma. Flow cytometry on lymph node tissue shows CD+ pos B cell lymphoproliferative disorder. IHC findings support Mantle Cell lymphoma. Flow cytometry on peripheral blood shows CD+ B cell lymphoproliferative disorder. Because the lymph node is positive for Mantle Cell lymphoma and the flow cytometry findings are the same on the lymph node tissue and peripheral blood, is the peripheral blood involved (Stage IV disease)?
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.No. Peripheral blood is not the same as bone marrow involvement which is what would be required for stage IV.
Lymphomas can arise in lymph nodes which are connected by lymphatic vessels. Both lymphatic vessels and blood vessels travel through lymph nodes and malignant cells can travel between the vessels. Cells in peripheral blood do not prove Stage IV.
CS Site Specific Factor--Lymphoma: Can the term "intermediate risk" be used to code IPI score? See Discussion.
Patient has Hodgkin disease. The physician states that the patient has bulky stage IIA intermediate risk disease. Is the term "risk" another way of stating IPI score? If so, how would intermediate risk be 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.Code SSF 3 for lymphoma based on the IPI score stated in the record. Do not attempt to interpret statements or terms in order to assign a code to SSF 3. If no further information is available for this case, code SSF 3 999 [Unknown].
CS Extension--Pancreas: How do you code this field for a head of pancreas primary with involvement of portal and splenic veins? See Discussion.
The splenic artery/vein is only mentioned in the body and tail scheme; no mention is made of this site in the pancreatic head 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.Assign CS extension code 54 [major blood vessels]. The portal vein is listed under code 54 for head of pancreas. The splenic vein branches from the portal vein.
Multiple Primaries--Breast: How many primaries should be reported when a lobular carcinoma with positive margins is followed 8 years later by a lobular carcinoma near the previous lumpectomy site? See Discussion.
Left breast invasive lobular ca diagnosed 3/00 and treated with a lumpectomy, but with multiple positive margins; she received no post operative radiation or other medical treatment (unknown why). 10/08 core biopsy of "an area of distortion" near the scar site is positive for invasive lobular ca. The radiologist states "compatible with recurrence at her previous lumpectomy site" on an x-ray report.
One thought is that this should not be a new primary because the patient was never disease free (multiple positive margins) and the patient received incomplete treatment. Or should this be a new primary because the tumors are diagnosed more that 5 years apart?
Abstract the 10/08 diagnosis as a new primary, per Breast rule M5. In spite of the positive margins and apparently incomplete treatment in 3/00, there is no mention of the presence of disease between 3/00 and 10/08 according to the information provided.
MP/H Rules/Histology--Breast: How is histology coded for a breast primary with a final diagnosis of "infiltrating duct carcinoma with apocrine features"? See Discussion.
I & R has conflicting answers: #25719 (dated 3/17/2008) says per rule H12 this is 8401/3 but #23347 (dated 8/12/07) says per rule H16, this is 8523/3.
For cases diagnosed 2007 or later, assign histology code 8401/3 [apocrine adenocarcinoma] according to rule H12. Apocrine is a type of duct carcinoma, see table 1. Code 8401 should be listed in Rule H12. Apocrine should be removed from table 3.
These corrections will appear in the revised version of the rules.
MP/H Rules/Histology--Melanoma: How is histology coded for a "melanoma in situ, lentiginous type," arising in the skin of the lower leg? See Discussion.
In researching this, acral lentiginous melanoma is observed on the palms, soles and under the nails. To code to 8744, do we specifically have to see the word "acral" lentiginous melanoma?
For cases diagnosed 2007 to 2020
Assign 8742/2 [lentigo maligna] to "melanoma in situ, lentiginous type."
Acral lentiginous melanoma is not the same as melanoma, lentiginous type. "Acral lentiginous melanoma," 8744, should be used only if the report states acral lentiginous melanoma or malignant melanoma, acral lentiginous type.
Acral lentiginous melanoma most often occurs on the soles of the feet or the palms of the hands.
CS Extension--Bladder: How should this field be coded for a high grade urothelial carcinoma with "focal micropapillary features and invasion of lamina propria, with a note stating there is invasive carcinoma focally involving thin muscle bundles...difficult to distinguish whether muscularis propria or muscularis mucosae"?
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 CS Extension code 15 [Invasive tumor confined to subepithelial connective tissue (tunica propria, lamina propria, submucosa, stroma)]. The information provided confirms invasion of the lamina propria (code 15) but is not definitive enough to assign a code higher than 15.
CS Tumor Size--Lung:. Does code 997 (diffuse, entire lobe) for lung and main stem bronchus take precedence over a stated tumor size? See Discussion.
Per SPCSM 2007 'Coding Instructions for CS Staging Data Items-CS Tumor Size' item 5c states that code 998 (diffuse, entire lung) for lung and main stem bronchus takes precedence over any mention of size. Does this apply to code 997 as well?
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 stated tumor size rather than 997. Code 997 does not take precedence over tumor size at this time. According to CoC, the instructions in the CS Manual, Part I-27, rule 5c are to alert the user to special circumstances. Code 997 is not included because it is not diffuse for all of the sites listed. The site-specific rules and codes in the schema always take precedence. Further instructions and clarifications will be added to the lung schema, CS Manual Part II-317 in the next version of CS.
MP/H Rules/Histology--Thyroid: How is histology coded for a thyroid tumor described as "predominantly papillary carcinoma, tall cell variant, follicular type"?
For cases diagnosed 2007 or later, assign code 8340 [Papillary carcinoma, follicular variant] according to rule H15 for Other Sites.
"Predominantly" and "type" indicate specific histologies. "Variant" does not. See rule H13. The histology in this case is papillary and follicular. Tall cell variant is ignored.
MP/H Rules/Histology--Esophagus: How is histology coded for a biopsy of the esophagus with a pathologic diagnosis of "adenocarcinoma, intestinal type" when there is no evidence of a gastric tumor in scans or EDG? See Discussion.
There is a rule for colon to disregard "intestinal type" and code to adenocarcinoma (8140) but no rule for esophagus. How should histology for this esophageal case be coded?
For cases diagnosed 2007 or later:
Follow MP/H Other Sites Rule H11 and code 8144/3 [Adenocarcinoma, intestinal type]. Adenocarcinoma, intestinal type, is called that because it resembles the normal pattern of adenocarcinoma seen in the large intestines. It is not an indication of the location of the adenocarcinoma. We find that it is not uncommon in the sinuses, stomach, lungs, cervix, and many other organs.