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].
Rosette-forming glioneuronal tumor of the 4th ventricle is a new WHO entity. There is no current ICD-O-3 code for this. The best code available at this time is 9505/1.
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.
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.
MP/H Rules/Histology--Ovary: How is histology coded for "serous carcinoma, papillary invasive pattern"?
For cases diagnosed 2007 or later, code the histology 8441/3 [Serous carcinoma, NOS]. Use the Other Sites rules. Start with rule H8 and stop at rule H11. "Pattern" is not one of the terms used to identify a specific type (See H16), so papillary is ignored.
MP/H Rules/Histology--Brain: How is histology coded for a "low grade neuroglial tumor" of the fourth ventricle?
For cases diagnosed 2007 or later, assign histology code 9505/1 [Ganglioglioma, NOS].
According to our pathologist consultant, low grade neuroglial tumor of the fourth ventricle correlates best to the "rosette-forming glioneuronal tumor of the 4th ventricle" which is a new WHO entity. There is no current ICD-O-3 code for this. The best code available at this time is 9505/1.
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.
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.
Radiation Sequence with Surgery--Head & Neck: How is this field coded for a tonsil primary diagnosed on 4/16/07 by a regional lymph node FNA when the patient subsequently initiates radiation on 5/8/07 and has a tonsillectomy with neck dissection on 7/30/07?
The best way to handle this situation is to assign code 2 [Radiation before surgery] in Radiation Sequence with Surgery. Code 2 provides the best description of the sequence of events in this case. Radiation was delivered prior to the resection of the primary site.
MP/H Rules/Multiple primaries--Vagina: How many primaries should be abstracted for a patient with a complex history of multiple occurrences of vaginal intraepithelial neoplasia (VAIN III) between 2001 and 2008 and invasive squamous cell carcinoma (SCCA) of the vagina diagnosed in 2006 and again in 2008? See Discussion.
Patient had VAIN III in March of 2001. She had a partial vaginectomy and then continues to have laser surgery in 2002, 2003, 2005 and 2006 for recurrences. In 12/2006 she is diagnosed with SCCA of the vagina with microinvasion (new primary). Then in 2/2008 she has VAIN III again -- new primary according to rule M10 (more than 1 year later). An invasive SCCA of the vagina is again diagnosed in 9/2008. Is this another new primary per rule M15 (invasive after in situ)? Every instance in 2008 is called a recurrence, but we disregard that statement.
There are two primaries according to the information provided.
1. VAIN III March 2001.
2. SCCA of vagina Dec. 2006 (invasive tumor following an in situ
For cases diagnosed 2007 or later, the MP/H rules apply to new tumors, which means that there has been a disease-free interval at some point. In this case, the patient has never been declared disease-free (NED) using the information provided in the question. The consistent recurrence of VAIN is typical of this disease.