MP/H Rules/Multiple primaries--Breast: How many primaries should be reported when an in situ diagnosis is followed by an invasive diagnosis in the same breast 1.5 years later? See Discussion.
Patient had a core biopsy 1/07 that showed DCIS and PE showed no adenopathy. Patient refused resection, and adjuvant treatment. In 6/08, the pt returned for a modified radical mastectomy which showed infiltrating duct carcinoma and positive lymph nodes. A comment in the Correction Record stated "Per MD, patient did not see any urgency and delayed surgery 1.5 years after diagnosis." The patient did not have any treatment in that time period and there is no statement that there was progression.
For cases diagnosed 2007 or later, abstract the 6/08 invasive diagnosis as a separate primary according to rule M8. Rule M8 applies whether or not the later diagnosis in this case is progression of disease.
Surgery of Primary Site/Scope Regional LN Surgery--Breast: How should these fields be coded when a sentinel lymph node dissection removes one-to-three axillary lymph nodes and a total/simple mastectomy is done?
Assign code 41 [Total (simple) mastectomy, NOS WITHOUT removal of uninvolved contralateral breast] for Surgery of Primary Site. Assign code 2 [Sentinel lymph node biopsy] for Scope of Regional Lymph Node surgery. Code 41 applies to a total/simple mastectomy with any number of sentinel lymph nodes removed -- as long as all of the nodes removed are designated as sentinel nodes.
CS Site Specific Factor--Head & Neck: Can SSF 1-6 be coded using clinical information only, or does the source of information for lymph nodes need to be pathological?
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.CS Site Specific Factors 1 through 6 for head and neck sites may be coded using either clinical or pathologic information.
CS Lymph Nodes/CS Site Specific Factor--Melanoma: When CS Lymph Nodes is coded 13, 14 or 15 (codes used when satellite nodule(s) or in-transit metastases are present), why must CS SSF 3 be coded 000 (No lymph node metastasis)? See Discussion.
3/11/05 Consult - PE: huge exophytic lesion right lower leg (mushroom-type lesion), 6cm. Below that lesion is another ulcerative lesion 2cm. Right upper arm lesion w/ satellite nodule. Note from physician states malignant melanoma on right lower leg metastatic to the left arm/shoulder. No scans done so there is no assessment of the lymph nodes.
We coded CS LNS to 13, which captures the satellite nodule, CS SSF3 = 999 and CS Reg Nodes Eval = 0. SEER Edit 216 requires the SSF3 to be 000. SSF 3 is coded 999 as there is no information about the clinical status of 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.When CS lymph nodes is coded 13-15, SSF 3 must be coded 000. Follow the instruction in the SSF 3 Note: Use code 000, No lymph node metastases, if ... there are satellite nodules or in-transit metastases, but no regional lymph node metastases, i.e., CS Lymph Nodes is coded 13-15.
For this case, assign CS lymph node code 15 [Satellite nodule(s) or in-transit metastases greater than 2cm from primary tumor WITHOUT regional lymph node involvement or involvement of regional nodes not stated]. The arm lesion is more than 2cm from the leg lesion.
CS Site Specific Factor--Head & Neck: How is Site Specific Factor 2 coded when the pathologist describes regional lymph nodes as "matted"? See Discussion.
The primary tumor is located in the tonsil. The patient underwent neck dissection. Pathology report stated there were matted regional lymph nodes. Does the term matted describe extracapsular extension? The definition for site specific factor 2 uses the term "fixed" to describe extracapsular extension (but not matted). For breast, fixed/matted appear to be interchangeable. Would they also be interchangeable for head and neck 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."Matted" is not a synonym for "Fixed" in the CS schema for Head and Neck. "Matted" is not indicative of extracapsular extension for the Head and Neck schema.
MP/H Rules/Histology--Esophagus: Should the modifying expression "with areas of" be used to code histology? See Discussion.
Patient was found to have two tumors in the esophagus. The large tumor was diagnosed as adenocarcinoma with areas of neuroendocrine differentiation (small cell carcinoma). The smaller tumor was diagnosed as small cell carcinoma. If we accept the "areas of" to be part of the diagnosis, rule H16 indicates that histology for the large tumor would be coded 8045 (combined small cell and adenocarcinoma). If we ignore the "areas of," then histology for the large tumor would be coded to 8140 (adenocarcinoma). Either way, when counting primaries, rule M17 would be applied and the two tumors would be classified as separate primaries. However, it seems that the two tumors are probably the same disease process since they both show small cell carcinoma.
For cases diagnosed 2007 or later, do not use the modifying expression "with areas of" to determine a more specific histology per rule H13 in the MP/H rules.
MP/H Rules/Multiple Primaries--Lung: How do we apply the MP/H rules if a pathologist states a patient has multiple reportable primaries after he compares an October 2006 RLL lung specimen with a March 2009 RML lung specimen? See Discussion.
Patient had a right lung lobectomy (RLL) in Oct. 2006 diagnosed as adenocarcinoma. In March of 2009, two nodules in the right upper lobe were identified. Following a RUL wedge resection, the pathology report indicated: Two foci of M.D. adenocarcinoma with mixed mucinous and micropapillary and solid patterns. COMMENT: The present tumor is compared to the previous adenocarcinoma reviewed in 2006. Although there is some overlap in their appearance, the present tumor shows a much greater component of mucinous adenocarcinoma. Because there is some difference in the appearance, and the nodule is located in a separate lobe, this will be dictated as a separate lung primary.
For cases diagnosed 2007 or later, this is two primaries.
MPH General Instructions tell us a pathologist may decide when there is recurrence when comparing the current tumor to a previous specimen. In this case, the pathologist did the comparison and documented that the second tumor is NOT a recurrence but a new primary.
Histologies described by the terms "pattern" and "component" do not indicate a more specific type when applying the histology rules. The histology for the 2009 diagnosis is adenocarcinoma [8140/3]. Rule H3 applies.
Reportability--Anal canal: Are squamous cell carcinomas arising in a condyloma of the rectum reportable or should we assume that the site is skin of anus or perianal area and not reportable?
Squamous cell carcinoma arising in a rectal condyloma is reportable. Do not assume the site is skin of anus or perianal.
Primary site--Bladder: What is the correct subsite for "interureteric ridge"? See Discussion.
Description: 4 mm nodule at base of bladder near interureteric ridge.
For this case, assign code C670 [Trigone of bladder]. The description for this case states that the tumor location is the base of the bladder. Base is a synonym for trigone.
The interureteric ridge (or interureteric crest, or interureteric fold) is a fold of mucous membrane extending accross the bladder between the two ureteric orifices. The trigone is located below the interureteric ridge.
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.
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