EOD-Extension--Colon: How is this field coded for an appendical primary when the appendix has ruptured and intrapentoneal fluid is positive?
For cases diagnosed 1998-2003: Code EOD extension as 85 [Metastasis]. Positive intraperitoneal fluid is equivalent to distant metastasis (implantation) for colon, including appendix, primaries.
Primary Site/Histology--CLL/SLL: How should these fields be coded when the pathological diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma is made on bone marrow biopsy only but scans show lymphadenopathy? See Description.
What histology would we give these two examples?
1. Bone marrow bx: CLL/SLL. CT chest/abdomen: Mediastinal and retroperitoneal adenopathy.
2. Bone marrow bx: CLL/SLL. CT chest/abdomen: Mediastinal and retroperitoneal adenopathy suspicious for lymphoma.
For cases diagnosed prior to 1/1/2010:If a lymph node or other solid tissue is involved initially, code to SLL. For lymphoma, any mention of lymph nodes is indicative of involvement. Involvement does not have to be proven pathologically in order to code to Small Lymphocytic Lymphoma (SLL). Code both of the examples to SLL.
For cases diagnosed 2010 forward, 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.
Ambiguous terminology/EOD-Extension: Is the term "within" a term of involvement in coding extent of disease? See Description.
For example: a kidney tumor is described as "completely encased within the renal capsule with no extension into perirenal fat." Does this mean the renal capsule has been invaded (extension code 20) or that the tumor is totally contained within an area surrounded by the renal capsule (extension code 10)?
For cases diagnosed 1998-2003: The term "within" is not one of the listed ambiguous terms for EOD. Determine extent of involvement from the context in which "within" appears.
In the example, "Encased" is an ambiguous term meaning not involved. Code extension for the example to 10 [Invasive cancer confined to kidney cortex and/or medulla].
Primary Site/Histology (Pre-2007)--Bone: How are these fields coded for a squamous cell carcinoma in bone? See Description.
The consult path report says "I believe that there is definitely high grade malignant tumor in this amputation specimen, and that this tumor represents an invasive squamous cell carcinoma, which is extending into the bone and permeating in between the bone trabeculae. ... The fact that squamous cell carcinoma can arise from the sinuses of chronic osteomyelitis is well recognized."
For tumors diagnosed prior to 2007:
Based on the information provided, code the primary site as C40._ or C41._ [bone] because the tumor originated in the sinuses of chronic osteomyelitis. Code to the site in which the tumor arises. Override the SEER site/histology edits to allow this rare combination of bone and squamous cell carcinoma.
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.
Histology/Reportability/Behavior Code--Testis: Is a mature teratoma that is metastatic to lymph nodes reportable? See Description.
Pathology report states, "Histologic sections reveal lymph node metastases, consisting predominantly of mature teratoma. In addition, there are cells scattered through the fibrous stroma which exhibit mild cytologic atypia but have low N:C ratios. The largest metastasis grossly measures 10cm. In addition extracapsular extension is identified. Diagnosis: Lymph Nodes--Metastatic Testicular Carcinoma Involving Multiple Lymph Nodes." The morphology code for mature teratoma is 9080/0. The pathologist does not classify this as an immature teratoma (9080/3). Is this reportable?
Yes, this metastatic teratoma is reportable.
This is a malignant teratoma by virtue of the lymph node metastases. Code the histology as 9080/3 [Teratoma, malignant, NOS]. Primary site is testis [C62_].
Hormone Therapy--Thyroid: Is pre-op hormone replacement therapy coded in this field? See Description.
Patient was admitted for thyroidectomy with a diagnosis of probable thyroid cancer. Patient's history stated that patient received work-up for hypothyroidism and was found to have thyroid nodule. FNA suggested carcinoma. Patient's medications included Cytomel and Synthroid.
Do not code hormone replacement given to treat hypothyroidism as cancer treatment. Thyroid hormone therapy is coded as treatment only for follicular and papillary thyroid carcinomas.
EOD/Surgery of Primary Site--Melanoma: If a melanoma primary site is other than skin, vulva, penis, or scrotum should these fields be coded using melanoma schemes? See discussion.
Should a melanoma of the cervix be coded using the melanoma or the cervix schemes for these fields?
For cases diagnosed 1998-2003: Use the EOD and surgery code schemes for cervix uteri. The EOD scheme for melanoma excludes melanoma of the cervix uteri. The surgery code scheme for skin excludes cervix uteri.
EOD-Extension--Breast: How is this field coded when the diagnosis includes both invasive and in situ disease, and the pathology report stated the tumor size may or may not include the size of the in situ portion of the tumor? See Description.
Examples:
1. Invasive ductal carcinoma well differentiated, 1.2 cm, gross tumor size, ductal carcinoma in situ.
2. Gross tumor size 3.2 x 2.5 x 2.3 cm. well differentiated to moderately differentiated invasive ductal ca, accompanying component well differentiated ductal carcinoma in situ, solid, cribiform.
For cases diagnosed 1998-2003: Use extension codes 16, 26, or 36 depending on extent of involvement. These codes indicate that invasive and in situ components are present, the size of the entire tumor is coded in Tumor Size, the size of the invasive component is not stated, and the proportions of in situ and invasive are not known.
Both examples above measure the entire tumor including invasive and in situ components. Assign extension code 16, unless there is evidence of further involvement.
EOD-Lymph Nodes--Colon: Are "multiple submucosal lymphoid collections infiltrated with tumor" or "lymphoid areas" coded as lymph node involvement, similar to the way nodules in the pericolic fat are coded? See Description.
For an adenocarcinoma in the colon, under the "lymph node" section of the final path diagnosis it states "multiple submucosal lymphoid collections infiltrated with tumor" in addition to "one of two involved lymph nodes." The micro description states "There are multiple small lymphoid areas with tumor. A definite node excised from the mesentery shows...replacement of stroma and an additional very small node shows no tumor."
For cases diagnosed 1998-2003: No, do not code tumor infiltration of lymphoid collections or lymphoid areas as lymph node involvement.
However, code lymph node involvement for this case as 3 [mesenteric, NOS] because a mesenteric node is involved.
Regarding tumor infiltration of lymphoid collections or lymphoid areas from our pathologist consultant: Unless the anatomy of lymph node is evident (sinuses, trabeculae, primary and secondary follicles) these aren't lymph nodes and should not be coded as such. Unless there is evidence to the contrary in the path report, I would suggest that this be considered intramural spread, not lymph node spread.
Summary Stage 2000--Colon: How should this field be coded for involvement of "pericolonic fat, NOS" when there is no mention of whether the fat is sub-serosal or supra-serosal? See Description.
In the summary staging manual pericolic fat is listed under regional direct extension with no mention of whether sub-serosal or supra-serosal. According to our report the pathologist must specify whether involvement of pericolonic fat is of subserosal or supraserosal fat. If involvement of pericolonic fat was not specified as such, this should be localized vs regional direct extension.
Code Summary Stage as 2 [Regional by direct extension only].
In Summary Stage 1977 and 2000, pericolic fat is listed under Regional Direct Extension. If there is no indication by the pathologist that the involved fat is subserosal, code as Regional Direct Extension.
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