EOD-Extension--Kaposi Sarcoma: Is a "markedly enlarged spleen" involvement for cases of Kaposi Sarcoma?
For cases diagnosed 1998-2003: No. Splenomegaly is not synonymous with "extension to" or "involvement of" the spleen in Kaposi's sarcoma. Look for a definite statement of Kaposi's lesion(s) involving the spleen.
Primary Site/EOD-Size of Primary Tumor--Lung: If the only lung mass described in CXR is a "hilar mass," is the primary site coded to C34.9 [Lung, NOS] or C34.0 [Main Bronchus; incl. Carina]? Also, can the size of the hilar mass be used to code the size of tumor field?
Because the only description available is "hilar mass," code primary site as C34.0.
For cases diagnosed 1998-2003: Use size of mass for EOD-Size of Primary Tumor.
Histology--Hematopoietic, NOS: Because histology 9895/3 [Acute myeloid leukemia with multilineage dysplasia] was recognized as a distinct entity by WHO with too few cases of the subtypes [with or without prior MDS] to warrant separate histology codes for each, should the wording for the non-bold definitions in ICD-O-3 be changed to the following in both the alpha and numeric sections? See Description.
AML with multilineage dysplasia and prior MDS
AML with multilineage dysplasia and without prior MDS
How do we code histology for the following case of AML?
Patient was admitted for profound anemia and thrombocytopenia with
no immediate explanation. Path final diagnosis on bone marrow biopsy: acute myelogenous leukemia (AML). Per micro description: findings are
characteristic of AML that appears to be arising within the context of a myelodysplastic syndrome. The discharge diagnosis (2 days after bone marrow biopsy) read: myelodysplastic syndrome with profound anemia and
thrombocytopenia.
Do we code the histology per the final path diagnosis (code 9861/3)?
Using the current version of ICD-O-3, we could arrive at a histology code of 9895/3 based on the micro findings of AML with prior myelodysplastic syndrome. However, per the above-mentioned SEER e-mail, we would not because there was no mention of multilineage dysplasia.
For cases diagnosed prior to 1/1/2010:To assign code 9895, it is important that the diagnosis includes "multilineage dysplasia." Use code 9895 when the diagnosis is with or without prior (not concurrent) myelodysplastic syndrome AND multilineage dysplasia. Acute myeloid leukemia without prior myelodysplastic syndrome and without multilineage dysplasia is coded 9861 [Acute myeloid leukemia, NOS].
Although the wording of 9895 cannot be changed, coders can make a note that the synonyms are intended to include:
-Acute myeloid leukemia WITH multilineage dysplasia with prior myelodysplastic syndrome
and
-Acute myeloid leukemia WITH multilineage dysplasia without prior myelodysplastic syndrome.
The histology code for the case example is 9861/3 [Acute myeloid leukemia, NOS].
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.
Primary Site--Pancreas: Should tumors with the histology "islet cell carcinoma" be coded C25.4 [Islet of Langerhans] even though the tumor location is stated to be in head of pancreas?
Assign code C25.4 [Islets of Langerhans...Endocrine pancreas]. Islet cell carcinoma of the pancreas is a tumor of the endocrine pancreas. Although Islet cells are present throughout the pancreas, the best code is C25.4 to distinguish endocrine from exocrine cancers.
EOD-Lymph Nodes--Head & Neck: If a pre-treatment description of a chain of lymph nodes doesn't meet the criteria for involvement but the post-treatment description of the same chain of lymph nodes does, should those nodes be counted as involved in coding EOD? See Description.
(Primary site = larynx)
9/12/02 CT neck showed right cervical chain adenopathy. After chemotherapy, an 11/18/02 CT soft tissue of neck showed decrease in size by 50% of what was probably necrotic metastatic node to right mandibular angle.
The term "lymphadenopathy" should be ignored when determining involvement of lymph nodes per SEER. In this case, a probable necrotic metastatic node is mentioned in a subsequent CT taken after treatment.
Should lymph node involvement be coded to 9 based on the 9/12/02 CT or coded to 4 because of the mention of a decrease in size of what was probably a metatastic node on the 11/18/03 CT?
For cases diagnosed 1998-2003, code EOD using the best information available. In this example, the post-treatment description of lymph nodes. A post-treatment description of lymph nodes can be used to code lymph node involvement in the absence of disease progression. Pre-operative treatment does not affect lymph node involvement.
Case example: Code lymph nodes as involved (codes 1-4 depending on size and number) based on the later CT report.
EOD-Extension--Corpus Uteri: How is this field coded for a stage III A endometrial primary with positive pelvic washings, involvement of the omental serosa, and negative lymph nodes?
For cases diagnosed 1998-2003: Code EOD-extension as 85 [Metastasis]. According to our TNM consultant, Omental metastasis is M1, Stage IVB [EOD 85].
Other Therapy: How do we classify "thalidomide" when it is given as cancer directed therapy?
Code to the appropriate code (1, 2 or 3) under Other Therapy, depending on whether the drug was given as part of a clinical trial. If not part of a clinical trial, assign code 1 [Other cancer-directed therapy].
Thalidomide is not FDA approved for treating cancer. It is under investigation for anti-angiogenesis effects in different cancers.
Multiple Primaries/Histology--Hematopoietic, NOS/Lymphoma: How many primaries are represented and what are the histologies for "B-cell lymphoma with immunophenotypic findings consistent with hairy cell leukemia" found on a bone marrow biopsy? See Description.
Pathologist completed AJCC lymphoma staging form indicating this case should be abstracted as a lymphoma.
For cases diagnosed prior to 1/1/2010:Abstract as one primary, 9591/3 [B-cell lymphoma, NOS]. The bone marrow diagnosis indicates that the main/definite diagnosis is B-cell lymphoma, with a lesser indication of hairy cell leukemia. Both of these are mature B-cell neoplasms according to the WHO histological classification.
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.
Hematologic Transplant and Endocrine Procedures--Brain and CNS: Is stem cell transplant coded as treatment for medulloblastoma? See Description.
The PDQ lists high-dose chemotherapy with autologous bone marrow rescue as treatment for children under three. A case of medulloblastoma that was treated with gross total resection of the tumor, followed by chemotherapy and autologous PBSC (peripheral blood stem cell) transplant.
A stem cell transplant does not fit the definition of "treatment" because it does not affect, control, change, remove or destroy proliferating cancer tissue. However, there is a place to code this procedure. Code stem cell transplant under Hematologic Transplant and Endocrine Procedures. Assign code 20 [Stem cell harvest].
EOD-Clinical Extension--Prostate: How is this field coded when biopsies of the prostatic apex are positive and the physician clinically stages the case as T1c?
For cases diagnosed 1998-2003:
Code clinical extension to 33 [arising in the prostatic apex] when a biopsy of the prostatic apex is positive for malignancy, with no further evidence of involvement. If biopsies of both the apex and another site within the prostate (for example right lobe) are positive and there is no mention that the malignancy arose in the apex, code extension to 34 [extending into the prostatic apex].