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.
Multiple Primaries (Pre-2007): Would osteosarcoma of the right arm diagnosed four years after malignant fibrous histiocytoma, also in the right arm, be a second primary when the physician states, "the patient's disease progressed to sarcoma after radiation was administered?"
For tumors diagnosed prior to 2007:
The osteosarcoma is a second primary. The first three digits of the histology codes are different: 8830 [Malignant fibrous histiocytoma] and 918_ or 919_ [Osteosarcoma]. In addition, the diagnoses are four years apart. According to SEER rules, these are separate primaries.
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.
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.
Diagnostic Confirmation--Hematopoietic, NOS: Is a multiple myeloma diagnosed by an FNA of the lumbar spine (or any other non-bone marrow location) a diagnostic confirmation 1 or 2? See Description.
Does the rule on page 111 of the SEER Program Coding Manual, 3rd Edition, for code 1 apply to myelomas (in the same way it applies to leukemias)?
Assign code 1 [Positive histology] for aspiration of bone marrow. This rule is not limited to leukemias.
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.
Reportability/Histology--Hematopoietic, NOS: What histology code is used for a patient diagnosed with "myelodysplasia" prior to 2001, if a bone marrow biopsy in 2002 is consistent with myelodysplastic syndrome with refractory anemia with bilineage dysplasia with excess blasts and the final impression is "myelodysplastic syndrome slowly evolving toward acute leukemia?"
Patient was admitted in July 15, 2002. Per the H&P, patient was diagnosed 5 years ago with myelodysplasia. Patient had bone marrow biopsy about 5 years ago and then again on 6-10-02. Patient has become transfusion dependent since mid-March. Bone marrow on 6-10-02 was consistent with myelodysplastic syndrome with refractory anemia with bilineage dysplasia with excessive blasts. Impression: Myelodysplastic syndrome slowly evolving toward acute leukemia. Plan: start chemo. 7-16-02 bone marrow biopsy showed acute myeloid leukemia.
Can we assume that the myelodysplasia diagnosed 5 years ago was refractory anemia and therefore, patient's first reportable diagnosis would be the AML? Or is the 6-10-02 bone marrow biopsy showing refractory anemia to be the first reportable diagnosis because the term "myelodysplasia" is non-specific?
For cases diagnosed prior to 1/1/2010:
Based on the information provided, the diagnosis date is June 2002. The diagnosis is 9895/3, acute myeloid leukemia with multilineage dysplasia (AML with prior myelodysplastic syndrome). According to the SEER table of hematopoietic diseases, refractory anemia and myelodysplastic syndrome followed by AML is one primary.
Prior to 2001, a diagnosis of myelodysplasia was not reportable.
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.
EOD-Lymph Nodes--Lung: Are positive "neck nodes" coded to 7 [Distant lymph nodes, other than above (including cervical lymph nodes)] in this field because we do not have a specific lymph node chain named or are they coded to 6 [Contra lateral hilar or mediastinal (incl. bilateral); supraclavicular (transverse cervical), ipsilateral or contralateral; scalene, ipsilateral or contralateral] because this code represents the lowest possible code for involved neck nodes?
For cases diagnosed 1998-2003: Code EOD-Lymph Nodes as 7 [Distant lymph nodes, other than above (incl. cervical neck nodes)]. Lymph nodes in the "neck" are distant, rather than regional, for lung.
Surgical Fields--Head & Neck: How does one code the removal of benign submandibular and sublingual glands performed during a neck dissection for a head and neck cancer? See discussion.
Should the removal be coded as incidental in the surgical Procedure if the Other Site field? Does it make a difference if the submandibular gland is removed en toto with lymph nodes or if the gland is submitted as a separate specimen? Does it make a difference if the glands are involved?
Removal of the lower salivary glands is part of a radical neck dissection and is not recorded in Surgery of Primary Site or Surgery of Other Site. Radical neck dissection is coded under "Scope of Regional Lymph Node Surgery."
It does not matter whether or not the gland is submitted as a separate specimen. It does not matter whether or not the gland is involved.
EOD-Pathologic Extension--Prostate/Lymphoma: How is this field coded for a prostatic lymphoma?
For cases diagnosed 1998-2003: Do not code the prostate pathologic extent of disease field for prostatic lymphoma. Leave the path extension for prostate field blank. Code the extent of disease using the lymphoma scheme. Use ONLY the lymphoma scheme - do NOT try to code both lymphoma and prostate extension fields for prostatic lymphoma.
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].
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