CS Tumor Size--Bladder: Is tumor size coded to 080 when the bladder mass is described as "greater than 8 cm in diameter"?
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.Based on the information provided above, code CS tumor size 080 [8 cm]. Code the information that is avaliable. Since size of tumor is not used to stage bladder cancer, an approximation is adequate.
Primary Site/Priorities--Breast: When there are conflicting references to subsite in different reports, which report has priority? See Discussion.
The clinical site of the palpable mass is outer quadrant. The pathologist states inflammatory breast cancer located in the central breast. Should the site be coded to C501 for central breast, C509 for inflammatory breast ca, or C508 for outer quadrant?
Code the breast subsite from the pathology report (C501, central).
The priority order for coding subsite from conflicting reports is
1. Pathology report
2. Operative report
3. Physical examination
4. Mammogram, ultrasound
The primary site of inflammatory breast carcinoma is coded to C509 when there is no palpable tumor.
Grade, Differentiation/Priorities: Which has priority, the differentiation or the nuclear grade for a liver biopsy histology described as "well differentiated hepatocellular carcinoma, nuclear grade 3/4"?
For most sites, differentiation has priority over the nuclear grade when both are specified (excluding breast and kidney). Assign grade code 1 [well differentiated] to the example above.
Histology--Lymphoma: How is "histiomonocytic lymphoma" coded?
For cases diagnosed prior to 1/1/2010:Assign code 9755 [Histiocytic sarcoma; True histiocytic lymphoma]. "Histiomonocytic" is not standard terminology, according to our expert consultant. However, 9755 is the best code to assign.
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.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: How are the number of primaries, histologies and CS extension fields coded for breast tissue that contains separate areas of invasive ductal carcinoma, intraductal carcinoma and Paget disease? See Discussion.
Excisional biopsy of a breast mass: 1.0 cm tumor that was infiltrating ductal carcinoma, high grade, with an associated intraductal component with comedonecrosis.
Pathology report for the mastectomy three weeks later: no residual tumor was found near the original biopsy site. In another portion of the same breast was found high-grade intraductal carcinoma involving the nipple ducts, with Paget Disease of the nipple. (No size was given for this.)
For tumors diagnosed prior to 2007:
This is a single primary. According to Exception 3 of Multiple Primary Rule 6 for multiple tumors, combinations of Paget disease and ductal carcinoma are a single primary. The histology code for this case is 8541 [Paget disease and infiltrating duct carcinoma]. Assign CS extension code 10 [confined to breast tissue] based on the information above.
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.
Chemotherapy/Radiation Therapy--Lymphoma: How is treatment coded when Rituxan is given in combination with the monoclonal antibody Zevalin conjugated to 90-Yttrium or the monoclonal antibody Bexxar conjugated to 131-Iodine in the treatment of NHL?
Code Rituxan as chemotherapy. Code 90-Yttrium as radioisotope. Code 131-Iodine as radioisotope when given with Rituxan as treatment for lymphoma.
Zevalin is a monoclonal antibody conjugated to Yttrium 90. Bexxar is a monoclonal antibody conjugated to Iodine 131. In both drugs, the monoclonal antibody is only the delivery agent for the radioisotope. Both drugs should be coded as radioisotopes. The one-two-three punch of Rituxan and zevalin followed by Rituxan and Bexxar should be coded as chemotherapy plus radioisotopes. Zevalin is also used by itself for people who have not responded to Rituxan.
CS Site Specific Factor 4--Prostate: For apex involvement at prostatectomy, is only apical involvement found at prostatectomy included or is all histologically proven apical involvement documented in the second digit of Site Specific Factor 4? See Discussion.
Per note 1 for Site Specific Factor 3 - Pathologic Extension all histologic information is used. Biopsy information would be included when coding path extension. Would all histologic information be used for coding prostatectomy apex involvement in Site Specific Factor 4?
Example 1: Prostate biopsies of the right and left apex and right and left mid gland show adenocarcinoma. Prostatectomy shows bilateral adenocarcinoma. Apex negative for tumor.
Example 2: Prostate biopsies of right apex and mid gland show adenocarcinoma. There is no mention of apex on prostatectomy path. How is CS Site Specific Factor 4 Prostate Apex Involvement 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.
Assign the second digit of CS SSF 4 based on prostatectomy only, do not include biopsy or other histologic information in the second digit.
According to the CS Steering Committee, the clinical or biopsy of the prostate is included in the first number of the code and should not be combined with the prostatectomy code which is the second number. These were separated purposely.
Example 1: Code the second digit of SSF 4 based on the prostatectomy, 1 [no involvement of prostatic apex].
Example 2: Code the second digit of SSF 4 based on the prostatectomy, 5 [apex extension unknown].
Reportability--Brain and CNS: Does a case of astrogliosis meet the criteria for gliomatosis cerebri? See Discussion.
Case clinically stated to be a glioma of the brain. Pathology from resection states astrogliosis.
Anderson's Pathology defines astrogliosis as astrocytic proliferations. Gliomatosis cerebri is defined as diffuse neoplastic transformation of poorly differentiated astrocytes over a wide area; predominantly invovles hemispheric white matter.
The pathologic diagnosis for this case, astrogliosis, is not reportable to SEER. Take the definitive diagnosis for this case from the pathology report from the resection. The pathology report takes precendence over the clinical diagnosis.
Surgery of Primary Site--Prostate: How is the use of a Laserscope Niagara laser (modulated KTP-YAG laser beam (Niagara 122 prostate vaporization)) coded for prostate primaries? See Discussion.
The Laserscope Niagara laser performs an operation similar to the TURP, but there is virtually no bleeding and patients can sometimes go home the same day, most without a catheter. The laser is delivered through a fiber (the thickness of hair) into the cavity via an endoscope inserted through the urethra.
When performed as part of the first course of therapy, assign surgery code 15 [Laser ablation] to Niagara laser photovaporization of the prostate.
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