CS Lymph Nodes--Breast: Must there be a statement of "moveable" present to code 25 in this field and if a lymph node is not stated to be "fixed" is it presumed to be moveable? Please provide an example in your answer of when to use code 25.
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.
The word "movable" does not have to be used to assign code 25. A "movable" lymph node is an involved lymph node not described as fixed or matted. The general rule is to code the lesser or lower category, which would be the case if neither movability nor fixation is mentioned. See page C-471 of the 2004 SEER Manual.
Code 25 Example: Involved lymph nodes per lymph node dissection. No mention of fixation or matting. Size of largest met within a lymph node is 4mm.
CS Lymph Nodes: Are lymphatic channels/vessels within an organ coded as regional 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.Lymphatic channels/vessels carry lymph fluid throughout the organs and tissues of the body. Lymph channels/vessels within an organ are not nodes. Lymph channels/vessels outside an organ are not nodes.
CS Lymph Nodes/CS Site Specific Factor--Breast: When there are no lymph nodes removed and none palpable for an inflammatory breast cancer and the physician stages the case Nx, is the CS Lymph Node field code to 00 [None, no regional lymph nodes involved] or 99 [Unknown, not stated] and would SSF 4 and 5 be coded to 000 [Regional lymph nodes negative...] or 888 [Not applicable]?
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.
Code CS Lymph Nodes 00 [clinically negative]. See note 3 for CS Lymph Nodes.
CS Site Specific Factor--Melanoma: What is the correct code for measured thickness in SSF 1 for a melanoma of the choroid without an enucleation? See Discussion.
CS Site Specific Factor 1 for melanoma of the choroid codes "Measured Thickness (Depth), Breslow's Measurement." The note for this field states "Record actual measurement in millimeters from the pathology report." For melanoma of the eye, there is often only an eye exam report stating the thickness. Can PE thickness (clinical statement only) be coded for SSF 1 or is this field coded only from pathology? (i.e., all cases treated without enucleation would have this field coded to 999)
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.
Code SSF 1 999 [Unknown] when there is no enucleation, and therefore, no pathology report for a choroid melanoma.
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.
Histology (Pre-2007)--Sarcoma: How is "acral myxoinflammatory fibroblastic sarcoma" coded?
For tumors diagnosed prior to 2007:
The ICD-O-3 histology code is 8811/3 [Fibromyxosarcoma] according to the WHO Classification of Tumours of Soft Tissue and Bone. WHO defines myxoinflammatory fibroblastic sarcoma (MIFS) as "a unique low grade sarcoma with myxoid stroma, inflammatory infiltrate and virocyte-like cells that predominantly involves the hands and feet."
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.
CS Eval--Ovary: How is CS Mets Eval coded when the patient has positive pleural effusion confirmed by cytology?
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.Code CS Mets Eval for the example above 3 [path exam of metastatic tissue] assuming there has been no pre-treatment. Positive cytology is required for confirmation of pleural effusion for an ovarian primary.
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.
CS Tumor Size/CS Extension--Brain and CNS: How are these fields coded for a glioblastoma multiforme occurring in a 3.5 cm tumor in the parietal lobe and a 3.0 cm tumor in the occipital lobe?
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 Extension code is 10 [confined to cerebral hemisphere]. Record the size of the largest lesion in CS Tumor Size. Both the occipital and parietal lobes are supratentorial and confined to the cerebral hemisphere with no mention of crossing midline or involvement of ventricles.
CS Extension--Prostate: Can the EOD Manual clarifications regarding apparent and inapparent tumors be used to determine CS clinical extension for prostate primaries?
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.Do not use the EOD information to determine apparent and inapparent when coding Collaborative Stage for tumors diagnosed 1/1/2004 or later.
The August 2007 CoC Flash stated that "After consultation with the AJCC curators for genitourinary disease, the CS Steering Committee has determined that the SEER list of terms for apparent and inapparent in the SEER Extent of Disease Manual is NOT to be used for interpreting reports for Collaborative Staging. While it was a convenient tool for registrars, the curators are of the opinion that the use of the list will lead to misinterpretation of reports. Rather, the curators recommend that registrars rely on a direct physician statement of apparent or inapparent disease for Collaborative Staging."
August 2007 CoC Flash: http://www.facs.org/cancer/cocflash/august07.pdf, Coding Prostate Cancer: A Message from the Collaborative Staging Steering Committee.