MP/H Rules/Multiple Primaries--Lung: If the biopsy for a lung primary is actually taken from a pleural mass, can the default rule "when there are several lung masses and only one lesion is biopsied, consider this a single primary" apply? See Discussion.
Scenario: A parenchymal lesion in each lung. One lung also has a pleural lesion. MD biopsies the pleural mass only and it is positive for cancer.
For cases diagnosed 2007 or later:
Do not assume the biopsy of the pleural mass is a biopsy of the lung. Apply the 2007 MP/H Lung rules to the lung tumors only. For this case, the pleural lesion would be a metastasis (outside the lung). The 2007 MP/H rules do not apply to metastatic lesions.
The 2007 MP/H Lung rules do not apply to pleura as a primary site. If the pleural lesion is primary, it should be abstracted as a separate primary.
Multiplicity Counter-Breast: The general instructions say to ignore separate microscopic foci when determining when to use the single tumor or multiple tumor modules. Do these instructions apply if sizes are given for the foci? See Discussion.
For instance, would a 1.2 cm breast tumor with 3 scattered microscopic foci ranging from 2-4 mm be treated as multiple tumors (4), or as a single tumor?
If the microscopic foci are measured and listed as part of the diagnosis, they should be counted as multiple tumors.
Grade, Differentiation--Bladder: Can grade be coded from the pathology report for a recurrent bladder cancer specimen? See Discussion.
In 2006 a TURB was done for bladder carcinoma diagnosed 10 years ago. Is grade always coded 9 on class 3 cases unless the original slides were reviewed?
Code grade from the original tumor; do not code grade from recurrence.
If the grade of the original primary tumor is specified, code it, regardless of class of case.
MP/H Rules--Urinary: How many primaries are abstracted when a patient has a May 2000 invasive papillary transitional cell carcinoma of the bladder, a November 2004 invasive papillary transitional cell carcinoma of the right ureter and a May 2007 urothelial carcinoma in situ of both the left and right ureters?
For cases diagnosed 2007 or later:
Using the pre-2007 multiple primary rules, the PTCC of the bladder in 2000 and the invasive TCC of the right ureter in Nov. 2004 would have been abstracted as separate primaries.
Use the 2007 MP/H rules to evaluate the May 2007 diagnosis. Start with rule M3. Stop at rule M8. The May 2007 diagnosis is the same primary.
Rule M4 does not apply because of the 2000 bladder primary. A clarification will be added to M4 to stress that for the urinary rules, any urinary tumor up to the present point in time is counted when applying this rule.
MP/H Rules/Histology--Colon: How is histology coded when the final pathology diagnosis is "adenocarcinoma with extensive mucinous features" and the percent of mucinous features is not stated?
Code 8140 using rule H6. Rule H6 applies because the percent of mucinous is not specified.
MP/H Rules/Multiple Primaries/Histology--Prostate: How many primaries should be abstracted and how should the histology field(s) be coded for a case in which the pathology specimen showed adenocarcinoma in 20% of the tissue and sarcoma in 50% of the tissue? See Discussion.
Patient has TURP. The final path diagnosis is adenocarcinoma in 20% of tissue and sarcoma in 50% of tissue.
Because it is unknown whether there is a single or multiple tumors, rule M1 (Other Sites) is used which states the case is to be abstracted as a single primary.
Single invasive histology rules are followed to rule H16, but table 2 does not contain a mixed code for this situation, even though ICD-O-3 has a code 8933/3 for "adenosarcoma". Therefore, rule H17 is applied that states to use the highest code, which in this case would be 8800/3 [Sarcoma, NOS]. Is this correct?
For cases diagnosed 2007-2014, code as two primaries, one adenocarcinoma and the other sarcoma.
This is two tumors (adenocarcinoma and separate sarcoma) until proven otherwise. Do not code as adenosarcoma, as this is a gyn-specific diagnosis. Adenosarcoma of the prostate is not a recognized entity in the WHO classification of prostate tumors.
Histology--Pancreas: How is a "gastrin and somatostatin producing endocrine neoplasm" coded that has lymph node metastasis?
The best code available for this situation is 8153/3 [Gastrinoma, malignant].
Many pancreatic endocrine tumors produce more than one peptide, such as gastrin and somatostatin in this case. ICD-O-3 does not provide a code for pancreatic endocrine tumors which produce more than one peptide. According to the WHO Classification of Tumours of Endocrine Organs, there is a distinct hormonal syndrome associated with gastrin producing tumors, and not with many of the somatostatin producing tumors. Therefore, our pathologist consultant advises us to code to gastrinoma in this case.
Primary Site/CS Extension--Lymphoma: How are these fields coded for a lymphoma found in the spleen and retroperitoneal lymph nodes? See Discussion.
A patient presents with a 6-month history of night sweats, low grade fever and significant weight loss. Physical exam reveals no palpable lymph nodes, tender abdomen and splenomegaly. Patient undergoes an exploratory laparotomy with splenectomy and dissection of two retroperitoneal lymph nodes. Spleen and both lymph nodes were positive for small cleaved-cell lymphoma, high grade.
Code the primary site to spleen.
Code CS extension as 22 [involvement of spleen plus lymph nodes below the diaphragm]. This gives it a stage IIS.
Spleen is an extranodal (not extralymphatic) site.
The retroperitoneal lymph nodes are located below the diaphragm.
CS Site Specific Factor/Melanoma: How is CS SSF1 (depth of invasion) coded for a melanoma that demonstrates dermal invasion to a depth of "less than .2 mm" be coded to 999 [unknown]? See Discussion.
The path report says "superficial spreading malignant melanoma; 2 areas of papillary dermal invasion to depth of less than .2mm."
The revised CS pages include codes for "less than" a certain tumor size, but these are not included in the depth of invasion SSF. Using 999 results in an unstageable melanoma, when we know it is "less than .2mm".
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 SSF1 (depth of invasion) to 019 [.19mm]. For any case with an SSF1 code in the range of 001-100 mm, the T category will be determined using CS extension and SSF2 [ulceration]. All cases with an SSF1 code in the range of 001-100 mm will map to a T1 (either T1NOS, T1a or T1b).
CS Site Specific Factor--Prostate: Given that the CS Manual instruction is to code the highest PSA value recorded in the medical record, can a PSA value obtained a year prior to admission be used to code the SSF 1 and SSF2 fields?
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 PSA recorded in CS SSF 1 and 2 must be documented in the medical record. Record the highest PSA value prior to diagnostic biopsy or treatment. If the highest PSA value documented in the medical record is from the previous year, record it.