Behavior Code--Bladder/Lymphoma: Should the "in situ" designation on a bladder primary's pathology report be ignored that states a diagnosis of "in situ lymphoma"?
Ignore the in situ designation. You cannot assign an in situ behavior code to a lymphoma primary. The term or designation of "in situ" is limited to solid tumors; carcinoma and/or cancer.
EOD-Extension--Lymphoma: What code is used to represent a non-Hodgkin lymphoma presenting with involvement of an extralymphatic organ and lymph nodes on the opposite side of the diaphragm?
For cases diagnosed 1998-2003: Code the EOD-Extension field to 31 [30 + localized involvement of an extralymphatic organ or site; Stage III E].
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: What codes are used to represent these fields when only a regional lymph node (positive) aspiration is performed?
For cases diagnosed 1998-2003:
With the exception of those sites/histologies that require 99 in these fields, code the Number of Regional Lymph Nodes Positive field to 97 [Positive nodes but number of positive nodes not specified]. Code the Number of Regional Lymph nodes Examined field to 95 [No regional Lymph nodes removed, but aspiration of regional Lymph nodes was performed].
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined--Colon: What codes are used to represent these fields when the pathology from a colon cancer resection describes 2/16 positive pericolonic lymph nodes and a "metastatic nodule in the pericolonic fat"?
For cases diagnosed 1998-2003:
Code the Number of Regional Lymph Nodes Positive field to 03 and the Number of Regional Lymph Nodes Examined field to 17. Each grossly detectable nodule in the pericolonic fat is counted as one regional lymph node.
EOD-Lymph Nodes/TNM--Breast: Do we code these lymph nodes fields for a breast primary that describes ipsilateral axillary lymph node involvement as "extending through the lymph node capsule and into perinodal soft tissue/fat" as "fixed/matted"?
For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 6 [Axillary regional lymph nodes, NOS], if the size of the metastasis within the lymph node is not known. "Extension into perinodal soft tissue" does not imply that the lymph nodes are fixed to one another or to other structures. AJCC stage for lymph nodes is coded to N1 [Metastasis to moveable ipsilateral axillary lymph nodes].
In order to code the EOD-Lymph Nodes field to 5 [Fixed/matted ipsilateral axillary nodes] which is the equivalent to AJCC equivalent N2, there must be some clinical or pathologic statement of fixation or matting. There can be extension through the capsule without fixation or matting. "Fixation" is a clinical term and "matting" can be either clinical or pathologic. A pathologist can recognize two or more lymph nodes stuck together by tumor.
Histology (Pre-2007)--Colon: What code is used to represent histology when the surgeon describes a sessile polyp and the final path diagnosis is stated as: "Rectal sessile polyp: Invasive moderately differentiated adenocarcinoma" (pathologist does not state that it is "arising in a sessile polyp")?
For tumors diagnosed prior to 2007:
Code the Histology field to 8210/3 [adenocarcinoma arising in a polyp]. The structure in which this adenocarcinoma is arising, is a polyp.
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.
Surgery of Primary Site/Reconstruction-First Course--Breast: If the plan is to "reconstruct" the breast 6 months after an ipsilateral modified radical mastectomy, is the time span a problem or should it be coded in the Surgery of Primary Site field because it was planned?
For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 55 [Modified radical mastectomy WITHOUT removal of uninvolved contralateral breast, Implant]. The time span is not a problem as long as the reconstruction was planned as first course, which is indicated by tissue expander insertion at the time of the original surgery.
EOD-Extension--Stomach: What code is used to represent this field for a stomach primary described as linitis plastica?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 30 [Localized, NOS], unless more information is known about the extent of tumor involvement. Coding the Histology field to 8142/3 [Linitis plastica] and the Size of Primary Tumor field to 998 [Diffuse; widespread; 3/4 or more: Linitis plastica] identifies this diagnosis.
In the EOD-Extension field, the depth of invasion is the important characteristic to be coded. The 10 digit EOD corresponds to the AJCC Staging Manual in which the "T" is based on level of invasion. While a diagnosis of linitis plastica indicates a worse prognosis, it does not define the extent of infiltration. There is no luminal mass with linitis plastica. Instead, the entire gastric wall is thickened by tumor.
EOD-Extension--Corpus Uteri: What code is used to represent this field for a corpus primary (sounding 8 cm or less in length) treated with radiation prior to a hysterectomy that pathologically showed superficial myometrial invasion? Is it possible that the invasion could have been more extensive prior to the radiation treatment?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 12 [Myometrium, inner half] which represents the extension you know. In this particular case, there was no clinical evidence of extension outside the corpus. As long as the surgery was not performed because of disease progression, use information from the surgery to code EOD extension.
EOD-Extension/SEER Summary Stage 2000--Kidney/Eye: What codes are used to represent these fields for simultaneous bilateral Wilms tumor or simultaneous bilateral retinoblastoma?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 85 [Metastasis] and the SEER Summary Stage 2000 field to 7 [Distant] for both types of tumor. Each kidney and each eye are staged separately in the AJCC, 6th ed., but for SEER we would abstract these diagnoses as one case and code the EOD and stage fields to distant to reflect the involvement of both eyes or both kidneys.
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